Oral Habits, Malocclusion, Orthodontic Treatment Need in Children with Mixed Dentition: A Systematic Review

Tia Nurlita¹, Sindy Cornelia Nelwan^2*, Dimas Prasetianto Wicaksono²

Abstract

Oral habits can modify the functional balance of the lips, tongue, cheeks, and masticatory system during mixed dentition, creating conditions that may alter occlusal development and increase orthodontic treatment need. This systematic review synthesized contemporary evidence on oral habits, malocclusion, and objective treatment need in children with mixed dentition, while retaining malocclusion traits as clinically relevant secondary outcomes. A population-exposure-outcome framework guided eligibility. PubMed/MEDLINE and Scopus were used as the primary bibliographic databases, supported by targeted retrieval from PubMed Central, publisher platforms, and journal portals for articles published from January 2020 to July 2026. Methodological quality was appraised with design-appropriate JBI checklists, and narrative synthesis was used because habit definitions, dentition stages, treatment-need indices, and effect measures were heterogeneous. Forty-five unique records entered screening, 35 full texts were assessed, and 30 studies were included. Treatment-need evidence was most consistent for breathing-related dysfunction. Sleep-disordered breathing was associated with higher IOTN grades, mixed-dentition mouth breathing showed a strong relationship with IOTN-DHC need, and school-based ICON assessment identified a substantial treatment-needed group among children in whom oral habits were evaluated. Tongue thrust and dysfunctional swallowing were repeatedly related to open bite, increased overjet, crossbite, and sagittal discrepancies, while sucking, biting, and unilateral chewing showed more variable patterns. Eleven studies were judged at low risk of bias, and 19 raised some concerns. Oral habits were associated with clinically relevant malocclusion during mixed dentition, but the strength of evidence for a specific treatment-need grade differed by habit. Breathing dysfunction provided the clearest direct signal for elevated orthodontic treatment need, whereas other habits were more often linked to occlusal traits that may contribute to interceptive treatment decisions.

Keywords

oral habits; malocclusion; orthodontic treatment need; mixed dentition; children

Cite This Article

Nurlita, T., Nelwan, S. C., Wicaksono, D. P. (2026). Oral Habits, Malocclusion, Orthodontic Treatment Need in Children with Mixed Dentition: A Systematic Review. International Journal of Scientific Advances (IJSCIA), Volume 7| Issue 5: Sep – Oct 2026, Pages 616-628 URL: https://www.ijscia.com/wp-content/uploads/2026/10/Volume7-Issue5-Sep-Oct-No.1082-616-628.pdf

Volume 7 | Issue 5: Sep – Oct 2026