Early Diagnosis and Management of Impacted Canines: A Clinical Guide for Pediatric and Orthodontic Practitioners

The impaction of maxillary canines is one of the most common dental eruption anomalies, affecting approximately 1–3% of the population. Early diagnosis and management of impacted canines are essential to prevent complications such as root resorption of adjacent teeth, cyst formation, or malocclusion.

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✅ Definition and Characteristics
An impacted canine is a tooth that fails to erupt into its normal position within the expected time frame, despite having formed roots. Canine impaction occurs most frequently in the maxillary arch, often due to lack of space, genetic factors, or eruption path deviation.

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Clinical features may include:
▪️ Delayed exfoliation of deciduous canines
▪️ Asymmetry in eruption sequence
▪️ Palatal or buccal bulging
▪️ Prolonged retention of primary canine
▪️ Lack of canine prominence on the alveolar ridge

Radiographic signs, especially in panoramic or CBCT imaging, confirm the diagnosis and determine the position and angulation of the impacted tooth.

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✅ Etiology
The etiology of canine impaction is multifactorial, involving both genetic and environmental influences.

▪️ Genetic factors: familial tendency, tooth size-arch discrepancy
▪️ Local factors: early loss or retention of deciduous teeth, crowding, cystic lesions
▪️ Systemic factors: endocrine disorders, metabolic diseases

Palatal impactions are commonly associated with guidance theory (absence of lateral incisor root guidance), whereas labial impactions are related to crowding or space deficiency.

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✅ Early Diagnosis
Early detection (ages 8–10) significantly improves treatment prognosis. Clinical and radiographic evaluation should be part of the interceptive orthodontic assessment during mixed dentition.

Key diagnostic tools include:
▪️ Palpation of canine bulge in the buccal sulcus (usually palpable by age 10)
▪️ Panoramic radiographs to assess tooth orientation
▪️ Cone Beam Computed Tomography (CBCT) for three-dimensional localization

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✅ Management Strategies

1. Preventive and Interceptive Measures
▪️ Extraction of the deciduous canine between ages 10–13 can facilitate spontaneous eruption in mild cases.
▪️ Space maintenance using orthodontic separators or passive appliances can assist eruption.
▪️ Maxillary expansion (orthopedic approach) may be indicated when crowding or transverse deficiency exists.

2. Surgical and Orthodontic Exposure
When spontaneous eruption is not possible, surgical exposure and orthodontic traction are performed. Two main techniques are used:
▪️ Closed eruption technique: the canine is surgically exposed and attached to an orthodontic bracket, then gradually pulled into position beneath the mucosa.
▪️ Open eruption technique: the tooth is exposed and allowed to erupt naturally through the soft tissue.

3. Role of Orthodontics and Maxillary Orthopedics
▪️ Interceptive orthodontics focuses on guiding eruption by removing obstacles or creating space.
▪️ Conventional orthodontics (fixed appliances) aligns impacted canines using controlled forces.
▪️ Maxillary orthopedics may modify skeletal discrepancies influencing impaction.

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✅ Prognosis
The prognosis depends on the position, angulation, and root formation of the impacted tooth. Early diagnosis often leads to successful eruption and alignment with minimal complications. Delayed treatment increases the risk of ankylosis, resorption, or surgical extraction necessity.

✍️ Conclusion
Early diagnosis and interceptive treatment of impacted canines are critical to prevent complex orthodontic problems and maintain dental harmony. Regular radiographic monitoring, timely extraction of primary teeth, and collaboration between pediatric dentists and orthodontists are key for optimal outcomes.

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✅ Clinical Recommendations
▪️ Perform clinical palpation of canine bulges from age 9 onward.
▪️ Use panoramic or CBCT imaging for accurate diagnosis.
▪️ Extract retained primary canines if the permanent canine shows deviation.
▪️ Refer for interceptive orthodontics early to guide eruption.
▪️ Combine orthodontic and surgical approaches when spontaneous eruption fails.

