Bite problems, also called malocclusions, are the misalignment of teeth and/or jaws, and they can lead to serious dental issues that extend beyond mere cosmetic imperfections. According to the American Association of Orthodontists, the seven most common bite problems are underbite, crossbite, overbite (deep bite), crowding, spacing, open bite and overjet. All of these bite issues can be resolved, and you should talk with your orthodontist about the best treatment plan for you.
An underbite occurs when the lower teeth extend beyond the top teeth. Your front teeth are naturally designed to fit over your bottom teeth when you close your mouth or chew, so this condition can cause problems both cosmetically and medically.
Problems Associated with Underbites
Patients suffering from underbites often have pain in the mouth, jaw and facial muscles. Underbites can cause chronic mouth breathing, which can lead to halitosis (bad breath) and bacterial infections. This malocclusion also can cause excessive wear of tooth enamel, leading to decay. Sufferers of underbites can experience sleep disruptions, snoring, and sleep apnea.
Cosmetically, when the lower jaw extends too far beyond the upper jaw, it can create a bulldog-like facial expression. However, underbites also can make pronouncing words and making certain speech sounds more difficult.
Causes of Underbites
An underbite is usually a genetically inherited trait. However, certain childhood habits can exacerbate the severity of an underbite, including excessive thumbsucking or pacifier use and continued feeding from a bottle past infancy. In some cases, a child’s habit of tongue thrusting, frequently pushing the bottom teeth with the tongue, can create an underbite.
An orthodontist can correct an underbite at any life stage, but it’s best to fix this malocclusion early. The bone is still malleable in younger patients, so an orthodontist often can achieve the desired realignment using appliances. The most common apparatus used to aid the correction of underbites are upper jaw expanders and reverse-pull headgear.
An expander is custom-made for each individual and fits over several top teeth in the back of the mouth. A screw connects the two halves of the appliance in the middle. The patient activates the expander by turning a key in part of the appliance as instructed by the orthodontist. This creates tension at the junction of the two palatal bones, causing them to gradually move apart until the lower teeth no longer close against the outside of the uppers. Patients typically wear the expander for several months to a year, followed by a retainer. The expander can be worn with or without concurrent treatment with braces.
Reverse-pull headgear is an appliance that is attached to the upper jaw and is worn like a face mask. It wraps around the child's head and pulls the upper jaw into the correct position using metal bands fastened to the upper back teeth. Patients normally wear this headgear between 12 and 18 hours daily.
Adults with underbites will usually require surgery, where the oral surgeon will either lengthen the upper jaw or shorten the lower jaw by cutting, reshaping or repositioning the jawbone. Screws, plates, wires, and rubber bands hold the jaw in place after surgery. Standard recovery time is one to three weeks, and often a dentist will recommend braces or other dental appliances after the jaw has healed.
In mild cases where the underbite is only causing cosmetic concerns, a dentist can sometimes reshape the lower teeth and apply veneers to the upper teeth to create the appearance of a corrected bite.
A crossbite occurs when the top teeth and bottom teeth do not come together or they bite into an incorrect overlapping position. Two types of crossbites exist: anterior and posterior.
An anterior crossbite is similar to an underbite–where the top teeth fit inside of the bottom teeth– but an anterior crossbite often affects only some of the teeth rather than all. A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. This misalignment can happen on one or both sides of the mouth.
Problems Associated with Crossbites
People with crossbites are more susceptible to chipping or cracking their teeth while biting down, because of the mismatch between the upper and lower jaws. As with any misaligned bite, teeth can be more difficult to clean, which makes the overgrowth of bacteria and plaque leading to cavities more likely. Improper tooth position also can accelerate the recession of the gumline, exposing the tooth roots and leading to infection and/or gum disease.
Causes of Crossbites
The primary cause of any crossbite is genetics. People who are born with a larger lower jaw and a smaller upper jaw are most likely to develop a crossbite. Chronic mouth breathing can exacerbate the underdevelopment of the upper palate and may cause a crossbite to develop. If your child is late in developing permanent teeth, this could also lead to the potential formation of a crossbite when the adult teeth erupt. If the primary teeth take too long to fall out on their own–especially in the upper jaw–they might need to be extracted.
