1. MEASURING OTHER CONDITIONS IN ORAL EPIDEMIOLOGY
CHAPTER 18
MEASURING OTHER CONDITIONS IN ORAL EPIDEMIOLOGY

2. MALOCCLUSION
Any deviation from the physiologically acceptable relationship of the maxillary teeth to the mandibular teeth
The determination of the classification of occlusion is based upon the principles of Edward H. Angle, presented in the early 1900’s.
Angle based his system of classification upon the relationship of the first permanent molars
Angle defined NORMAL OCCLUSION as: “the normal relations of the occlusal inclined planes of the teeth when the jaws are closed”

3. MALOCCLUSION In a national survey, it was found that:
a) 9% of persons 8-50 years of age had severe crowding of anterior incisors and 25% had no crowding
b) 9% of persons had posterior cross-bite most common in non-Hispanic whites
c) 8% of persons had severe overbite and over-jet most common in non-Hispanic whites
d) fewer than 5% of non-Hispanic whites had an open bite

4. NORMAL (IDEAL) OCCLUSION
MB cusp max. 1st molar occludes B groove mand. 1st molar

5. CL I = NEUTROCLUSION
MB cusp max. 1st molar occludes B groove mand 1st molar
Malposition of individual teeth or groups of teeth
“Normal” facial profile

7. TYPES OF CONDITIONS THAT FREQUENTLY OCCUR IN CL I
Crowded maxillary or mandibular anterior teeth
Protruded or retruded maxillary incisors
Anterior crossbite
Posterior crossbite
Mesial drift of molars resulting from pre-mature loss of teeth

8. CL II - DISTOCLUSION
B groove of mand. 1st molar Distal MB cusp of max 1st molar by width of premolar
“Retrognathic” profile - maxilla protrudes; lower lip is full; mandible appears retruded or weak
DIVISION 1: mand. is retruded and max. incisors are “protruded” LABIOVERSION
DIVISION 2: mand. is retruded and max. incisors are “retruded” LINGUOVERSION

9. CL II – DISTOCLUSION

10. CL II - DISTOCLUSION

11. TYPES OF CONDITIONS THAT FREQUENTLY OCCUR IN CL II
CL II Div 1:
Deep overbite
Excessive overjet
Abnormal muscle function (lips)
Short mandible
Short upper lip
CL II Div 2:
Maxillary lateral incisors protrude while both central incisors retrude
Crowded maxillary anterior teeth
Deep overbite

12. CL III - MESIOCLUSION
B groove of mand. 1st molar Mesial MB cusp of max 1st molar by width of premolar
“Prognathic” profile - lower lip and mandible are prominent

13. CL III - MESIOCLUSION

14. CL III - MESIOCLUSION

15. TYPES OF CONDITIONS THAT FREQUENTLY OCCUR IN CL III
Maxillary incisors are lingual to mandibular incisors in an anterior crossbite
Maxillary and mandibular incisors are in edge-to- edge occlusion

16. EDGE-TO-EDGE BITE
Incisal surfaces occlude
END-TO-END BITE
Molars in cusp-to-cusp occlusion

17. OVERJET
The “horizontal” distance between the mandibular incisors and the maxillary incisors
OVERBITE
The “vertical” distance by which the maxillary incisors overlap the mandibular incisors

18. OPEN BITE
Lack of incisal or occlusal contact
Teeth cannot be brought together and a space remains as a result of the arching of the line of occlusion
CROSS BITE
Anterior: maxillary incisors are lingual to mandibular incisors
Posterior: maxillary or mandibular posterior teeth are either facial or lingual to their normal position

19. IDENTIFY THE FOLLOWING….

20. INDEX
An index is a systematic way of collecting and arranging data gathered from observations so that they can be quantified, analyzed and understood
Accomplished under specifically defined criteria and conditions
Eg: record of data collected from periodontal probing

21. MALALIGNMENT INDEX
Assesses rotations and tooth displacement
OCCLUSAL FEATURE INDEX
Records crowding, cuspal interdigitation, overbite and overjet