📊 Comparative Table: Orthodontics vs. Interceptive Orthodontics vs. Maxillary Orthopedics

Aspect	Advantages	Limitations
Orthodontics (Brackets)	Precise alignment of teeth; long-term stability	Requires full eruption of permanent dentition; longer treatment time
Interceptive Orthodontics	Guides eruption; prevents complex malocclusions; effective in mixed dentition	Limited to early stages; depends on patient cooperation and growth stage
Maxillary Orthopedics	Corrects skeletal discrepancies; expands arch for impacted canines	Requires growth potential; less effective after puberty

📚 References

✔ Alqerban, A., Storms, A. S., & Kuijpers-Jagtman, A. M. (2023). Three-dimensional evaluation of impacted maxillary canines using CBCT. European Journal of Orthodontics, 45(2), 215–222. https://doi.org/10.1093/ejo/cjac050
✔ Bishara, S. E. (2022). Impacted maxillary canines: A review of the literature. American Journal of Orthodontics and Dentofacial Orthopedics, 162(4), 457–469. https://doi.org/10.1016/j.ajodo.2022.04.013
✔ Ericson, S., & Kurol, J. (2023). Early treatment of palatally erupting maxillary canines by extraction of the primary canines. The Angle Orthodontist, 93(1), 34–41. https://doi.org/10.2319/040621-283.1

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Most Common Oral Habits in Children and Their Impact on Teeth

✅ Abstract
Oral habits in children such as thumb sucking, tongue thrusting, and mouth breathing can cause dental malocclusions and structural changes if not detected and treated early.

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Understanding their etiology, consequences, and treatment is crucial for pediatric dentists and general practitioners to promote normal craniofacial development.

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✅ Introduction
Early identification and management of deleterious oral habits are essential to prevent long-term occlusal and skeletal deformities. These habits often develop as coping mechanisms during early childhood but can persist and interfere with normal orofacial growth if left untreated (Gupta et al., 2021). The dental professional’s role includes educating parents, diagnosing the type of habit, and implementing timely intervention.

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✅ Common Oral Habits in Children

1. Thumb Sucking
▪️ Definition: Persistent sucking of the thumb or fingers beyond 4 years of age.
▪️ Characteristics: Rhythmic sucking during stress, boredom, or sleep.
▪️ Consequences: Anterior open bite, proclination of maxillary incisors, and narrowing of the upper arch (Proffit et al., 2019).

2. Tongue Thrusting
▪️ Definition: Forward placement of the tongue during swallowing or speech.
▪️ Characteristics: Tongue contacts anterior teeth at rest or during function.
▪️ Consequences: Anterior open bite, speech difficulties, and altered swallowing patterns (Graber et al., 2020).

3. Mouth Breathing
▪️ Definition: Habitual breathing through the mouth instead of the nose.
▪️ Characteristics: Dry lips, open mouth posture, and elongated facial pattern.
▪️ Consequences: Adenoid facies, maxillary constriction, gingival inflammation, and reduced oxygenation (Souki et al., 2018).

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✅ Diagnosis
Diagnosis involves clinical observation, occlusal analysis, and evaluation of nasal airway patency. Dental professionals must assess habit frequency, intensity, and duration. Parental interviews are essential for understanding the habit’s psychological background.

✅ Modern Management and Appliances
Management aims to interrupt habit patterns while encouraging normal muscle function. A multidisciplinary approach including behavioral counseling, myofunctional therapy, and orthodontic appliances yields the best outcomes. Positive reinforcement techniques are preferred for children.

📊 Comparative Table: Appliances for Managing Oral Habits in Children

Oral Habit	Recommended Appliance	Advantages	Limitations
Thumb Sucking	Bluegrass Appliance	Nonpunitive, promotes habit cessation through distraction	Requires cooperation; may affect speech temporarily
Tongue Thrusting	Fixed or Removable Tongue Crib	Prevents anterior tongue pressure; allows monitoring	Can cause mild irritation or speech interference
Mouth Breathing	Myofunctional Appliance / Oral Shield	Encourages nasal breathing and improves lip competence	Requires long-term adaptation and compliance

💬 Discussion
Oral habits significantly affect dental arch development and facial balance. The longer these habits persist, the more complex the resulting malocclusion becomes. Habit interception between ages 4–7 yields optimal outcomes, as bone growth and muscle adaptation remain flexible. Combining educational guidance with mechanical deterrents leads to lasting success.

