In recent years, different investigations have highlighted the importance of constructing the diagnosis based on complexity in health, which implies putting the concept of comprehensive dental health in perspective. Occlusal alterations in childhood have a multifactorial etiology, considering the dental, muscular and skeletal factors of the stomatognathic complex as well as the subject in their psychism and social environment, noting the maturational development of the child, therefore this article presents an update on the affectation Psychology in child malocclusions and the impact they cause in the construction of the childhood personality.

Keywords: Psychic affectation, Malocclusions, Childhood

Since dental work it is necessary to consider certain psychological aspects of the child patient that are significant in thedetection of occlusal alterations, their need to approach and treatment for the correct pediatric care. The mouth is one of the organs of the human being that intervenes most in his social relations withothers,sounfavorable psychological onsodations can cause various affectations, giving rise to certain inappropriate behaviors and attitudes in the development and well-being of the individual.¹ From a complex perspective of the human being, growth and development contemplate the biological, social and psycho cognitive aspects. The interest aroused in recent years by the study of psychological and social determinants reflects a substantial change in medical thinking^2,3 and invites us to question ourselvesfor the integral approach in childhood.

Currently it is very common to observe functional maloclusions in children, specifically during mixed teething. This morphological and functional abnormality of bone, muscle and dentary components can affect not only the normal functioning of the stomatopathic system such as breathing, phonation, chewing, all of which are vital functions for the development and growth of the child, directly affecting the proper psychic maturation.² Occlusions or occlusal alterations have a multifactorial etiology, among them the most common are: tooth crowding, open bites, cross bites, little or excessive growth of the jaws among others. Each has very particular characteristics and has varying degrees of complexity to the treatment; however, they have a common appearance, usually affecting the aesthetics and psiquis of patients.³ We are interested in placing ourselves in the latter aspect since the effects on the subjective construction of the child take on a vital dimension.

Peñaranda points out the psychologicalmeaning of the mouth and face posed in various articles, expressinghowthese two areas can be white of manifestations and alterations of a psychological nature. Character alterations such as: depression, loss of sense of humor, irritability, fall of affective bonds, anhedonia (inability to obtain pleasure, loss of interest), psychomotor delay (slowness of thought, word and mimicry), feelings of disability, guilt, impotence, negative content in conversation, personal neglect, pessimism and sometimes ideasof suicide, which may be related to problems of dental type.⁴

Accordingly, the authors claim that the face is the mirror of the soul, beyond aesthetics, the harmony of the face is an important factor in the health and quality of life of people.⁴ Facial and occlusal disarmony has both physical and psychological effects on people, especially in children and adolescents.⁵ Occlusal alterations can make certain people shy, retracted and fearful, warning of possibilities to cause social unrest, create inferiority complexes and negative attitudes that alter their performance before the vinea.⁶ To establish a correct diagnosis of maloclusions it is importantto take a thorough approach that examines not only the dental, muscle and skeletal factors of the stomatognetic set but also, the individual himself in his psychic personality and social environment. ⁷ to look into the thresholds of psychological involvement present in thechild associated with occlusal alterations introduces a unique look at establishing comprehensive approaches that contemplate multidisciplinary work in order to improve the quality of life and the proper growth of the subject.

Development

Malocclusion is often something visible that could lead to adversesocial reactions and arepresentation of itself with veryimportantcharacteristics fromwhich disadvantageous effects on the subject accrue. A small deformity in the stomatopathic system can cause psychological alterations and social discomfort in the development and well-being of the individual, and may present a car with decreased brushing and self-esteem.^8-11 In the same sense studies of Meneses, D. and Botero, P., mention that aesthetic commitment during growth can generate harmful psychological effects depending on the degree of physical deformity.

