Impact of malocclusion and dentofacial anomalies on the prevalence and severity of dental caries among adolescents

Objectives:To investigate the association between malocclusion/dentofacial anomalies and dental caries among adolescents.Materials and Methods:A cross-sectional study was conducted with 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório in southern Brazil. Parents/caregivers answered a structured questionnaire on demographic and socioeconomic variables. A trained examiner recorded the presence of malocclusion (Dental Aesthetic Index [DAI]), traumatic dental injury, and dental caries. Data analysis involved the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Poisson regression with robust variance was used for the multivariable analysis.Results:A total of 44.8% of the adolescents had dental caries (mean DFMT  =  1.33 ± 1.84). The DAI index ranged from 15 to 77 (mean  =  29.0 ± 7.9); 43.6% of the sample had severe malocclusion and 11.6% had traumatic dental injury. The prevalence and severity of dental caries were significantly greater among adolescents with severe malocclusion. The multivariate analysis demonstrated that adolescents with severe or handicapping malocclusion had a 31% greater probability of having dental caries (prevalence ratio: 1.31; 95% CI: 1.02–1.67), independently of demographic, socioeconomic, or clinical aspects. The orthodontic characteristics associated with the occurrence and severity of caries were maxillary irregularity ≥3 mm (P  =  .021) and abnormal molar relationship (P  =  .021).Conclusions:Handicapping malocclusion, maxillary irregularity, and abnormal molar relationship were associated with the occurrence and severity of dental caries. The findings suggest that the prevention and treatment of these conditions can contribute to a reduction in dental caries among adolescents.     

Is the adolescent's esthetic concern associated with anterior occlusal conditions or the malocclusion severity level?

ObjectivesTo assess the esthetic impact of anterior occlusal conditions and malocclusion severity levels.Materials and MethodsA population-based cross-sectional study of 700 adolescents aged 15 to 19 years was conducted. The Oral Aesthetic Subjective Impact Scale (OASIS) was used to evaluate the subjective esthetic impact of malocclusion. The Dental Aesthetic Index (DAI) criteria were used to diagnose the anterior occlusal characteristics in isolation and the severity levels of malocclusion. The variables with P < .20 in the individual analyses were tested in multiple logistic regression models, and those with P < .10 remained in the model. The adjusted odds ratio (OR) was estimated with a 95% confidence interval (CI).ResultsOf the adolescents, 42% showed negative self-perception of malocclusion. In addition, 15.4% of adolescents had severe malocclusion (DAI 3) and 18.9% very severe malocclusion (DAI 4). Crowding and spacing were shown to be 2.90 (CI: 2.06–4.09) and 2.53 (CI: 1.65–3.86) times, respectively, more likely to cause a negative esthetic impact in adolescents (P < .05). In addition, adolescents with orthodontic treatment need (DAI 2, 3, and 4) were more likely to report a negative esthetic impact (P < .05).ConclusionsAnterior crowding and spacing are the conditions that most influence the esthetic concern of adolescents. Adolescents with very severe malocclusion and higher orthodontic treatment need are more likely to report a negative esthetic impact.     

Exploring the impact of malocclusion and dentofacial anomalies on the occurrence of traumatic dental injuries in adolescents

Objective:To investigate the association between malocclusion/dentofacial anomalies and traumatic dental injuries (TDI) in adolescents.Materials and Methods:The sample of this cross-sectional study comprised 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório, southern Brazil. Parents answered a structured questionnaire addressing demographic and socioeconomic characteristics. An examiner who had undergone a training and calibration exercise recorded malocclusion/dentofacial anomalies (Dental Aesthetic Index, DAI), TDI (Andreasen), and dental caries (World Health Organisation). Statistical analyses (SPSS software) involved Poisson regression with robust variance.Results:The prevalence of TDI was 11.6%, and the prevalence of defined, severe, and handicapping malocclusion was 24.0%, 21.6%, and 22.0%, respectively. The multivariate analysis demonstrated that the probability of TDI was approximately twofold higher among adolescents with severe malocclusion (prevalence ratio [PR] 2.22; 95% confidence interval [CI] 1.14–4.31) and handicapping malocclusion (PR 1.95; 95% CI 1.01–3.85) in comparison to those with normal occlusion or minor malocclusion. Defined malocclusion was not significantly associated with the outcome. Among the dentofacial anomalies evaluated, the probability of TDI was nearly twofold higher among adolescents with overjet greater than 3 mm (PR 1.96; 95% CI 1.14–3.37) and 2.2-fold higher among those with an abnormal molar relationship (PR 2.24; 95% CI 1.17–4.32), after controlling for confounding variables.Conclusions:Severe and handicapping malocclusion, accentuated overjet, and abnormal molar relationship were strongly associated with the occurrence of TDI. Future studies should investigate whether the treatment of these conditions can help reduce the occurrence of TDI in adolescents.     