Braces are capable of fixing most mild crossbites. The type of braces you can consider will depend on the location and severity of the teeth affected by your crossbites, but clear aligners are often an option for many patients, along with traditional metal brackets.
In children, additional appliances may be needed, especially in more severe cases. Rapid palatal expanders or reverse-pull headgear might be used to expand or shift the upper jaw to align the teeth. In adults, veneers may be capable of fixing mild crossbites, but more severe cases will require jaw surgery.
An overbite, also sometimes referred to as a deep bite, occurs when the top front teeth excessively overlap the bottom front teeth when the mouth is closed. An overbite can be vertical (where the top teeth significantly overlap the bottom teeth), or horizontal (where the top teeth protrude over the bottom teeth).
Problems Associated With Overbites
The misalignment caused by an overbite can put additional stress on teeth, causing them to grind and wear down prematurely and increasing the risk for tooth decay. An untreated overbite can eventually cause significant jaw pain, facial pain and headaches.
An overbite also might cause a patient to frequently bite into the roof of the mouth, causing painful sores and ulcers to develop. Overbites also are associated with cosmetic and speech concerns typical to other types of bite misalignments.
Causes of Overbites
The most common cause of an overbite is a problem with the shape and/or size of the jaw or the teeth. Often the lower jaw is too small. However, there also could be too much room in the upper jaw. If not treated, an overbite will allow the teeth to crowd each other and grow crooked if there is too little room or the teeth will be spaced too far apart if the jaw area is too large.
This malocclusion can be genetic, or–much like an underbite–it can be caused by thumbsucking, extended bottle feeding or tongue thrusting on the upper teeth. Overbites also can be caused by one or more missing teeth in the lower jaw.
In the case of most children and younger teenagers, an overbite problem is caused by crowding of the teeth in the mouth and can typically be fixed with braces. Other potential solutions include the removal of primary teeth (making it easier for the permanent teeth to grow into their correct positions) and growth modification devices (such as blocks, repositioning appliances or headgear).
For many adults with an overbite problem, the lack of preventative treatment earlier in life makes the process more difficult. If the overbite is relatively mild, then traditional braces will typically be sufficient to correct tooth alignment. In more severe cases, the orthodontist may need to extract teeth to make room in the mouth or perform surgery to reshape the jaw.
Dental crowding occurs when there is not enough space in the mouth for teeth to grow in straight. As a result, some or all of the teeth may rotate and/or overlap each other. Overcrowding can be mild, moderate or severe depending on the number of teeth affected and whether it occurs in one or multiple areas of the mouth.
Problems Associated with Dental Crowding
Overcrowded teeth can create difficulties brushing and flossing, leading to the buildup of plaque and bacteria. Straight teeth are easier to clean, brush and floss, which leads to better overall dental health.
If you have moderate to severe crowding, you are more likely to develop tooth decay and gum disease. Poor oral hygiene also can lead to health problems over time, including a weakened immune system and, in rare cases, heart disease.
Causes of Crowding
Crowding can be caused by teeth that are larger than they should be in relation to the size of the jaw. These teeth then do not have the space to grow correctly and can overlap or twist. Crowding also can be caused by the premature loss of primary teeth, enabling other teeth to move into the empty space and throw off alignment. Similarly, if the primary teeth stay in the mouth too long, dental crowding can result when the larger permanent teeth are trying to grow into a spot that’s too small.
Dental braces are the most common treatment for overcrowding. In most cases, the orthodontist can use ceramic braces, traditional metal brackets, or alternatives such as clear aligners or lingual braces. Dental veneers also can often be used to treat mild to moderate cases of crowding in adults.
Teeth spacing is a condition in which gaps appear between some or all of the teeth. Spacing can occur anywhere in the mouth but is most noticeable in the upper front teeth. This condition affects both adults and children. With adults, spacing is usually permanent and requires correction to fix. In some cases, children who have not finished developing their permanent teeth may see gaps close as those teeth come in.
