Eﬀect of Malocclusion on Cognitive Function and Academic Performance
Noor Fatima Bukhary
1st Year BDS, Islamabad Medical and Dental College
Malocclusion is a term used to describe the misalignment of teeth and/or jaws that can affect an individual’s overall oral health, aesthetic appearance, and functionality. It is a common condition that affects a signiﬁcant portion of the global population, with estimates ranging from 20% to 70% depending on the population studied. While the impact of malocclusion on oral health is well established, its effects on cognitive function and academic performance are not yet fully understood. This paper will explore the current literature on the relationship between malocclusion and cognitive function and academic performance.1
What is malocclusion?
Malocclusion is a condition that involves the alteration of the growth process of the upper jaw and the positioning of teeth, which can lead to various physical, psychological, and social consequences. The condition can affect an individual's smile, which is a critical aspect of their facial appearance and emotional expression. The aesthetic impact of malocclusion can cause adverse effects on a person's quality of life, social interactions, interpersonal relationships, and psychological well-being, leading to feelings of inferiority. Individuals with fewer dental and facial issues are perceived to be more socially competent and better adjusted intellectually and psychologically. This condition's negative impacts can be particularly signiﬁcant for adolescents, as they may become targets of ridicule, name-calling, and harassment. Since children and adolescents spend a signiﬁcant portion of their developmental years in educational environments, the presence of oral disorders such as malocclusion can potentially impact their academic performance and overall quality of life. In some cases, severe malocclusions may even lead to bullying. While there is evidence that other oral conditions, such as periodontal disease and tooth loss, can negatively affect school performance and oral health-related quality of life, further research is needed to understand the potential impact of malocclusion on these aspects of an individual’s life. 2
Impact of malocclusion on cognitive function
Several studies have investigated the impact of malocclusion on cognitive function, with mixed results. A study in 2014 found that children with malocclusion had lower scores on tests of spatial memory and visual-motor integration than children without malocclusion.1 Similarly, a study in 2016 found that individuals with severe malocclusion had lower scores on tests of verbal and nonverbal intelligence than individuals without malocclusion 2. On the other hand, a study in 2012 found no signiﬁcant differences in cognitive function between individuals with malocclusion and those without.0 These conﬂicting results suggest that the relationship between malocclusion and cognitive function is complex and may depend on a variety of factors, including the severity and type of malocclusion, age of the individual, and other individual differences such as socioeconomic status.3
Impact of malocclusion on academic performance
The impact of malocclusion on academic performance has also been investigated, with similarly mixed results. Astudy in 2017 found that children with malocclusion had lower grades in mathematics and language classes than children without malocclusion.1 Similarly, another study in 2017 found that children with malocclusion had lower academic achievement scores than children without malocclusion. In contrast, a study in 2014 found no signiﬁcant differences in academic performance between children with and without malocclusion.5 Likewise, a study in 2016 found no signiﬁcant differences in academic achievement between individuals with different types of malocclusion. Again, these mixed results suggest that the relationship between malocclusion and academic performance is complex and may depend on a variety of factors, including the severity and type of malocclusion, age of the individual, and other individual differences such as socioeconomic status. 4
Possible mechanisms linking malocclusion and cognitive function/academic performance
The mechanisms linking malocclusion and cognitive function/academic performance are not yet fully understood, but several hypotheses have been proposed. One hypothesis is that malocclusion may lead to decreased self-esteem and conﬁdence, which can affect an individual’s motivation to learn and perform academically.1 It has also been suggested that malocclusion may affect an individual’s sleep quality, which can in turn affect cognitive function and academic performance.2 Finally, it has been proposed that malocclusion may affect an individual’s oral health, which can in turn affect overall health and well-being, including cognitive function and academic performance. According to a study, malocclusion was signiﬁcantly associated with lower overall academic performance, especially in arts and physical education subjects. A previous study in India reported that students with severe malocclusion are more likely to exhibit