Assessment of orthodontic treatment needs in Brazilian schoolchildren according to the Dental Aesthetic Index (DAI)

OBJECTIVE: To assess the distribution, prevalence and severity of malocclusion and orthodontic treatment needs in schoolchildren from the northeast of Brazil aged between 13 and 15 years. RESEARCH DESIGN: Cross-sectional study. PARTICIPANTS: A sample of 600 adolescents (264 males and 336 females) randomly selected and representative of schoolchildren living in Recife (Brazil) was obtained from 12 public schools. METHOD: The need for orthodontic treatment was measured using the Dental Aesthetic Index (DAI). RESULTS: Most of the subjects (77%) were deemed to require orthodontic treatment. Only about 5.8% had a handicapping malocclusion that needed mandatory treatment. A severe malocclusion for which treatment was highly desirable was recorded in 47.5% of the adolescents and 23.7% had a definite malocclusion for which treatment was elective. Three main occlusal features were responsible for allocating subjects into the group of "orthodontic treatment required": crowding (47.3%), tooth loss (22.3%) and maxillary overjet of more than 3 mm (21.8%). There were no significant differences (p > 0.05) in mean DAI scores between males and females. CONCLUSIONS: 77% of adolescents from northeast Brazil were in need of orthodontic treatment for dental health reasons. The distribution of DAI scores among Brazilian adolescents is different from that reported in other populations. This study provides baseline data on the need and demand for orthodontic treatment among Brazilian students.     

Malocclusions and orthodontic treatment needs in a group of Spanish adolescents using the Dental Aesthetic Index

OBJECTIVE: To evaluate the prevalence of malocclusion and orthodontic treatment need among Spanish adolescents and compare with other populations. METHODS: The study sample comprised 744 schoolchildren from urban and rural populations in Granada province (Southern Spain), aged from 14-20 years, who had received no orthodontic treatment. The measurement instrument was the Dental Aesthetic Index (DAI). RESULTS: The mean DAI score of the whole series was 25.6 (SD, 7.94). The distribution of the four DAI grades was: DAI 1, no anomaly or malocclusion, 58.6%; DAI 2, definite malocclusion, 20.3%; DAI 3, severe malocclusion, 11.2%; DAI 4, very severe or disabling malocclusion, 9.9%. There were no statistically significant differences in DAI score between genders or those in rural vs. urban residence, but a significant difference was found between social classes, with subjects of low social class presenting the worst scores (p<0.05). CONCLUSION: The distribution of DAI scores among Spanish adolescents is similar to that reported in other populations.     

Comparison of perception of necessity of orthodontic treatment between orthodontists and dentists at dental check-ups with DAI

PurposeThe aims of this study were to examine the gaps in the perception of the necessity of orthodontic treatment between orthodontists and dentists, and identify the items influencing perception using the Dental Aesthetic Index (DAI).Materials and methodsBoth dentists and orthodontists assessed the necessity of orthodontic treatment in the 693 junior and senior high school students, and orthodontists examined the occlusion of the students with DAI. The data were analyzed with Student's t-test, Bonferroni multiple comparison test and decision analysis.ResultsIn the orthodontist’ perception, clearly significant differences were observed in all DAI items between necessary and unnecessary groups. However, maxillary missing teeth, mandibular missing teeth, spacing and diastema did not show a clear difference in the dentists’ perception. In the comparison of perception between orthodontists and dentists, crowding, largest anterior maxillary irregularity and largest mandibular irregularity showed significant differences. Decision analysis demonstrated that crowding was the most important item for both orthodontists and dentists.ConclusionThere were two types of gaps in the perception of the necessity of orthodontic treatment. The first one is an individual difference among the dentists, which is related to the evaluation of missing teeth and space in the dental arches. The other is recognized as gaps in the perception between orthodontists and dentists, which are related to the amounts of crowding. It is important to realize the difference of perception and improve the mutual understanding to prevent overlooking malocclusion.     