Problems Associated with Spacing
Spacing most often does not pose any risk to dental and medical health so long as the patient follows proper dental hygiene practices. Spacing can be one of the most noticeable malocclusions, so cosmetic concerns are common with this bite misalignment.
In rarer cases, spacing could be an indication of a serious condition involving the gums. Periodontal disease, or advanced gum disease, is described by the CDC as severe inflammation of the gums, tissues and bones supporting the teeth. Periodontal disease can cause teeth to loosen and gaps to form.
Causes of Spacing
Many patients with dental spacing have teeth that are too small for the jawbone. An overgrowth of the tissue that borders the gum line and the upper front teeth also can cause spacing, and the tissue can sometimes bulge between the teeth.
Certain habits, especially during childhood, also contribute to spacing. Thumbsucking can put pressure on the front teeth, pushing them to either side of the thumb. In older children, poor swallowing reflexes also can contribute to spacing. The tongue should naturally position itself at the roof of the mouth during the swallowing process. But, if the tongue instead pushes against the front teeth, a result similar to thumbsucking can occur over time.
Braces are commonly used to fix spacing, and your orthodontist can help you determine whether traditional braces, clear braces, removable braces or lingual braces are right for you. Other methods of filling in gaps include veneers and bonding.
If the gums above the two upper front teeth overextend and cause a gap, you might need surgery to remove excess tissue. If your orthodontist diagnoses you with gum disease, you will have to treat that before you can begin to correct the spacing.
An open bite occurs when the upper and lower front teeth do not meet when the mouth is fully closed, resulting in open space between the top and bottom rows of teeth.
Problems Associated with Open Bites
An open bite that does not resolve on its own during childhood can create a few problems later in life. Open bites also can lead to wear on the back teeth that can prematurely age the teeth and make them more susceptible to decay. As with other malocclusions, lisps or other speech impediments can develop, and the inability to bring the teeth together can make eating difficult.
Causes of Open Bites
In many cases, the cause of an overbite is a mechanical problem with the jawbone. Some children also develop an opening in their bite when they have a mix of baby and permanent teeth, but this usually self corrects when the permanent teeth finish growing. In some cases, prolonged tongue thrusting can contribute to an open bite.
Open Bite Correction
The options for correcting an open bite often depend upon your age. In children ages 0-4, there typically is no need for intervention, as tongue thrusting and an open bite are normal during this time. Parents who are concerned about their child’s tongue thrusting can restrict access to pacifiers and curb thumbsucking behavior.
In patients between the ages of 7 and 10, your dentist typically can discern whether the eruption of permanent teeth is contributing to an open bite. Between 11 and 17, treatment for an open bite can begin and typically involves the application of braces to correct the malocclusion. In adult patients older than 18, braces still may be used to correct mild open bites, but most patients will require jaw surgery.
An overjet occurs when the upper front teeth protrude too far outward. In a normal bite, the upper front teeth should rest relatively snuggly over the bottom front teeth (about 2 millimeters apart) when the mouth is closed. In an overjet, the teeth grow outward at a more horizontal angle. Overjets can be barely detectable, or they can be severe.
Problems Associated with Overjets
Along with difficulty biting or chewing, poor alignment of your teeth can make it difficult to close your lips completely. As with other malocclusions, an overjet could lead to speech problems or frequently bite your tongue or the inside of your cheek. Severe overjets may cause sufferers to feel self-conscious, which could lead to anxiety and depression.
Causes of Overjets
An underdeveloped jawbone can cause your front teeth to protrude more than they should. And certain childhood habits such as tongue thrusting, excessive pacifier use and thumbsucking can make an overjet more likely to develop.
Several treatment options exist to correct overjets. Braces, the most popular method, can correct the angle of the front teeth. Different types of braces are available for an overjet, including traditional metal braces and removable clear aligners.
Another option to correct an overjet is to extract the set of premolars in order to change the dental arch and guide the front teeth into place. For patients suffering from a deficiency in jaw development, surgery often becomes the preferred option.
Bite problems are very common, and they can lead to a host of health and cosmetic concerns. While it’s most often ideal to catch malocclusions early, you can seek treatment at any age. If you’re concerned you might have a bite problem, schedule a free consultation with one of our board-certified orthodontists today.