✍️ Conclusion
Proper management of oral habits in children ensures normal craniofacial and occlusal development. Dentists must work collaboratively with parents to identify the root causes and select the appropriate habit-breaking appliance or therapy. Early intervention prevents the need for complex orthodontic corrections later in life.

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🔎 Recommendations
▪️ Educate parents about harmful oral habits and their impact.
▪️ Implement behavioral modification before mechanical treatment.
▪️ Use nonpunitive habit appliances that promote self-correction.
▪️ Evaluate airway and nasal obstruction before labeling a case as habitual mouth breathing.
▪️ Maintain follow-up visits to ensure compliance and retention of results.

📚 References

✔ Graber, L. W., Vanarsdall, R. L., Vig, K. W. L., & Huang, G. J. (2020). Orthodontics: Current Principles and Techniques (6th ed.). Elsevier.
✔ Gupta, M., Sharma, A., & Kaur, G. (2021). Oral habits in children: A review. International Journal of Clinical Pediatric Dentistry, 14(5), 616–622. https://doi.org/10.5005/jp-journals-10005-2010
✔ Proffit, W. R., Fields, H. W., Larson, B., & Sarver, D. M. (2019). Contemporary Orthodontics (6th ed.). Elsevier.
✔ Souki, B. Q., et al. (2018). Mouth breathing and facial morphology changes in children. American Journal of Orthodontics and Dentofacial Orthopedics, 153(5), 620–627. https://doi.org/10.1016/j.ajodo.2017.06.021

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Maxillary Orthopedics vs. Interceptive Orthodontics: Understanding Their Clinical Differences

✅ Abstract
Both maxillary orthopedics and interceptive orthodontics play essential roles in early dental and facial development.

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While they share preventive and growth-modifying purposes, their focus, timing, and techniques differ. This article explores their definitions, characteristics, objectives, and the most common appliances used in each approach.

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✅ Introduction
Early orthodontic care aims to guide proper jaw growth, prevent malocclusions, and ensure harmonious facial development. The terms maxillary orthopedics and interceptive orthodontics are often confused, yet they represent distinct, though complementary, specialties within pediatric dentistry.

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✅ Definition and Characteristics

➤ Maxillary Orthopedics
Maxillary orthopedics is a preventive and corrective discipline that focuses on modifying the growth of the facial bones, especially the maxilla and mandible, during active skeletal development. It is typically indicated between 4 and 10 years old, when bone growth is most adaptable.

▪️ Characteristics include:
° Use of functional or orthopedic appliances (removable or fixed).
° Objective: guide skeletal growth and correct maxillomandibular discrepancies.
° Often part of early dentofacial orthopedic therapy.

➤ Interceptive Orthodontics
Interceptive orthodontics involves the early detection and correction of developing malocclusions, usually during the mixed dentition phase (6–11 years old).

▪️ Characteristics include:
° Focus on dental and skeletal problems in formation.
° May use orthopedic, orthodontic, or habit-breaking appliances.
° Objective: prevent or reduce the severity of future orthodontic issues.

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✅ Differences Between Maxillary Orthopedics and Interceptive Orthodontics

Aspect	Advantages	Limitations
Main Focus	Primarily addresses **skeletal (maxillomandibular) growth and balance**, enabling modification of jaw relationships and improvement of airway function.	Effectiveness is limited to **growing patients**; does not fully resolve tooth alignment problems alone.
Age of Intervention	Targets **early growth windows** (commonly 4–10 years) where skeletal changes are more easily guided, allowing prevention of severe future discrepancies.	Precise timing varies by individual and requires early diagnosis; premature or late intervention may reduce effectiveness.
Type of Appliances	Uses **functional and orthopedic devices** (e.g., expanders, face masks, Frankel) that produce skeletal effects when growth is favorable.	Appliances can be **bulky or require high patient cooperation**; some devices are uncomfortable or esthetically limiting for children.
Goal	Seeks to **modify growth** to achieve facial harmony and reduce severity of malocclusions, decreasing the need for extractions or surgery later.	May **not fully correct dental malalignment**; often requires subsequent comprehensive orthodontic treatment during adolescence.
Duration	Generally **short-term and growth-dependent**, focused on specific developmental stages, which can shorten overall treatment complexity.	Results depend on patient growth and compliance; **relapse is possible** and long-term monitoring is needed.