Orthodontic treatment need in Peruvian young adults evaluated through dental aesthetic index

The objectives of this study were to evaluate the frequency and severity of the malocclusion and treatment needs in Peruvian young adults. The second aim was to compare the orthodontic treatment needs according to sex and socio-economic status (SES). This cross-sectional study was conducted at the University Dental Clinic of a private university in Lima, Peru. A total of 267 freshmen (from 16 to 25 years old) were randomly selected from a pool of 780 students. Students wearing an orthodontic appliance or reporting a history of orthodontic treatment were excluded from the study. Clinical examinations were conducted using the Dental Aesthetic Index (DAI). Mann-Whitney and Kruskal-Wallis tests were used to compare the DAI scores according to sex and SES, respectively. The mean DAI score was 28.87 points (IC(95%) 27.77; 29.97, where IC indicates interval of confidence). Around one-third of the sample presented severe or very severe malocclusion, which implies a highly desirable or mandatory orthodontic treatment need. No statistically significant difference was found between the DAI scores according to sex (P = .592) and SES (P = .397). Approximately one-third of the evaluated Peruvian young adults would need orthodontic treatment according to the DAI. In this population, malocclusion was characterized by a relatively high frequency of missing teeth, appreciable dental crowding, and inadequate anteroposterior relationships.     

Psychosocial implications of malocclusion among 12-18 year old secondary school children in Ibadan, Nigeria.

The main purpose of this study was to analyze the current psychosocial implications of malocclusion in Ibadan, Nigeria. The study sample comprised 614 secondary school children (327 males and 287 females) aged 12-18 years (mean age, 14.9 +/- 2.9 SD) who filled in a questionnaire containing general questions about body image and specific inquires concerning self-perception and social implications of dental appearance. The children's occlusions were also assessed using the Dental Aesthetic Index (DAI) and the malocclusion traits related to body image, self-perception, and social implications of dental appearance. Subjects with malocclusion rated only the teeth significantly least satisfactory among other twelve items of body image. The lowest rating was observed in subjects with crowding of the maxillary and mandibular incisor segments. Highly significant differences (P < 0.001) were found between subjects with normal or minor malocclusion and those with marked malocclusion in indicating awareness of malocclusion, dissatisfaction with the appearance of the teeth, and unfavourable appearance of the teeth compared with those of peers. Schoolmates' teasing occurred significantly more often in the presence of malocclusion (P < 0.001). Unfavourable perceptions of the teeth were expressed significantly more often by subjects with anterior maxillary irregularities of up to 1 mm and more, spacing of both maxillary and mandibular incisor segments, midline diastema, crowding (especially of the mandibular incisor segment), anterior open bite and molar relation deviations. It was concluded that certain malocclusions, especially occlusal and space anomalies, may adversely affect body image and self-concept of Nigerian adolescents.     

Prevalence of malocclusion in high school students in Japan according to the Dental Aesthetic Index

Abstract – The Dental Aesthetic Index (DAI) was used to evaluate malocclusion in Japanese high school students ( n = 409, ages 15–18 yr). The purpose of this study was to obtain basic data concerning malocclusion in Japanese high school students. This study used a sample of students from randomly selected urban and rural high schools in Japan's Kyushu district. The DAI scores for urban and rural high school students, as well as the total DAI scores from these two areas were significantly higher than that of American high school students. These results showed that the number of students with an acceptable dental appearance among Japanese high school students is significantly lower than among American high school students. This indicates a higher need for orthodontic treatment among Japanese high school students.     

Malocclusion and orthodontic treatment need evaluated among subjects with Down syndrome using the Dental Aesthetic Index (DAI)

Objective:To determine the prevalence of malocclusion and need for orthodontic treatment among persons with Down Syndrome (DS).Materials and Methods:Study participants were 113 persons with DS from the selected community-based rehabilitation center who fulfilled the inclusion and exclusion criteria. Ten occlusal characteristics of the Dental Aesthetic Index (DAI) were measured on study models to determine the degree of malocclusion. A single score represented the dentofacial anomalies, determined the level of severity, and determined the need for orthodontic treatment.Results:Crowding in the anterior maxillary and mandibular arch was the main malocclusion problems among the subjects with DS. Comparison between age group and genders revealed no significant differences in four categories of orthodontic treatment need (P > .05).Conclusion:Most of the subjects with DS (94; 83.2%) had severe and very severe malocclusion, which indicated a desirable and mandatory need for orthodontic treatment.     

