3.2 Oral Examination

Developmental Anomalies, Delayed Tooth Eruption, and Malocclusion

Malocclusion.

During the extraoral examination, note any craniofacial anomalies or facial asymmetry. Most children with cleft palate/cleft lip are under the care of a multidisciplinary team of health professionals beginning immediately after birth, since treatment consists of a sequence of corrective surgeries and therapies.

Moving intraorally, check for malocclusion in the primary teeth that may create problems in the permanent teeth. Malocclusions occur frequently in children with developmental problems. Hypoplasia of the maxilla, micrognathia, and prognathia are especially prevalent in this population.

Delayed eruption of teeth is seen in children with certain genetic disorders, particularly Down syndrome, and in children with developmental delays that involve the oral musculature. Check the sequence of eruption to determine whether the sequence is normal, and just delayed, or whether there is a more isolated eruption problem.

Note any deviations or morphologic defects in teeth that may be due to growth disturbances, muscle dysfunction, Down syndrome, cleft palate/cleft lip, hypothyroidism, ectodermal dysplasia, or other conditions that are associated with variations in the number, size, and shape of teeth.

Supernumerary teeth as well as fused and geminated teeth may be seen. Anodontia and hypodontia also are associated with genetic disorders and syndromes. Damage to the developing teeth can be caused by laryngoscopy and endotracheal intubation in infants born preterm or who experienced other problems after birth.