Anterior malalignment and the risk for poor oral health

Abstract

Little knowledge and contradictory results are available on the effectiveness of incisor malalignment as an indicator of poor oral health (e.g., dental caries, periodontal disease). This research project aimed to examine the relationship between incisor malalignment and two common diseases of poor oral health—periodontal disease and dental caries—and their cumulative outcome (i.e., tooth loss) in anterior teeth. Prospective and cross-sectional data from the Veterans Affair (VA) Dental Longitudinal Study were utilized in this research. Incisor malalignment traits were measured by determining the anterior tooth size–arch length discrepancy index (aTSALD) and Little’s Irregularity Index (LII). Incisor malalignment indices were categorized by severity. We computed per arch adjusted estimates of the amount of change/events in anterior periodontal disease, tooth loss, and dental caries (i.e., coronal and root caries) by the level of the incisor malalignment traits. Pocket depth (PD), clinical attachment loss (CAL), and alveolar bone loss (ABL) were used as periodontal disease outcomes. Prospective data included information from 400 maxillary and 408 mandibular casts with a complete set of anterior sextants. In the upper anterior arch, crowding and spacing were significantly associated with an increased mean PD. Maxillary incisor irregularity involved a significantly increased mean CAL. In the anterior mandibular arch, incisor crowding and irregularity were significantly associated with increased PD, CAL, and ABL. Prospective data to test the association between all-cause tooth loss and incisor alignment traits included a sample size of 400 maxillary and 408 mandibular casts with a complete set of anterior sextants. Maxillary segments with spacing had a 401% significantly greater hazard (hazard ratio [HR]= 5.01, 95% confidence interval [CI] = 1.16-21.64) of all-cause tooth loss, compared to the ideal alignment (i.e., the reference group). Multiple cross-sectional data to test the association between anterior dental caries outcomes and malalignment traits included a sample size of 211 maxillary and mandibular casts with a complete set of anterior sextants. Compared to ideally aligned teeth, spacing in the maxillary segment significantly decreased the mean maxillary anterior CDFT by 0.93 teeth. Specific malalignment traits may be linked to certain poor oral health indicators.