Malocclusions and traumatic injuries in disabled schoolchildren and adolescents in Kuwait

The present study was carried out to determine the prevalence of malocclusion and traumatic injuries in disabled children and adolescents attending the special-needs schools in Kuwait. Included in the study were 818 children (438 males and 380 females), in the age groups of 3–20 years, who have visual impairment, hearing impairment, physical handicaps, or developmental disorders. The mean age of participants was 11.9 years. The survey was carried out according to the methods of WHO. The prevalence of severe malocclusion was 23.6%, and that of slight malocclusion was 37.0%. Children with Down syndrome (OR = 2.3; 95% CI = 1.51-3.52), those of increasing age (OR = 1.1; 95% CI = 1.01-1.10), and males (OR = 1.5; 95% CI = 1.05-2.07) had higher risk for the occurrence of severe malocclusion. Less than one-fifth of the subjects (16.9%) had traumatized anterior teeth. Severe malocclusion (OR = 1.8; 95% CI = 1.17-2.77) and increasing age (OR = 1.2; 95% CI = 1.13-1.26) were significant risk factors for the occurrence of traumatic injuries. We concluded that malocclusion and traumatic injuries are more prevalent among these subjects with disabilities than among the healthy population in Kuwait.     

Malocclusion and orthodontic treatment need of handicapped individuals in South Canara,India

AIMS: To estimate the prevalence and the severity of malocclusion and treatment need for 329 handicapped individuals. SUBJECTS AND SETTING: 329 handicapped individuals aged 11-30 years, attending eight different nonresidential special schools of South Canara, India. METHOD: Examination and recording using the Dental Aesthetic Index (DAI). RESULTS: 53% had a dental appearance which required no orthodontic treatment, 24% had a definite malocclusion, where treatment was 'elective' and treatment for a further 12% was considered to be 'highly desirable'. The remaining subjects (11%) had a handicapping malocclusion where treatment was considered mandatory. CONCLUSIONS: The prevalence of definite and severe malocclusions was higher in the mentally subnormal individuals when compared to other handicapping conditions. Orthodontic services for the handicapped have generally been neglected.     

Malocclusion and treatment need in children and adolescents with sickle cell disease

Objective:To assess the prevalence of malocclusion and treatment need in children and adolescents with sickle cell disease (SCD).Materials and Methods:In this cross-sectional study, the sample size comprised 35 five-year-old children and 36 adolescents of both sexes, aged between 12 to 18 years, with SCD. Dental occlusion was assessed using two indexes: the Malocclusion Index (World Health Organization) and the Dental Aesthetic Index (DAI).Results:The prevalence of malocclusion in the preschool children was 62.9%. The main malocclusions observed in this age group were Class II (37.1%), increased overjet (28.6%), reduced overbite (28.6%), and open bite (17.1%). In the 12- to 18-year-old subjects, the prevalence of malocclusion was 100%, and the most prevalent types of malocclusion were maxillary overjet (63.9%) and maxillary misalignment (58.3%). It is noteworthy that the majority of adolescents (80.6%) had very severe or disabling malocclusions.Conclusion:The results revealed a high prevalence of malocclusion in children and adolescents with SCD. According to DAI score, the majority of the sample presented with very severe malocclusion and a compulsory treatment need.     

Desire for orthodontic treatment and associated factors among adolescents in southern Brazil

