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Caries & malocclusion from an evolutionary perspective http://vimeo.com/27788340
ABSTRACT: Evolutionary Medicine (EM), also known as Darwinian Medicine, is a new approach providing a useful framework for understanding modern systemic diseases.
Evolutionary Oral Medicine, or Darwinian Dentistry is a branch of EM whose goals are to understand the evolutionary origins of oral disease and to use this understanding for diagnosis, prevention and treatment.
Worldwide, dental caries and malocclusion (crooked/crowded teeth, impaired jaw/facial growth) are common oral diseases afflicting people of all ages.
Surprisingly, within the pre-historic and fossil records, and in many present-day non-westernized cultures, malocclusion is barely detectable; in fact, there is little evidence to suggest that malocclusion appeared appreciably in humans until around the mid-17th century, and mostly in Europe.
Dental caries has been plaguing mankind since the advent of agriculture and there is even fossil evidence of tooth decay as far back as 400,000 years ago in one A. Heidelbergensis skull. A sharp rise in caries prevalence, however, doesn't appear in humans until nearly 1,000 years ago with the introduction of sugarcane to the Western World, and only began to reach epidemic proportions in the late 19th/early 20th centuries. Susceptibility to dental caries, clearly a dietary-infectious disease caused by increased sugar consumption resulting in increased acid production by oral bacteria, is not likely influenced by genetic changes that might have occurred since the Agricultural Revolution some 10-15,000 years ago.
While the cause of malocclusion is less clear, it is also not likely a result of recent genomic change. We will develop the hypothesis that malocclusion, like caries, results from a “mismatch” between current Western diets and the lifelong dietary regimes under which our teeth and masticatory mechanisms evolved. As modern orthodontic thinking is relatively uninformed by the new EM paradigm, the second part will focus on a novel approach to orthodontic diagnosis and treatment called Orthotropics.
The influence of an experimentally-induced malocclusion on vertebral alignment in rats: a controlled pilot study.
D'Attilio M, Filippi MR, Femminella B, Festa F, Tecco S.
Department of Orthodontics, University of Chieti, Italy. firstname.lastname@example.org
There is a growing interest in the relationship between occlusion and posture because of a greater incidence of neck and trunk pain in patients with occlusal dysfunction. The study was designed to verify whether an alteration of the spinal column alignment may be experimentally induced in rats as a consequence of altering dental occlusion and also to investigate whether the spinal column underwent any further changes when normal occlusion was then restored. Thirty rats were divided into two groups. Fifteen (15) rats (test group) wore an occlusal bite pad made of composite resin on the maxillary right first molar for a week (T1). The same rats wore a second composite bite pad for another week on the left first molar in order to rebalance dental occlusion (T2). Fifteen rats were included in an untreated control group. All the rats underwent total body radiographs at T0 (before the occlusal pad was placed), at T1 (one week after application of a resin occlusal bite pad on the maxillary left first molar) and at T2 (one week after application of a second resin occlusal bite pad on the maxillary right first molar). A scoliotic curve developed in all the test rats at T1. There were no alterations of spinal position observed in any of the control rats. Additionally, the spinal column returned to normal condition in 83% of the test rats when the balance in occlusal function was restored. The alignment of the spinal column seemed to be influenced by the dental occlusion.
Ben-Bassat Y, Yitschaky M, Kaplan L, Brin I.
Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. email@example.com
INTRODUCTION: Idiopathic scoliosis is an orthopedic condition characterized by faulty posture. It might also be associated with some mild forms of facial asymmetry or dental deviations. The aim of the study was to clinically examine the occlusions of patients with idiopathic scoliosis.
METHODS: Ninety-six consecutive orthopedic patients with idiopathic scoliosis were examined. The orthopedic data of this group were recorded from their hospital files. The occlusal features of a random group of 705 Ashkenazi children served as the control. Frequency distributions were compared with the chi-square test.
RESULTS: The distribution of the Angle classes of malocclusion was significantly different in the 2 groups (P = .0001) because of many Class II subdivision patients in the orthopedic group. Other evidence of asymmetrical malocclusion was found in upper (P =.002) and lower midline deviations (P =.0001), and a higher frequency of anterior (P = .024) and posterior (P =.020) crossbites. In the experimental group, no association was found between site, side, or severity of scoliosis and the appearance or site of the malocclusion features examined.
CONCLUSIONS: Patients with idiopathic scoliosis have asymmetric features of malocclusion compared with a random population.