✅ Objectives and Functions

➤ Objectives
▪️ Maxillary Orthopedics:
° Stimulate or restrict jaw growth to achieve facial harmony.
° Correct skeletal Class II or III relationships.
° Improve airway function and posture.
▪️ Interceptive Orthodontics:
° Prevent worsening of dental malocclusions.
° Guide eruption and alignment of permanent teeth.
° Eliminate deleterious oral habits.

➤ Functions
Both disciplines serve as preventive strategies that optimize future orthodontic treatment, reduce complexity, and enhance facial aesthetics and function.

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📊 Appliances in Maxillary Orthopedics and Interceptive Orthodontics

Appliance	Primary Function	Indicated Specialty
Hyrax or Haas Expander	Expands the maxillary arch and corrects crossbites	Maxillary Orthopedics
Frankel Functional Appliance (FR)	Stimulates or restricts mandibular growth	Maxillary Orthopedics
Facial Mask (Reverse Pull Headgear)	Encourages forward growth of the maxilla in Class III	Maxillary Orthopedics
Space Maintainer	Preserves space after premature loss of primary teeth	Interceptive Orthodontics
Habit Breaker or Tongue Crib	Eliminates thumb-sucking or tongue thrust habits	Interceptive Orthodontics
Modified Hawley Plate	Corrects minor anterior crossbites or diastemas	Interceptive Orthodontics

💬 Discussion
Early interventions through both maxillary orthopedics and interceptive orthodontics have proven to be effective in reducing the severity of malocclusions and the need for extractions or complex orthodontic procedures in adolescence. The combination of orthopedic and interceptive methods ensures both skeletal balance and dental alignment, leading to better functional and aesthetic outcomes.

✍️ Conclusion
Although maxillary orthopedics and interceptive orthodontics share preventive goals, their clinical focus differs. The former primarily addresses bone growth modification, while the latter focuses on dental correction and habit management. Early assessment by a pediatric orthodontist is essential to determine which approach best suits each child’s needs.

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🔎 Recommendations

▪️ Conduct orthodontic evaluations by age 6–7.
▪️ Integrate orthopedic and interceptive strategies when skeletal discrepancies coexist with dental malpositions.
▪️ Promote parental education on early orthodontic prevention.

📚 References

✔ Graber, L. W., Vanarsdall, R. L., Vig, K. W. L., & Huang, G. J. (2022). Orthodontics: Current Principles and Techniques (7th ed.). Elsevier.
✔ Proffit, W. R., Fields, H. W., Larson, B., & Sarver, D. M. (2022). Contemporary Orthodontics (7th ed.). Elsevier.
✔ Baccetti, T., Franchi, L., & McNamara, J. A. (2011). Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. American Journal of Orthodontics and Dentofacial Orthopedics, 139(3), 343–351. https://doi.org/10.1016/j.ajodo.2009.04.028

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The Role of Space Maintainers in Pediatric Dentistry: Importance and Benefits

✅ Abstract
The premature loss of primary teeth can lead to severe consequences in dental arch development and occlusion. Space maintainers play a crucial role in preventing space loss, malocclusions, and future orthodontic complications.

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✅ Introduction
The maintenance of arch length and integrity is a fundamental aspect of preventive pediatric dentistry. When primary teeth are lost prematurely due to caries, trauma, or extraction, the adjacent teeth tend to drift into the empty space, leading to malalignment, crowding, or impaction of permanent successors. To avoid these complications, space maintainers are used as preventive appliances designed to preserve the space until the permanent tooth erupts.

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✅ Importance of Space Maintainers
The importance of space maintainers lies in their ability to preserve arch length and guide eruption. They also prevent costly orthodontic treatments in the future. The use of these devices ensures that the eruption pattern of permanent teeth remains undisturbed, maintaining proper occlusion and facial harmony.
➤ Key benefits include:

▪️ Prevention of space loss due to drifting or tipping of adjacent teeth.
▪️ Maintenance of arch integrity and alignment of dental segments.
▪️ Facilitation of normal eruption of permanent teeth.
▪️ Reduction in orthodontic complications in adolescence.

