Should early overjet reduction be recommended to prevent dental trauma?

There is an association between increased overjet and risk of trauma to the maxillary incisor teeth in children and adolescents. It would therefore seem sensible to recommend overjet reduction as early as possible to help reduce this risk.

This article explores the complex association between early overjet reduction and dental trauma in the context of current best evidence.

Traumatic injuries to the dentition are a relatively common problem among children and young adults, with life-long consequences for affected individuals.1 The prevalence of dental trauma, which predominantly affects the maxillary incisor teeth, ranges from 10-12% at ages 15 and 12, respectively, in the UK.2 Global prevalence has been reported at just over 15% in the permanent dentition, with up to 18% of 12-year-olds affected.3 A wide range of risk factors are associated with dental trauma, including: patient sex; increased overjet (particularly with dental protrusion and inadequate lip coverage); anterior open bite; risk-taking children; certain medical disorders, such as epilepsy, cerebral palsy or learning difficulties; social deprivation; obesity; inappropriate use of the teeth; previous dental injury and oral piercings

However, orthodontic outcomes are essentially the same whether you start treatment in the early or late mixed dentition, while early treatment carries a heavier burden on compliance - taking longer and involving more appointments.

Thus, Careful case selection for overjet reduction in the early mixed dentition is advised, focusing on those children with a significant increase in the overjet (>10 mm), excess maxillary incisor tooth show (short upper lip length, gummy smile, significant proclination) and those being teased or bullied at school because of their dental appearance.

Reference:

Cobourne, M., DiBiase, A., Seehra, J. et al. Should we recommend early overjet reduction to prevent dental trauma?. Br Dent J 233, 387–390 (2022). https://doi.org/10.1038/s41415-022-4916-0