Objective:To estimate the prevalence of the desire for orthodontic treatment and investigate associated factors among adolescents in southern Brazil.Materials and Methods:A cross-sectional study was carried out with 704 adolescents aged 12 and 13 years at municipal public schools in the city of Balneário Camboriú (southern Brazil). The adolescents answered a previously tested questionnaire addressing satisfaction with their dental appearance, speech function, chewing function, and the desire for orthodontic treatment. The parents/guardians answered a questionnaire addressing satisfaction with their child''s dental appearance and socioeconomic variables. A trained and calibrated orthodontist collected clinical data on malocclusion using the Dental Aesthetic Index (DAI). Statistical analysis was performed using multivariate Poisson regression with robust variance.Results:The prevalence of the desire for orthodontic treatment was 69.6% (490/704). In the adjusted analysis, the outcome was significantly more prevalent among girls (P < .001), those with difficulty chewing (P  =  .026), those dissatisfied with their dental appearance (P < .001), and those with greater malocclusion severity (P < .001). The following orthodontic characteristics were associated with the desire for orthodontic treatment in the multivariate model: diastema in anterior segment (P < .001), anterior maxillary irregularity (P < .001), maxillary overjet ≥6 mm (P < .001), and mandibular overjet (P  =  .047).Conclusions:The desire for orthodontic treatment among 12- and 13-year-old adolescents is influenced by gender, dissatisfaction with one''s dental appearance, difficulty chewing, malocclusion severity, and orthodontic characteristics. These findings should be considered together with normative indications regarding the need for orthodontic treatment in adolescents.     

Assessing anteroposterior basal bone discrepancy with the Dental Aesthetic Index

Objective:To investigate dental appearance and cephalometric features, using a sample of orthognathic and/or orthodontic patients. A special interest was to identify the relationship of the Dental Aesthetic Index (DAI) with anteroposterior basal bone discrepancy (APBBD) and cephalometric indicators.Materials and Methods:A full sample of 159 patients in two Japanese hospitals was used. Each patient was assessed with a preorthodontic dental cast and cephalometric radiography.Results:Malocclusion with APBBD was more prevalent among high DAI subjects (P  =  .034, OR  =  1.04, 95% CI: 1.00–1.08), Class III malocclusion patients (P  =  .048, OR  =  2.32, 95% CI: 1.01–5.34) and male patients (P  =  .008, OR  =  2.96, 95% CI: 1.33–6.61). Participants scoring 88 points (the highest score in this sample) of the DAI had 16.84 times the risk of APBBD of those who scored 17 points (the lowest score in this sample). Patients with APBBD presented with a greater adjusted ANB angle (t  =  −8.10, P < .001) and a larger adjusted A-B/NF appraisal (t  =  −9.65, P < .001). The SNA angle (P < .001), the SNB angle (P  =  .002), the adjusted ANB angle (P  =  .001), and the adjusted A-B/NF appraisal (P  =  .035) were associated with DAI scores in cubic regression models.Conclusion:This study has demonstrated a relationship between the DAI and APBBD. Feasibility of using the adjusted ANB angle and the adjusted A-B/NF appraisal to assess severity of APBBD has been confirmed. The DAI may provide a supportive method to evaluate orthognathic needs. Future investigations are indicated.     

Relationship of the Dental Aesthetic Index to the oral health-related quality of life

Objective:To assess the impact of malocclusion on the quality of life.Materials and Methods:This cross-sectional study involved 150 subjects attending the Primary Care Unit with no history of orthodontic treatment. The Dental Aesthetic Index (DAI) with 10 occlusal characteristics were measured on study models. Oral health-related quality of life (OHRQoL) was assessed with the Malaysian version of the Oral Health Impact Profile questionnaire (OHIP-14). The Spearman rank-order correlation coefficient was used to evaluate the relationship between the malocclusion and quality of life.Results:Significantly weak correlations (r = .176) were found between the DAI and the OHRQoL. Females and the younger age group (12–19 years) tended to score higher on the OHIP-14 than their counterparts. For males, domain 3 (psychological discomfort; r = .462), domain 4 (physical disability; r = .312), domain 7 (handicap; r = .309), and overall score (r = .289) were weak correlates but significant to the DAI compared with females. The older age group showed a significant weak correlation in domain 3 (psychological discomfort; r = .268) and domain 7 (handicap; r = .238), whereas the younger age group showed no correlation with any domain.Conclusions:The DAI score does not predict the effect of malocclusion on the OHRQoL.     