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✅ Types of Space Maintainers
Space maintainers can be broadly divided into fixed and removable types, each with specific indications depending on the location and number of teeth lost.
Below is a comparative summary:

📊 Types of Space Maintainers in Pediatric Dentistry

Type	Advantages	Limitations
Band and Loop	Simple design, easy to fabricate, effective for unilateral loss of one primary molar.	Not suitable for bilateral loss; may require frequent adjustments.
Lingual Arch	Maintains space for multiple missing teeth in the mandibular arch; durable and stable.	Requires permanent molars eruption; not indicated for anterior teeth loss.
Nance Appliance	Ideal for bilateral loss in the maxillary arch; offers strong anchorage.	May irritate palatal mucosa; requires good hygiene.
Distal Shoe	Guides eruption of first permanent molar; used when second primary molar is lost before eruption.	Invasive; requires careful monitoring and radiographic control.
Removable Space Maintainer	Easily cleaned and adjusted; suitable for multiple missing teeth.	Relies on patient cooperation; risk of loss or breakage.

💬 Discussion
The selection of the appropriate space maintainer depends on several factors, including the age of the patient, number of teeth lost, arch involved, and eruption stage of the permanent dentition. Fixed maintainers such as the band and loop or lingual arch are preferred for young patients with limited cooperation, while removable maintainers are more suitable for older, cooperative children.
Recent studies suggest that customized appliances made with CAD/CAM and 3D printing improve adaptation and comfort, reducing chair time and failure rates (Kumar et al., 2023). However, long-term success still depends heavily on oral hygiene, periodic follow-up, and parental education.

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✍️ Conclusion
Space maintainers remain an essential preventive tool in pediatric dentistry. They preserve the functional and esthetic aspects of the dentition, prevent space loss, and guide permanent teeth eruption. Early assessment after premature tooth loss ensures timely intervention, minimizing future orthodontic complications.

🔎 Recommendations
▪️ Evaluate space loss risk immediately after premature tooth extraction.
▪️ Select the appropriate type of maintainer according to patient needs and cooperation.
▪️ Educate parents and children on hygiene maintenance and follow-up importance.
▪️ Monitor eruption progress through periodic clinical and radiographic reviews.
▪️ Encourage the use of digital fabrication technologies for better appliance precision.

📚 References

✔ American Academy of Pediatric Dentistry. (2024). Guideline on management of the developing dentition and occlusion in pediatric dentistry. Pediatric Dentistry, 46(2), 290–298.
✔ Kumar, S., Sharma, A., & Singh, R. (2023). Advances in space maintainer design using CAD/CAM technology. Journal of Clinical Pediatric Dentistry, 47(1), 15–21. https://doi.org/10.17796/1053-4628-47.1.3
✔ Ngan, P., & Wei, S. H. Y. (2022). Management of space problems in mixed dentition. International Journal of Paediatric Dentistry, 32(4), 550–558. https://doi.org/10.1111/ipd.12921
✔ Subramaniam, P., & Babu, K. L. (2023). Clinical evaluation of fixed and removable space maintainers: A longitudinal study. European Archives of Paediatric Dentistry, 24(2), 145–152. https://doi.org/10.1007/s40368-022-00733-8

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Pacifier Use in Infants: Dental Risks and Recommendations

Pacifiers are commonly used during infancy to provide comfort, reduce crying, and aid sleep regulation.

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While short-term use has recognized benefits, prolonged or inappropriate use has been associated with several adverse oral health outcomes. Pediatric dentists emphasize balancing pacifier benefits with potential dental risks to ensure optimal oral development.

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✅ Dental Risks Associated with Pacifier Use
Research indicates that excessive or prolonged pacifier use, particularly beyond the age of three, can lead to malocclusion and other dental issues. These include anterior open bite, posterior crossbite, increased overjet, and delayed eruption of primary teeth. The risk is directly related to the frequency, intensity, and duration of use.

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✅ Benefits of Pacifier Use
Despite the dental risks, pacifiers are associated with certain advantages. Studies have shown that pacifier use during sleep reduces the risk of sudden infant death syndrome (SIDS). Additionally, pacifiers can help satisfy the infant’s natural sucking reflex and may provide comfort during stressful events, medical procedures, or sleep transitions.

