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The Consequences of Crowding

By Craig Smith
December 8, 2016

Your need to be concerned about crowding because it affects more than just your smile. It can affect your health in three ways: it can increase risk of periodontal disease, affect systemic health, and result in improper bite forces.

Increased risk of periodontal disease

Upload: December 1, 2016Periodontitis is prevalent in the American population. A recent CDC report states that 47.2% of adults aged 30 years and older have some degree of periodontal disease. The risk of this condition increases with age: 70.1% of adults 65 years of age and older have periodontal disease.

Although there are no statistics about the percentage of these cases of periodontitis that are caused by crowding, studies have shown there is a correlation.

  • Anterior crowding was found to be an independent risk factor for the presence of the chronic inflammatory processes that lead to periodontitis.
  • Supragingival plaque accumulation was significantly greater in crowded regions than in non-crowded regions in adult patients. In addition, the bacterial species were more numerous in crowded-region samples than samples from non-crowded regions.
  • Even after adjusting for other known risk factors, such as smoking and poor oral hygiene, occlusal discrepancies are shown to be an independent risk factor contributing to periodontal disease.
  • Poorly aligned teeth can also affect the oral health of children. A recent systematic review showed a clear association between malocclusion and poor oral health-related quality of life for children.
Impact on systemic health

The presence of dental plaque may affect more than just the teeth, bone, and soft tissue in the mouth.

  • Bacteria can form a film underneath the gums and get trapped in pockets, especially around misaligned teeth.
  • Gingiva, connective tissue, and blood vessels can become inflamed.
  • The immune system produces white blood cells to fight this inflammation.
  • This whole cascade of reactions may increase the risk of systemic conditions.
Improper dental forces

Crowding and other types of malocclusion can affect the forces exerted in the mouth. Increased pressure can affect both hard and soft tissues, which can result in difficulty chewing, increased mobility of teeth, abnormal wear, tooth pain, temporomandibular joint dysfunction, periodontal bone loss, fractures, and gingival recession.

Identify the cause

By recognizing crowding and discussing the consequences and potential solutions such as Invisalign® therapy, you can avoid the issues associated with this common condition.


  • Periodontal disease. Centers for Disease Control: Division of Oral Health National Center for Chronic Disease Prevention and Health Promotion. disease/ Updated March 10, 2015. Accessed October 25, 2016.
  • Staufer K, Landmesser H. Effects of crowding in the lower anterior segment — a risk evaluation depending upon the degree of crowding. J Orofac Orthop. 2004;65(1):12–25.
  • Chung CH, Vanarsdall RL, Cavalcant EA, et al. Comparison of microbial composition in the subgingival plaque of adult crowded versus non-crowded dental regions. Int J Adult Orthodon. Orthognath Surg. 2000;15(4):321–330.
  • Nunn, ME, Harrel SK. The effect of occlusal discrepancies on periodontitis. I. Relationship of initial occlusal discrepancies to initial clinical parameters. J Periodontol. 2001;72(4):485-494.
  • Kragt L, Dhamo B, Wolvius EB, et al. The impact of malocclusions on oral health-related quality of life in children — a systematic review and meta-analysis. Clin Oral Investig. 2016;20(8):1881–1894.
  • Geiger AM. Malocclusion as an etiologic factor in periodontal disease: a retrospective essay. Am J Orthod Dentofacial Orthop. 2001;120(2):112–115.
  • Cullinan MP, Ford PJ, Seymour GJ. Periodontal disease and systemic health: current status. Austr Dental J. 2009;54(1 Suppl):S62–S69.
  • Harrel SK. Oral health begins with tooth alignment. Dimensions Dent Hygiene. 2011;9(4):64–71.
  • Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134(2):220–225.

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