Trunk inclination, pelvic tilt and pelvic rotation in relation to the craniofacial morphology in adults.
Lippold C, Danesh G, Hoppe G, Drerup B, Hackenberg L.
Department of Orthodontics, University of Münster, Münster, Germany. firstname.lastname@example.org
OBJECTIVE: To relate the differences in the posture of patients with different craniofacial morphologies.
SUBJECTS AND METHODS: Fifty-three adult patients with Class II and III malformations were examined by cephalometric analysis and rasterstereography. The facial depth, maxillary position, mandibular plane angle, inner gonial angle, facial axis, and lower facial height were evaluated and classified into a basal distal-mesial group and a horizontal-vertical group by means of threshold parameters. Analyzing the results of the rasterstereography, the spine's lateral perpendicular deviation, the pelvic tilt, and the pelvic rotation were calculated by means of mathematical algorithms on the basis of the three-dimensional spine profile. To determine the statistically significant correlations between the studied parameters, the t-test was applied in groups with a normal distribution, and the Mann-Whitney U-test was used in the cases of abnormally distributed variables (significance level P < .05).
RESULTS: Statistically significant differences (P < .05) in pelvic torsion were documented with respect to the facial axis and facial depth. Moreover, the differences (P < .05) between patients with a skeletal horizontal-vertical facial axis and patients with a basal distal-mesial position for the facial depth could be determined for the pelvic torsion.
CONCLUSIONS: As a clinical consequence of the results, an extension of the interdisciplinary concepts within the sense of an orthopedic examination can be considered for patients undergoing a combined orthodontic-operative therapy.
Scoliosis and dental occlusion: a review of the literature.
Saccucci M, Tettamanti L, Mummolo S, Polimeni A, Festa F, Tecco S.
Department of Health Science, University of L'Aquila, Edificio Delta 6 L'Aquila Fraz, Coppito, 67010, L'Aquila, Italy. email@example.com.
BACKGROUND: Idiopathic scoliosis is a deformity without clear etiology. It is unclear wether there is an association between malocclusion and scoliosis. Several types of occlusion were described in subjects with scoliosis, mostly case-reports.
OBJECTIVES: The aim of this review was to evaluate the type of occluslins more prevalent in subjects with scoliosis
SEARCH STRATEGY: All randomised and controlled clinical trials identified from the Cochrane Oral Health Group Trials Register, a MEDLINE search using the Mesh term scoliosis, malocclusion, and relevant free text words, and the bibliographies of papers and review articles which reported the outcome of orthodontic treatment in subjects with scoliosis that were published as abstracts or papers between 1970 and 2010.
SELECTION CRITERIA: All randomised and controlled clinical trials published as full papers or abstracts which reported quantitative data on the outcomes malocclusion in subjects with scoliosis.
DATA COLLECTION AND ANALYSIS: Data were extracted without blinding to the authors, age of patients or type of occlusion.
MAIN RESULTS: Using the search strategy eleven observational longitudinal studies were identified. No randomized clinical trials were recorded. Twenty-three cross-sectional studies were recorderd, and the others studies were reviews, editorials, case-reports, or opinions. The clinical trials were often not controlled and were about the cephalometric evaluation after treatment with the modified Milwuakee brace, followed by the orthodontic treatment of the class II relationship with a functional appliance. Clinical trials also included the study of the associations between scoliosis and unilateral crossbite, in children with asymmetry of the upper cervical spine. This association was also investigated in rats, pigs and rabbits in clinical trials. The other associations between scoliosis and occlusion seems to be based only on cross-sectional studies, case-reports, opinions.
AUTHORS' CONCLUSIONS: Based on selected studies, this review concludes that there is plausible evidence for an increased prevalence of unilateral Angle Class II malocclusions associated with scoliosis, and an increased risk of lateral crossbite, midline deviation in children affected by scoliosis. Also, documentation of associations between reduced range of lateral movements and scoliosis seem convincing. Data are also mentioned about the association between plagiocephaly and scoliosis.
Craniofacial features of children with spinal deformities.
Segatto E, Lippold C, Végh A.
Department of Orofacial Orthopedics and Orthodontics, Heim Pál Children's Hospital, Zoltán u 18, 1054 Budapest, Hungary. firstname.lastname@example.org
BACKGROUND: The objective of this epidemiological study is to map the dentofacial anomalies that can be correlated to the two most frequent spinal diseases responsible for postural abnormalities and that can be clinically identified by the orthodontic examination.
