Summary

Malocclusion is multifactorial in nature, hereditary, environmental or a combination, can interfere with sucking and eating patterns, as well as breathing habits early in life.

As our key preventive role as oral health care providers, timing matters. Facial proportions become established early. Discussing key pregnancy milestones during dental appointments helps provide patients with valuable and timely information.

The embryo is entirely dependent on maternal nutrient supply. Deficiencies can directly alter gene expression and the embryological process. Nutrition is a foundation determinant of oral-facial development. Key nutrients include folate, (B9), Vitamins A & D, zinc, protein, and antioxidants. A nutrient dense and varied diet will provide optimal maternal nutrition to meet the demand of the growing fetus.

Human genetics and gene expression have contributed to the identification of genetic markers associated with certain skeletal malocclusions and dental malformations. Malocclusion is typically polygenic, involving multiple genes, such as DUSP6 and ADAMTS, causing mandibular prognathism. These gene expressions provide the baseline craniofacial blueprint.

Systemic and lifestyle influences, such as nutrition and feeding patterns, socioeconomic status and access to care, as well as disease, trauma and endocrine disorders, contribute to the severity of malocclusion. The interaction between genetics, which provide the baseline craniofacial blueprint and environmental factors, which modify growth expression, along with timing demonstrates the multifactorial relationship of malocclusion.

Nutritive sucking is an oral sensorimotor process that plays a fundamental role in craniofacial development. Exclusive and prolonged breastfeeding continues to support oral facial growth, development patterns and reduced malocclusion risks.

Non-nutritive sucking habits (NNS) are well established risk factors for malocclusion. Frequency and intensity are the strongest predictors of occlusal changes. Habits persisting beyond ages two to three significantly increases these risk factors.

On demand feeding patterns early in life can positively influence craniofacial structures. Feeding frequency in response to infant cues increases total duration of active suckling, variable oral motor activity and time under functional load, key drivers in craniofacial growth.

Weaning practices are a functional training period for oral musculature at a critical stage in an infant’s development, a gradual, yet critical window period from sucking to chewing and swallowing coordination.

The core principles of baby-led weaning (BLW) encourage infants to self-feed and explore textures, promoting chewing to stimulate the masseter, temporalis and pterygoid muscles. It promotes forward jaw growth, in turn reducing the risk of a retrognathic profile.

The foundations for oral and facial health are built on interacting pillars including biological, behavioral, clinical, environmental, and functional. Patient education and early intervention are critical for the well-being and patient centered outcomes in oral pediatric health.