Is there a relationship between dental crowding and caries?


The crowing of teeth disrupts the normal proximal and occlusal contacts and creates area for potential plaque and food accumulation. As a consequence it has been considered a risk factor for dental caries. However, studies looking at a relationship between crowding and caries have been contradictory. The aim of this review was therefore to assess the relationship between dental crowding and the development of dental caries.

The Cochrane Library, PubMed, Medline, LILACS, Google Scholar, and ISI Web of Science databases were searched together with hand searches of the Journal of Dental Research, Community Dentistry and Oral Epidemiology, American Journal of Orthodontics, American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, and European Journal of Orthodontics.

English language studies reporting on the prevalence or severity of dental crowding and dental caries, and assessing the association between them that included a comparator, or control group were included. Studies were assessed for quality and MOOSE guidelines followed.

  • Eighteen studies met the inclusion criteria with only 8 cross-sectional studies being included in the qualitative synthesis.
  • Four studies found no association between crowding or irregularity and caries
  • Significant negative correlations were reported in 2 studies.
  • One study showed a direct and significant relationship between crowding and proximal caries scores,
  • another study showed a positive association between crowding and proximal surface caries in the mandibular anterior region and an inverse correlation in the maxillary posterior region.

The authors concluded

To date, no high-quality studies confirm or refute a causal relationship between crowding and dental caries.


Hafez HS, Shaarawy SM, Al-Sakiti AA, Mostafa YA. Dental crowding as a caries risk factor: A systematic review. Am J Orthod Dentofacial Orthop. 2012 Oct;142(4):443-50. doi: 10.1016/j.ajodo.2012.04.018. PubMed PMID: 22999666.

MOOSE (Meta-analysis of Observational Studies in Epidemiology )


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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