METHODS: Twenty-three children with Scheuermann's disease participated in the study (mean age: 14Y8M; SD: 1Y8M), 28 with Scoliosis (mean age: 14Y7M; SD: 2Y3M) and a control group of 68 orthopedically healthy children (mean age: 14Y8M; SD: 0Y11M). Standardized orthodontic screening protocols were used to map the occlusal relations in the sagittal, vertical, and transversal dimensions, space relations of the maxillary and mandibular frontal segment, and the TMJ status and function. The examinations for the children with orthopedic disorders were supplemented by the evaluation of routine orthodontic radiograms - lateral cephalograms and panoramic X-rays.
RESULTS: The majority of the dentofacial features examined revealed more and greater abnormalities among patients in the Scheuermann's disease group than in the scoliosis group. In the latter group the proportion of the TMJ symptoms and the consecutive functional deviations were greater. When comparing the values of the two spinal-disorder groups and the control group, statistically significant differences (p < .05) occurred for the following measurements: frequency of unilateral Cl.II. molar occlusion, overjet and extreme overjet mean value (Scheuermann's disease group), as well as the frequency of TMJ pathological symptoms (scoliosis group). The evaluation of the panoramic X-rays showed significant differences among the mandibular measurements of the two spinal-disorder groups. Within the framework of the evaluation of the cephalograms significant differences (p < .05) were found only in the case of dental relations. However, several values differed significantly from the Ricketts' norms, none of the indices strictly characterized any of the groups with spinal disorders.
CONCLUSION: The more extended treatment of the malocclusions closely correlated to postural disorders draws attention to the indicators of a higher frequency and severity occurring in the case of the dentofacial deviations in the patients of the MSCH group who had previously been less examined.
Associations between orthopaedic disturbances and unilateral crossbite in children with asymmetry of the upper cervical spine.
Korbmacher H, Koch L, Eggers-Stroeder G, Kahl-Nieke B.
Department of Orthodontics, Center of Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. email@example.com
The objective of the present study was to detect possible associations between unilateral crossbite and orthopaedic disturbances in children with asymmetry of the upper cervical spine. Fifty-five children aged 3-10 years (22 girls and 33 boys) with a unilateral crossbite and 55 gender- and age-matched children with a symmetric occlusion but no crossbite, who served as the control group, were selected from an orthopaedic cohort of 240 patients. In all children, asymmetry of the upper cervical region was confirmed by radiographs and palpation. The following orthopaedic aspects were investigated: oblique shoulder and pelvis, scoliosis, functional leg length difference, and laxity of ligaments of the foot. The differences between the groups were analysed by means of an unpaired t-test. An increased occurrence of orthopaedic parameters in the frontal plane was observed in children with a unilateral malocclusion. A unilateral crossbite was not necessarily combined with a pathological orthopaedic variable, but statistically, children with a unilateral malocclusion showed more often an oblique shoulder (P = 0.004), scoliosis (P = 0.04), an oblique pelvis (P = 0.007), and a functional leg length difference (P = 0.002) than children with symmetry. The results suggest that a unilateral crossbite in children with asymmetry of the upper cervical spine is associated with orthopaedic disturbances. There is no evidence of a causal link.
[Occlusion and posture: is there evidence of correlation?].
[Article in Italian]
Michelotti A, Manzo P, Farella M, Martina R.
Istituto di Discipline Odontostomatologiche, Università degli Studi Federico II, Napoli. firstname.lastname@example.org
The observation that the masticatory system and the postural body regulating system are anatomically and functionally related, has led to postulate several hypotheses of correlation between occlusal and postural disturbances. In the last decade, these arguments have gained a great social impact, also because they have been broadly spread by the mass-media. As a consequence, there has been a growing number of patients seeking concomitant occlusal and postural treatments. The aim of this study was to review critically the current evidence of correlation between the two systems; this in order to address clinical issues for the management of patients. Methodology of the studies reviewed has been evaluated according to the criteria suggested by Storey and Rugh 20 rif. Although there are some evidences of correlation between occlusion and posture, this appears limited to the cranio-cervical tract of the column and tends to disappear when descending in cranio-caudal direction. On the basis of this review of the literature, it's not advisable to treat postural imbalance by means of occlusal treatment or vice versa, particularly if the therapeutic modalities are irreversible.