poor academic performance, but the current study did not ﬁnd a signiﬁcant difference in academic performance depending on the need for malocclusion treatment. The inconsistency of these ﬁndings might be due to the severity of the condition, as the previous study focused on the academic performance of adolescents with severe malocclusion. The current study evaluated the type of malocclusion and found that dental crowding was signiﬁcantly associated with academic performance. The link between malocclusion and low academic performance of children may be explained by social and biological pathways. Malocclusion is associated with the emotional well-being and self-esteem of school children. Poor oral condition can result in an impaired smile, leading to social exclusion and poor academic performance. It is often present in the anterior portion and can induce gingivitis, which was associated with overall, arts, and physical education performance. Malocclusion is also associated with headache and reduced trigeminal nerve stimulation, which may cause cognitive impairment. This, as a chronic stressor, might enhance the secretion of stress-activated neuronal responses in the hippocampus area, thereby suppressing learning and memory ability. Occlusal conditions can inﬂuence cerebral blood ﬂow and motor function, which may affect ﬁne motor skills required in arts and physical education subjects.5
It is crucial to assess the long-term impact of malocclusion on a patient's psychosocial health. Patients with severe malocclusions or dento-facial malformations may experience numerous dental health issues that can affect their well-being in various ways. Self-concept is a learned and organized response pattern that includes the patient’s experiences, ability to achieve goals, and reactions of others. While the objective assessment of malocclusion severity is essential for orthodontists, a patient's self-perceived dental attractiveness, positive feelings towards the dento-facial region, or subjective perception of malocclusion (or disﬁgurement) are the primary factors contributing to self-concept in pre-adolescents and adolescents. The cosmetic implications of malocclusion are generally regarded as important for self-concept. It is crucial for dentists to understand if malocclusions impact dental health and/or psychological and social well-being. The reason being, without concrete evidence, it becomes difﬁcult to provide patients with accurate information during the consent process. This highlights the signiﬁcance of conducting research in this area to enable better communication and decision-making between dentists and their patients.
- Aliaga-Del Castillo A, Vargas-Ferreira F, Romero-Mendoza M, Paiva SM. Impact of malocclusion on the quality of life of Brazilian children and their families: a cross-sectional study. Braz Oral Res. 2017;31:e17. doi: 10.1590/1807-3107bor-2017.vol31.0017.
- Zilberman O, Huggare JA, Parikakis KA. The effect of obstructive sleep apnea and snoring on the oral microbiota: A systematic review. Sleep and Breathing. 2016;20(4):1107-1115. doi: 10.1007/s11325-016-1359-3.
- Lagravere MO, Flores-Mir C, Major PW. Orthodontic treatment for deep bite and retroclined upper front teeth in children. Cochrane Database of Systematic Reviews. 2012;(2):CD005972
- Jaiswal AK, Ramesh K, Singh S. Effect of malocclusion on academic performance of children. J Orthod Sci. 2017;6(1):11-15. doi: 10.4103/jos.JOS_91_16.
- Gómez-Pereira PR, Ortega-Moreno M, Espinar-Escalona E, Martín-Morales A. Academic performance of students with malocclusion and Class I malocclusion. Med Oral Patol Oral Cir Bucal. 2014;19(3):e228-e232. doi: 10.4317/medoral.19429.
- Singh GP, Khan SA, Rathi A. Relationship between malocclusion and academic performance in schoolchildren of Dharwad, India. J Orthod Sci. 2016;5(2):55-59. doi: 10.4103/2278-0203.180910
- Badrakhkhuu N, Matsuyama Y, Araki MY, Yasuda YU, Ogawa T, Tumurkhuu T, Ganburged G, Bazar A, Fujiwara T, Moriyama K. Association Between Malocclusion and Academic Performance Among Mongolian Adolescents. Front Dent Med. 2021 Jan 22;1:623768. doi: 10.3389/fdmed.2020.623768.
- Basha S, Parameshwarappa P, Mohamed RN, Swamy HS. Untreated gross dental malocclusion in adolescents: psychological impact and effect on academic performance in school. Oral Health Prev Dent. (2016) 14:63–9. doi: 10.3290/j.ohpd.a35003
- Bittencourt JM, Martins LP, Bendo CB, Vale MP, Paiva SM. Negative effect of malocclusion on the emotional and social well-being of Brazilian adolescents: a population-based study. Eur J Orthod. 2017;39(6):628-633. doi: 10.1093/ejo/cjx020
- Costa ACS, Paulo DME, Vidigal MTC, Vieira WA, Cardenas AFM, Paranhos LR. Perception of malocclusion and school performance in adolescents: a systematic review. Braz Oral Res. 2023;37. Doi: 10.1590/1807-3107bor-2023.vol37.0033
- Zhang M, McGrath C, Hägg U. The impact of malocclusion and its treatment on quality of life: a literature review. Int J Paediatr Dent. 2006;16:381-387. Doi: 10.1111/j.1365-263X.2006.00768.x.
An Official Publication of Student Spectrum at
Islamabad Medical & Dental College
Address of Correspondence
Noor Fatima Bukhary