A. McKeever 1 drift, facilitated by interproximal and occlusal/incisal attrition. 13 Older adults in these well-occluded populations therefore typically exhibit what would clinically be described as heavily worn Class III edge-to- edge malocclusions with a slight tendency towards posterior crossbites. Crucially, con- ventional features of Class II malocclusion such as overbite and overjet are almost always entirely absent. This and the obser- vation that these individuals also exhibit larger mandibular dimensions 14 presum- ably through greater functional demands on the masticatory apparatusprovide the basis for the environment argument. The fndings of Normando etal. 15 are therefore very interesting and appear contrary to the current thinking. DISCUSSION It is unfortunate, however, that the exam- ple provided by the author shows an indi- vidual with tooth substance loss more characteristic of chemical erosion, rather than attritional wear as exemplifed in Figure1 (from my own as yet unpublished research on a 16th century New Mexican population). Furthermore, Normandos own research described a two-centre cross- sectional study where the mean ages of the study subjects were too young to assess the effects or otherwise of attritional wear (12.5 and 10.2 years). The main fndings of the paper appear to be statistically sig- nifcant increases in anterior open bites and Class III malocclusions in the inbred population, which would indeed support INTRODUCTION The question of genetics versus environ- ment as it relates to the aetiology of mal- occlusion is a signifcant one, yet there is too often a tendency to bring together distinct clinical entities, which may have different aetiologies, to construct an argu- ment. This evidence-based overview aims to breathe new life into the debate on the phylogenesis of malocclusion through a more open-minded and careful interpreta- tion of the facts. CROWDING WITH TOOTH WEAR D. Normando writes that a study of iso- lated Amazonian communities shows that genetics is more important than environ- ment in the aetiology of malocclusion and considers an individual with crowding in the presence of wear. 1 Most of the evidence on occlusal variation in either historical civilisations 2-8 or in modern pre-industrial populations 9-12 demonstrates that the prev- alence of malocclusion in these groups is very low and usually coupled with high levels of attritive tooth wear. Tooth wear is an important element in this discussion, as it is posited that once a Class I occlu- sion is established during childhood, it is maintained by a process of gradual mesial The ongoing debate regarding the relative contributions of heredity and environment to the aetiology of malocclusion would beneft from both a more careful interpretation of the evidence and the abandonment of the tendency to confate under one umbrella term distinct clinical entities, which may in turn have different aetiologies. D. Normandos letter of 24 February 2012 (BDJ 2012; 212: 153) raises some interesting and surprising points, which deserve attention and comment. the hypothesis that genetics has a more important role than environment when all other factors are effectively controlled. A high prevalence of Class III malocclusion has previously been documented in an iso- lated archaic population 5 again contrary to the observations in their well-occluded contemporariesalso suggesting a genetic explanation. The authors also found a sta- tistically signifcant increase in Class II malocclusions and overjet, although as there was no signifcant increase in over- bite it is assumed that this represents ante- rior open bite individuals. CONCLUSION Perhaps it is time to appreciate the futility of presenting the debate over heredity versus environment in the aetiology of malocclu- sion as a simple dichotomy. What the evi- dence tells us is that Class II malocclusions with increased overbites never occur in the ancestral environment; however, within one 1 General Dental Practitioner, Whitetree Specialist Centre, 1-3 North View, Bristol, BS6 7PU Correspondence to: Aidan McKeever Email: aidan@gotadsl.co.uk Refereed Paper Accepted 28 March 2012 DOI: 10.1038/sj.bdj.2012.465
British Dental Journal 2012; 212: 527-528
Provides an evidence-based overview of the human occlusal arrangement as it usually occurs in nature. Addresses the genetics versus environment question as it relates to the aetiology of malocclusion. Suggests that the confation of different classifcations of malocclusion may stife the debate on their phylogenesis. I N BRI EF O P I N I O N Fig. 1 Attritional tooth wear. Note that degree of wear is proportional to eruption sequence (reproduced with permission from the Duckworth Collection) BRITISH DENTAL JOURNAL VOLUME 212 NO. 11 JUN 9 2012 527 2012 M acm illan Publishers Lim ited. A ll rights reserved.
OPINION or two generations of adopting a modern urban culture they are rife. 9-12 Class II ante- rior open bites and Class III malocclusions do occur and, as far as we know, always have occurred in nature. Might it not be reasonable to suppose that heredity plays a more important role in the aetiology of the latter two, and function/environment in the former? It may be that the term malocclu- sion encompasses various clinical phenom- enaas well as variations of normalthat occupy opposite ends of the diagnostic and phenotypic spectrum and might therefore be better considered unrelated for research purposes. When it comes to comparing notes we can then at least be sure we are talking about the same problem. 1. Normando D. Crowding with tooth wear. Br Dent J 2012; 212: 153 2. Begg PR. Stone Age Mans Dentition. Am J Orthod 1954; 40: 298312, 373383, 462475, 517531. 3. Evensen JP, gaard B. Are malocclusions more prevalent and severe now? A comparative study of medieval skulls from Norway. Am J Orthod Dentofacial Orthop 2007; 131: 710716. 4. Helm S, Pryds U. Prevalence of malocclusion in medieval and modern Danes contrasted. Scand J Dent Res 1979; 87: 9197. 5. Inoue N, Ito G, Kamegai T. Malocclusion and its pathogenic factors in skeletal remains from west Japan. J Anthropol Soc Nip 1984; 92: 1322. 6. Mohlin B, Sagne S, Thilander B. The frequency of malocclusion and the craniofacial morphology in a medieval population in southern Sweden. OSSA 1978; 5: 5784. 7. Varrela J. Occurrence of malocclusion in attritive environment: a study of a skull sample from southwest Finland. Scand J Dent Res 1990; 98: 242247. 8. Weiland FJ, Jonke E, Bantleon HP. Secular trends in malocclusion in Austrian men. Eur J Orthod 1997; 19: 355359. 9. Corruccinni RS, Whitley LD. Occlusal variation in a rural Kentucky community. Am J Orthod 1981; 79: 250262. 10. Corruccini R. S, Pacciani E. Occlusal variation in Melanesians from Bougainville, Malaita, and New Britain. Homo 1989; 33: 1522. 11. Corruccini RS, Potter RH, Dahlberg AA. Changing occlusal variation in Pima Amerinds. Am J Phys Anthropol 1983; 62: 317324. 12. Corruccini RS, Lee GTR. Occlusal variation in chinese immigrants to the United Kingdom and their off-spring. Arch Oral Biol 1984; 29: 779782. 13. Kaifu Y, Kasai K, Townsend GC, Richards LC. Tooth wear and the design of the human dentition: a perspective from evolutionary medicine. Am J Phys Anthropol 2003; 122: 4761. 14. von Cramon-Taubadel N. Global human mandibular variation refects differences in agricultural and hunter-gatherer subsistence strategies. Proc Natl Acad Sci USA 2011; 108: 19, 54619: 551. 15. Normando D, Faber J, Guerreiro JF, Quinto CC. Dental occlusion in a split Amazon indigenous population: genetics prevails over environment. PLoS One 2011; 6: e28387. 528 BRITISH DENTAL JOURNAL VOLUME 212 NO. 11 JUN 9 2012 2012 M acm illan Publishers Lim ited. A ll rights reserved.
Reproducedwith permission of thecopyright owner. Further reproductionprohibited without permission.