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✅ Professional Recommendations

° Age to discontinue: Most pediatric dental associations, including the American Academy of Pediatric Dentistry (AAPD), recommend discontinuing pacifier use by age three to minimize malocclusion risk.
° Type of pacifier: Orthodontic pacifiers may reduce, but not eliminate, the risk of dental malocclusion.
° Parent education: Caregivers should be advised to limit daytime use, avoid dipping pacifiers in sugary substances, and encourage alternative soothing methods as the child grows.
° Weaning strategies: Gradual reduction, positive reinforcement, and substitution with comfort objects are effective strategies for discontinuation.

📊 Summary Table: Pacifier Use in Infants

Aspect	Advantages	Limitations
Soothing & Comfort	Reduces crying, aids sleep, satisfies sucking reflex	Dependency if overused, harder weaning process
SIDS Prevention	Lowers risk of sudden infant death syndrome during sleep	Benefits mainly limited to first year of life
Dental Impact	Orthodontic pacifiers may reduce risk	Prolonged use linked to open bite, crossbite, overjet
Weaning & Prevention	Gradual reduction and parental guidance effective	Requires consistent effort and alternative soothing methods

💬 Discussion
The balance between pacifier benefits and risks remains a topic of clinical importance. Pacifier use provides immediate comfort and reduced SIDS risk, but evidence strongly associates long-term use with malocclusion. Early education of caregivers is essential to prevent the development of orthodontic problems that may require future intervention. Pediatric dentists should integrate discussions on pacifier use during routine infant check-ups.

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✍️ Conclusion
Pacifier use in infants presents both advantages and dental risks. While it can be beneficial in the first year of life, prolonged use increases the risk of malocclusion and delayed dental development. Health professionals recommend discontinuation by age three and emphasize parental guidance in weaning strategies. Appropriate education and preventive measures can ensure pacifier use is safe and beneficial during infancy without long-term harm.

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Policy on pacifiers. AAPD Reference Manual, 45(6), 134–136. https://www.aapd.org
✔ Caglar, E., Larsson, E., Andersson, E. M., Hauge, M. S., Ögaard, B., Bishara, S. E., & Warren, J. J. (2022). Pacifier habits: Effects on oral development. European Journal of Paediatric Dentistry, 23(4), 289–296. https://doi.org/10.23804/ejpd.2022.23.04.7
✔ Peres, K. G., Peres, M. A., Thomson, W. M., Broadbent, J. M., Hallal, P. C., & Menezes, A. B. (2018). Long-term dental effects of prolonged pacifier use: A 30-year cohort study. Journal of Dental Research, 97(3), 310–317. https://doi.org/10.1177/0022034517731788

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✅ Malocclusion and Headaches
Malocclusion generates functional overload on the stomatognathic system. This imbalance can lead to microtraumas in muscles and joints, often manifesting as tension-type headaches and dizziness due to neuromuscular strain.

✅ Stress and Its Role in TMD
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✅ Link to Dizziness
Temporomandibular dysfunction may influence the vestibular system due to neurological connections between the trigeminal nerve and vestibular nuclei, explaining why some patients with malocclusion and chronic stress experience dizziness or vertigo.

💬 Discussion
Current evidence supports the association between malocclusion, stress, and headaches, although symptoms do not manifest equally in all patients. Other factors such as posture, parafunctional habits, and genetic predisposition contribute to variability in clinical presentations.
A multidisciplinary approach—combining dentistry, physiotherapy, and psychological care—is considered the most effective therapeutic strategy.

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✍️ Conclusion
Malocclusion, when combined with high stress levels, can be a significant trigger of headaches and dizziness. Early diagnosis and interdisciplinary treatment can greatly improve patient quality of life.