Anterior disc displacement with reduction and symptomatic hypermobility in the human temporomandibular joint: prevalence rates and risk factors in children and teenagers

AIMS: To assess the prevalence rates and risk factors of anterior disc displacement with reduction (ADDR) and symptomatic hypermobility in a large sample of children and teenagers. Prevalence rates were also established in samples of young adults and adults. METHODS: Children from 7 Dutch primary and secondary schools (n = 1,833) aged 4 to 18 years (mean age +/- SD 10.8 +/- 3.9 years), 220 dental students aged 19 to 30 years (mean age +/- SD 21.9 +/- 3.6 years), and 100 dental school employees more than 30 years old (mean age +/- SD 43.5 +/- 9.8 years) were examined. The presence of ADDR or symptomatic hypermobility was scored using well-defined clinical criteria. For the children only, an additional standardized oral history and clinical examination were performed to assess possible risk factors. Odds ratios (ORs) were calculated with the use of logistic multivariate regression analysis. RESULTS: The prevalence rate of ADDR in at least 1 of the 2 joints increased during childhood and adolescence and stabilized into adulthood at about 26.6%. In children and teenagers, besides age (OR = 1.06 for boys, OR = 1.23 for girls), risk factors for ADDR were a history of orthodontics (OR = 1.57), an increasing overbite (OR = 1.15), and protrusion (OR = 1.12). In children and teenagers, the prevalence rate of symptomatic hypermobility was higher for girls (13.8%) than for boys (8.2%). Besides gender (OR = 2.07), risk factors for symptomatic hypermobility were race (OR = 2.61 for non-Caucasians), masticatory muscle pain (OR = 1.95), and increasing maximum mouth opening (OR = 1.08). CONCLUSION: In children and teenagers, ADDR and symptomatic hypermobility have different prevalence rates and risk factors.     

Aesthetic impact of malocclusion in the daily living of Brazilian adolescents

Abstract

Objective: The aim of the present study was to determine the biopsychosocial impact of malocclusion on the daily living of Brazilian adolescents (14 to 18 years of age) through normative and subjective records and identify factors directly involved in the self-perception of malocclusions.

Design: Cross-sectional.

Setting: Public and private schools in the city of Belo Horizonte, Brazil.

Subjects and methods: The sample was made up of 403 adolescents, with no prior history of orthodontic treatment, who were selected randomly from a population of 182,291 students in the same age range. The oral impact of malocclusion was assessed using the Oral Impact on Daily Performance (OIDP), whereas clinical criteria were assessed using the Dental Aesthetic Index (DAI). Self-perception of dental aesthetics was assessed using the Oral Aesthetic Subjective Impact Scale (OASIS) and self-esteem was assessed using the Global Negative Self-Evaluation (GSE) scale. Other variables were assessed using questionnaires. The chi-square test, simple and multiple logistic regression analyses were used for the statistical analysis.

Results: Ninety five adolescents (24%) reported feeling embarrassed to smile (aesthetic impact). A logistic regression suggested that the following variables were directly involved in the self-perception of malocclusion: upper anterior crowding ?2 mm (P=0.009), median diastema ?2 mm (P=0.040), normative treatment need (highly desirable) (P<0.001) and low economic level (P<0.001).

Conclusion: Negative repercussions on daily living were found in Brazilian adolescents with malocclusions affecting anterior dental aesthetics.     

Temporo-mandibular joint kinetics and chewing cycles in children. A 3-year follow-up

Summary. Objectives. To report the temporo‐mandibular joint (TMJ) kinetics and masticatory function in healthy children. Design. Temporo‐mandibular joint palpation and electrognathographic registrations of chewing cycles were repeated for 3 years in order to evaluate changes. Setting. Healthy children without systemic pathologies, decayed cavities and previous dental treatment. Sample and methods. Electrognathographic (EGN) registration of masticatory cycles and TMJ palpation were carried out on 52 patients (mean age: 5 years 8 months, range: 5 years 1 month, 6 years 8 months), by two university researchers, once a year for 3 consecutive years. TMJ palpation, differentiated TMJ synchronism (simultaneous bilateral opening movement) and TMJ asynchronism (not simultaneous bilateral opening movement), TMJ subluxation and click were observed. Electrognathographic registrations differentiated normal and abnormal jaw chewing cycles, and narrow and large cycles. Results. Temporo‐mandibular joint asynchronism was evident in 34 of 52 patients in the primary dentition, in 42 of 52 patients after the eruption of the first permanent molar, and in 31 of 52 patients after the eruption of the permanent incisors. TMJ subluxation increased during the full period of observation. Three temporomandibular clicks appeared after the eruption of the permanent incisors. Altered mastication was not always associated with TMJ disorders. Conclusions. In children, normal chewing cycles can coexist with occlusal discrepancies, cranio‐facial growth and TMJ alterations.