22. OCCLUSAL INDEX (OI)
MEASURES THE FOLLOWING: 1) dental age 2) molar relation 3) overbite & overjet 4) posterior crossbite 5) posterior openbite 6) tooth displacement 7) midline relations 8) missing perm. max. incisors

23. ORTHODONTIC INDEX Developed in late 1980’s
Assesses aesthetic rather than clinical measures of function
Eg: DENTAL AESTHETIC INDEX (DAI)

24. DENTAL AESTHETIC INDEX (DAI)
RECORDS MALOCCLUSION IN THE FOLLOWING CATEGORIES: 1) missing incisor, canine, and bicuspid 2) incisal crowding in maxillary and mandibular anterior segments 3) spacing in maxillary and mandibular anterior segments 4) diastema between maxillary central incisors 5) rotations or displacements from normal alignments in the maxillary and mandibular incisors 6) overjet and openbite

25. ORAL CANCER
Oral cancer is limited to cancers of the lip, tongue, buccal mucosa, floor of the mouth, and pharynx
Most of these tumors are squamous cell carcinomas
Does not include cancer of the throat

29. ORAL CANCER MORTALITY
Of the 30,000 new cases of oral cancer diagnosed annually, only 1/2 affected individuals will survive longer than 5 years
3% of new cancers diagnosed in men and 2% in women are oral or pharyngeal cancers

30. ORAL CANCER OCCURRENCE
Varies widely throughout the world, depending on affected sites in the mouth and various environmental factors associated with oral cancer

31. ORAL CANCER PREVENTION & CONTROL
A) Early diagnosis increases the survival rate; thorough examinations of head, neck, and oral cavity can help identify early lesions B) Individuals with confined, localized lesions have a much higher survival rate than those with lesions that have spread to another region C) Individuals with lip cancer have 91% survival rate

32. ORAL CANCER RISK FACTORS
1) Tobacco use 2) Smoking (more closely associated with lip and pharyngeal cancer) 3) Alcohol consumption, especially in combination with tobacco use 4) Painful and ill-fitting dentures 5) Excessive exposure to sunlight (more closely associated with lip cancer) 6) Chronic inflammation 7) Smokeless tobacco (more closely associated with cancer of buccal mucosa)

33. DISEASE CONSEQUENCES OF TOBACCO USE
A) CANCER: oral cavity, lung, pharynx, esophagus, stomach, bladder, breast B) RESPIRATORY DISEASES: emphysema, bronchitis, asthma, pneumonia, tb, chronic obstructive pulmonary disease (COPD) C) CARDIOVASCULAR DISEASES: hypertension, atherosclerosis, coronary artery disease, aortic aneurysm, arterial thrombosis, cerobrovascular accident (CVA) D) PREGNANCY INFANT HEALTH: fetal neonatdeath, preterm labor, growth retardation, sudden infant death syndrome (SIDS) E) OTHER CONDITIONS: osteoporosis, alzheimer’s disease, wrinkling, early menopause

34. CLEFT LIP AND/OR PALATE
Cleft lip and palate represent a failure of normal fusion of embryonic processes during development in 1st trimester of pregnancy
Formation of lip occurs between 4th and 7th week in utero
Development of palate takes place during 8th to 12th week
Fusion begins in premaxillary region and continues backward toward uvula

35. Cleft lip - apparent by end of 2nd month in utero
Cleft palate - evident by end of 3rd month in utero
Occurrence - 1 in 700 births

36. CLEFT LIP / PALATE TREATMENT
Surgical union of cleft lip - before 6 months
Surgery to close palate - before 18 months
Bone grafting
Osseointegrated implant
Obturator
Orthodontics
Speech therapy

37. ORAL HEALTH & QUALITY OF LIFE
“ORAL HEALTH IMPACT PROFILE” is one index that measures social impact of oral conditions as perceived by the individual
Individual’s subjective assessment of his/her own oral health is as valid as dentists
Derived initially from statements given in interviews with dental patients and later tested for validity and reliability
Ranks oral disorders in terms of the impacts on people’s daily lives
Boon to both clinical treatment planning and research