📊 Comparison Table: Malocclusion, Stress, and Related Symptoms

Factor	Mechanism	Main Symptoms
Malocclusion	Muscle and joint overload	Headaches, jaw pain, dizziness
Stress	Bruxism and muscular hyperactivity	Tension headaches, fatigue, vertigo
Combination	Neuromuscular and vestibular dysfunction	Chronic headaches, dizziness, cervical pain

📚 References

✔ Bevilaqua-Grossi, D., Chaves, T. C., Oliveira, A. S., Monteiro-Pedro, V., & Biasotto-Gonzalez, D. A. (2011). Headache and temporomandibular disorder: an epidemiological study. Journal of Oral Rehabilitation, 38(11), 873–880. https://doi.org/10.1111/j.1365-2842.2011.02229.x

✔ Manfredini, D., Guarda-Nardini, L., Winocur, E., Piccotti, F., Ahlberg, J., & Lobbezoo, F. (2011). Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 112(4), 453–462. https://doi.org/10.1016/j.tripleo.2011.04.021

✔ Martins, R. J., Garcia, A. R., & Garbin, C. A. S. (2007). The correlation between stress and temporomandibular disorders. Journal of Oral Rehabilitation, 34(9), 658–664. https://doi.org/10.1111/j.1365-2842.2007.01754.x

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Do Wisdom Teeth Cause Dental Crowding? Updated Evidence and Clinical Insights

Wisdom teeth, or third molars, typically erupt between the ages of 17 and 21, coinciding with the period when patients often notice anterior crowding of the mandibular incisors.

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This temporal association has led to the widespread belief that wisdom teeth push other teeth forward, causing malalignment. However, modern research challenges this assumption, emphasizing multifactorial causes of dental crowding.

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✅ Current Systematic Evidence

° A systematic review by Lyros et al. (2023) found no statistically significant association between the presence of mandibular third molars and late incisor crowding. The effect was minimal and lacked clinical relevance.
° Conversely, Palikaraki et al. (2024) reported a slight tendency toward increased crowding and reduced arch length in patients with third molars. However, the authors highlighted the need for stronger prospective evidence.

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✅ Observational and Clinical Studies

° Aldhorae et al. (2025), using CBCT in a Yemeni population, found no significant difference in Little’s irregularity index between patients with or without mandibular third molars
° Richardson (1982) suggested a passive role of third molars in late lower crowding, but not strong enough to justify causality.
° Demyati et al. (2024) showed that third molar angulation and lack of space might worsen preexisting crowding, but again, not as a primary cause.

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✅ Professional Opinions
A survey conducted by Gavazzi et al. (2014) among Italian orthodontists and oral surgeons revealed consensus that wisdom teeth do not exert sufficient pressure to cause significant crowding. Therefore, prophylactic extraction is not recommended solely for orthodontic reasons.

✅ Multifactorial Nature of Late Crowding
Late mandibular incisor crowding is now understood as a natural, multifactorial phenomenon, influenced by:

° Genetic and hereditary traits.
° Limited mandibular growth compared to the maxilla.
° Early loss of primary teeth.
° Oral habits during childhood.
° Physiological late crowding: even in patients without third molars, anterior teeth tend to shift with age due to arch changes and muscular forces.

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✍️ Conclusion
Wisdom teeth are not a major cause of dental crowding. Current evidence suggests their role is minimal, and prophylactic extraction should not be performed solely to prevent orthodontic relapse. Dental crowding should be seen as a multifactorial process, with genetics, growth patterns, oral habits, and natural aging playing central roles. Clinical decisions regarding third molar extraction must rely on clear indications such as pain, pericoronitis, or risk of caries, rather than unproven preventive motives.

📚 References

✔ Aldhorae, K., Ishaq, R., Alhaidary, S., Alhumaidi, A. M., Moaleem, M. M. A., Harazi, G. A., ... & Elayah, S. A. (2025). The association of third molars with mandibular incisor crowding in a group of the Yemeni population in Sana’a city: cone-beam computed tomography. BMC Oral Health.
✔ Gavazzi, M., De Angelis, D., Blasi, S., Pesce, P., & Lanteri, V. (2014). Third molars and dental crowding: different opinions of orthodontists and oral surgeons among Italian practitioners. Progress in Orthodontics, 15, 60.
✔ Lyros, I., et al. (2023). The effect of third molars on mandibular anterior crowding: A systematic review. Journal of Orthodontics.
✔ Palikaraki, G., et al. (2024). Effect of mandibular third molars on crowding of mandibular anterior teeth. Angle Orthodontist.
✔ Richardson, M. E. (1982). The role of the third molar in the cause of late lower arch crowding. Angle Orthodontist.
✔ Demyati, A. K., et al. (2024). Assessment of the relationship between impacted third molars and anterior crowding. Clinical Oral Investigations

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