Research Article

Prevalence of crossbite in primary dentition

D. Shruthi*, Ganesh J

ABSTRACT

Introduction: Malocclusion, dental injuries, and dental anomalies in the primary dentition are conditions to take into account
when considering the need for oral health care in young children. Occlusion means intercuspation of the upper and lower
teeth when the jaws are not moving. Proper occlusion of teeth plays an important role in mastication, deglutition, speech, and
respiration. Materials and Methods: This study includes a total population of 1481 children at age 3–6 years from 6 private
schools and 5 government schools of Chennai. Examination of occlusion, molar relationship is done and data are recorded. The
collected data are evaluated and analyzed. Results: A total of 1481 children from 6 private schools and 5 government schools from
Chennai participated in this study. Among this population, 890 are males and 591 are females. Among total population, 67.5%
were reported with malocclusion. Among the malocclusions, the following transverse problems were diagnosed: Unilateral
posterior crossbite (20%), anterior open bite associated with posterior crossbite (7.79%), bilateral posterior crossbite (6.79%),
unilateral posterior crossbite associated with anterior crossbite (7.09%), and full crossbite (5.99%). The mandibular functional
deviation was observed in 59% of children with unilateral posterior crossbite. Conclusion: Dentofacial disorders that can cause
esthetic and functional problems for the child and affect dentofacial growth and development can be detected during routine
dental visits. Parents should be instructed to help their children to prevent the potential development of transverse malocclusions.

KEY WORDS: Eruption, Growth spurts, Habits, Malocclusion, Skeletal

INTRODUCTION • Distal step: The distal surface of mandibular

primary second molar is distal to that of the primary
The primary dentition in children should be ideal in maxillary second molar.
order so that during future adulthood, the children • Mesial step: The distal surface of mandibular
may exhibit normal dental features such as normal primary second molar is mesial to that of the
appearance, space, masticatory movements, and maxillary primary second molar.[3]
occlusion for the proper and healthy functioning of the
permanent dentition.[1] Primary teeth start to erupt at Crossbites are defined as any abnormal buccolingual
6 months of age and complete their eruption at the age relationship between opposing incisors, molar, or
of 3 years. Eruption time of primary teeth is affected by premolar in centric relation.[4] A crossbite can be of
several factors. Occlusion means intercuspation of the dental or skeletal origin or a combination of both.[5]
upper and lower teeth when the jaws are not moving. Many factors may be implicated in the etiology of
Proper occlusion of teeth plays an important role in crossbite in children.[6] The causative factors can
mastication, deglutition, speech, and respiration.[2] be related to congenital, environmental, genetic,
functional, or from oral habits.[7] The early treatment
Primary molar relationship (terminal plane) is the
aimed at promoting a better tooth/skeletal relationship,
relationship of the maxillary and mandibular second
thus improving masticatory function and establishing
primary molars in the vertical plane.
a symmetrical condyle/fossa relationship.[8] Habits
• Flush terminal plane: The distal surfaces of and crossbites should be diagnosed and, if predicted
mandibular and maxillary primary second molars not likely to be self- correcting, they should be
lie in the same vertical plane. addressed as early as feasible to facilitate normal
occlusal relationships. Parents should be informed
Access this article online about the findings of adverse growth and developing
malocclusions. Interventions/treatment can be
Website: jprsolutions.info ISSN: 0975-7619
recommended if the diagnosis can be made, treatment

Department of Pedodontics, Saveetha Dental College, Saveetha University, Saveetha Institute of Medical and Technical
Sciences, Chennai, Tamil Nadu, India

*Corresponding author: D. Shruthi, Saveetha Dental College, Saveetha University, Saveetha Institute of Medical and
Technical Sciences, Chennai, Tamil Nadu, India. E-mail: shruthi.dharshana@yahoo.com

Received on: 14-08-2018; Revised on: 11-09-2018; Accepted on: 24-10-2018

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 D. Shruthi

is appropriate and possible, and parents are supportive

and desire to have the treatment done.[9] Once the
growth spurt completes, the mid-palatal suture
progressively becomes more fused, heavier forces
across the suture are required to produce maxillary
skeletal expansion and may sometimes require
surgical interventions thus earliest possible treatment
would be favorable.[10]

MATERIALS AND METHODS

Sample Characteristics
This study was carried out involving a random sample
of 890 male and 591 female children aged 3–5 years
enrolled at private and public schools in the city of
Chennai, Tamil Nadu. The participants were selected Graph 1: Distribution of participants
from a total population of 1481 children in this age
group. 18 of the 6 private schools and 5 government
schools were randomly selected.