Facial and occlusal alterations bring both physical and psychological effects on people, especially in children and adolescents who are going through a process of growth and maturation. The health of adolescents and young people is of great importance to all societies, as they will be fundamental elements for the drive for progress and development.¹² In children and adolescents with malolusions, shame at their affectation can influence their school performance and subsequently their future occupation, income and social level.¹³ Especially young people begin to worry about their appearance, which is why orthodox treatment starts more often during adolescence, a time in life characterized by distorted self-image and overreaction towards personal-looking problems.^14,15

The oral aesthetics affected as a result of certain dental alterations, brings with it negative effects on interpersonal relationships.^1,3 The behavior of maloclusions worldwide ranges in ranges from 35 to 75%, with a difference in sex and age. In Cuba these occur at 36.3% and the most affected sex is the female with 52.6% (16%). According to studies carried out by porHidalgo y cols. crowdingconstitutesthe most commonanomaly, which contributes to malocclusion about 40 to 85 %. Latin America exhibits high levels of incidence and prevalence of maloclusions, they occur in 85% of the child population¹⁷ This study showed how a small deformity in the stomatognetic system can cause psychological alterations and social discomfort in the development and well-being of the individual.^6,18,19 Although there is no uniformity in epidemiological evaluative methods of occlusal problems, because there is no single statistical assessment that can be used by all researchers, most have agreed that 54 to 78.8% of children need orthodontic treatment at ages 12 to 18 years.²⁰ Some authors classify these maloclusions as disabling dentofacial deformities or states that interfere with the child's overall well-being, as it can affect the dentofacial aesthetics, chewing or respiratory functions, speech or physical or psychological balance of the child.²¹ Other authors consider very few maloclusions to be preventable, but 25% of these can be avoided by eliminating risk factors at an early age to achieve improvement, such as deforming oral habits, these being one of the most important environmental causes of maloclusions that alter the normal function and balance of teeth and jaws. Deforming oral habits are patterns of muscle contraction of a complex nature that are learned and that when repeated become unconscious, for example: digital suction, lingual pronation, onychophagy, physychophagia, oral breathing and chewing objects.²² It might be thought that the apprehension of oral habits could sometimes be associatedwith psychic stresses and/or situations that represent a level of internal conflict for the child, the passage from isolated behavior to a habit of repetition occurs through a certain psychic energy that would not manage to be otherwise processed.

The effects of malolusions on quality of life are psychosocial in type, without the fun limitations they may present.^23,24 So these can significantly influence the perceptions of others, their behavior and their intentions to interact.²⁵ They also pose an increased risk of psychological disadvantages and adverse social reactions that could affect people'swell-being.²⁶

In a study in Saudi Arabia they found that children aged 11 to 14 with malocclusion had a significantly greater impact, and therefore a worse quality of life compared to a group of individuals without malocclusion.²⁷ This result is of great importance, since most orthodontic patients are children and adolescents.^28,29 In Belo Horizonte, Brazil reports that 72% of schoolchildren were un happy with the position of their upper incisors, 21% mention that they mock them for their teeth and 8.2% of the study population had nicknames because of their teeth.³⁰

Dentofacial anomalies represent an important social disadvantage, with a high correlation between maloclusions and low self-esteem.³¹ Agou and cabbage. they conducted research in which they find that the psychological profile of children with malocclusion can influence their social and emotional development, as well as their self-esteem.³² A study in Jordan showed that children with dental and facial abnormalities are victims ofbullyng.³³ Jung found that the teacher's perception of an attractive student can influence the student's expectations and assessment, employees perceived most attractive by their supervisors give them better grades in the performance of their work than less attractive employees. So those who are perceived by their teachers, peers, and employers as attractive are more likely to experience more positive social interactions and assessments.^34,35

According to studies carried out by García Peláez y cols. psychological involvements are more predominant in patients with dentary abnormalities represented at 48.9%.³⁶ These findings respond to what is published by Duke of Estrada,²¹ where he refers to certain types of maloclusions producing profound psychological impacts on the child; in some they affect speech and the way they behave socially, as their physical appearance makes them manifest themselves shy, withdrawn, secluded or even aggressive.

A comprehensive diagnosis of childhood malocclusions involves taking into account multifactorial aspects of oral health as well as the levelsof psychic involvement that certain alterations in occlusion could pose to the child in building his personality. Therefore, identify the presence of deforming oral habits froman early age, allows to perform adequate prevention by means of educational interventions that allow modifying them and thereby decrease the risk of maloclusions. Prevention is the challenge of medical care intoday's world. So the oral health tripod, quality of life and psychic condition are three dimensions that articulately allow, within the framework of primary care, tore-think about possible health interventions.

There was no conflict of interest during the conduct of the study.

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