It’s not uncommon that the more your dentistry knowledge grows, the more you seem to find on day to day clinical examinations. Particularly the ability to spot malocclusions in young patients is an important skill to develop, as the earlier they are noted the more treatment options are available to them. The goal is to balance the creation of a functional and non-traumatic occlusion with maintaining a full set of dentition where possible, but where do you start? In this lecture we will explore the concept of ‘normal’ occlusion, the different types of malocclusions you might be faced with, what indications there are for treatment, what treatment options besides extraction are available, and how to decide which option is right for the patient in front of you.