Eligibility Criteria
Inclusion criteria: Age 3–5  years; exclusively in
the primary dentition phase; and agreement to
participate in the clinical exam were included in the
study. Exclusion criteria: Presence of at least one
permanent tooth; loss of mesiodistal diameter due to
caries; previous orthodontic treatment; and refusal to
participate in the clinical exam were excluded from
the study. Chart 1: Distribution of malocclusion

Data Collection Table 1: Percentage of the distribution of crossbite

Clinical examination was performed. Packaged and
Distribution of crossbite Incidence (%)
sterilized disposable dental mirrors and dental gauze
(to dry the teeth) were used for the examination. Unilateral 205 (20)
AOB with posterior crossbite 78 (7.79)
Aspects of crossbite were recorded. Radiography was Bilateral 68 (6.79)
not used for the diagnosis. The collected data were unilateral posterior crossbite with 71 (7.09)
analyzed and tabulated in the form of a graph. anterior crossbite
Full crossbite 60 (5.99)
Mandibular deviation 591 (59)
RESULTS
A total of 1481 children from 6 private schools and 5
DISCUSSION
government schools participated in this study. Among
the total participants, 890 were male and 591 were This study was conducted to evaluate the prevalence
female [Graph 1]. Of these 480 children were recorded of crossbite in primary dentition involving children
with normal occlusion. Among these 480 children with of age 3–6 years. In this study, it is determined that
normal occlusion, almost 310 were male and 170 were normal occlusion was observed in 32.41% of the
female. Almost 1001 children were recorded to be with sample, 67.58% of children presented some type
some kind of malocclusion among the total participants of malocclusion. Among the malocclusions, the
[Chart 1]. Among the malocclusions, the following following transverse problems were diagnosed:
transverse problems were diagnosed: Unilateral Unilateral posterior crossbite (20%), anterior open
posterior crossbite (20%), anterior open bite associated bite associated with posterior crossbite (7.79%),
with posterior crossbite (7.79%), bilateral posterior bilateral posterior crossbite (6.79%), unilateral
crossbite (6.79%), unilateral posterior crossbite posterior crossbite associate with anterior crossbite
associate with anterior crossbite (7.09%), and full (7.09%), and full crossbite (5.99%). The mandibular
crossbite (5.99%). The mandibular functional deviation functional deviation was observed to be 59%
was observed to be 59% of children with unilateral of children with unilateral posterior crossbite,
posterior crossbite, characterizing the functional characterizing the functional unilateral posterior
unilateral posterior crossbite [Table 1 and Graph 2]. crossbite.

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 D. Shruthi

Graph 2: Distribution of crossbite

The incidence of different types of crossbite such less than our study and the study showed that it was
as unilateral crossbite, bilateral crossbite, unilateral female gender predominantly.[14] In another study,
posterior crossbite with anterior crossbite and full the crossbite was noted to be 11.7% of the overall
crossbite were higher than a study done by da subjects they examined. This study has also noted
Silva et al. in which normal occlusion was observed various other forms of malocclusion possible among
in 26.74% of the sample; thus, 73.26% of children primary dentition.[15] A study done to correlate the
presented some type of malocclusion. Among the habits with malocclusion showed that digit sucking
malocclusions, the following transverse problems were was most reported habit that commonly causes
diagnosed: Unilateral posterior crossbite (11.65%), malocclusion.[16] A study done in Saudi Arabia
anterior open bite associated with posterior crossbite showed that the prevalence of posterior crossbite was
(6.99%), bilateral posterior crossbite (1.19%), unilateral 4%.[17] The prevalence of posterior crossbite between
posterior crossbite associate with anterior crossbite many cultures might be due to the differences in the
(0.79%), and full crossbite (0.19%) totalizing 20.81% prevalence of sucking habits to some extent and which
of the transverse problems. The incidence of mandibular was found to be lower among Saudi children[18] than
deviation was observed less than da Silva et al. in among children in Western nations.[19] Correction
which the incidence of mandibular functional deviation of functional posterior crossbite in the mixed
was observed in 91.91% of children with unilateral dentition as early as possible after diagnosis has been
posterior crossbite, characterizing the functional recommended. If left untreated can have deleterious
unilateral posterior crossbite.[11] More importantly effects on the development and functions of the
from a clinical perspective, the present study reported a TMJ’s.[20]
relatively high prevalence of crossbite among children
than Miotto et al. in which the prevalence of crossbite CONCLUSION
was of 16.2%.[12] AOB and PC may require professional
assistance during the primary dentition stage in the Many studies were conducted on dental occlusion
form of counseling which may or may not be combined in different communities. Ethnic, behavioral, and
with interceptive orthodontic treatment. Some form of nutritional differences have also been assessed. Our
intervention is often required to prevent dentoskeletal study showed that many malocclusions need to be
alterations and eliminate perpetuating factors that affect treated at early ages such as crossbite, mandibular
swallowing and speech, such as interposition of the functional deviation, and anterior open bite. Special
tongue between the incisors.[13] attention should be paid to occlusion of primary
dentition since timely diagnosis and treatment may
In a study done in Iran, the posterior crossbite obviate future complications. Habits and crossbites
percentage recorded was 2.3 which is comparatively should be diagnosed and, if predicted not likely to

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 D. Shruthi

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12. Miotto MH, Cavalcante WS, Godoy LM, Campos DM,
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2015;15:57-64.
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9. Clinical Affairs Committee Developing Dentition
Subcommittee. Guideline on management of the developing
Source of support: Nil; Conflict of interest: None Declared

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