Malocclusion

What is malocclusion?

Malocclusion or “bad bites” is one of the most common dental problems. When you have malocclusion, your upper and lower teeth don’t align when you close your mouth. Malocclusion typically happens when your teeth are crowded — meaning your teeth are too large for your mouth — or are crooked. But it can also happen if your upper and lower jaws aren’t aligned. Malocclusion is usually treated with orthodontics or braces. Some more serious malocclusion might require surgery.

Can malocclusion affect my overall health?

Left untreated, malocclusion can cause several health problems. Apart from causing dental problems such as decayed teeth, losing teeth or developing gum disease, malocclusion can affect how you chew food or how you speak. It can also damage your tooth enamel or cause problems with your jaw.

Just as important, untreated malocclusion can affect your mental health. Researchers have found connections between malocclusion and self-esteem. Some studies show people who have malocclusion avoid social situations and relationships because they feel self-conscious about their appearance.

What causes malocclusion?

Malocclusion can happen several different ways:

• Your teeth are too large for your jaw, causing your teeth to crowd together and affect the alignment between your upper and lower jaw.
• You often sucked your thumb when you were a baby or toddler.
• You lost a tooth and your remaining teeth shifted to fill that gap.
• You have an inherited condition that affects your jaw, causing your teeth to be misaligned.

Does teeth grinding (bruxism) cause malocclusion?

Some researchers believe grinding your teeth (bruxism) is a risk factor for malocclusion. Some people grind their teeth when they’re feeling stressed, anxious or angry.

Can malocclusion cause temporomandibular joint disorders (TMJ)?

Malocclusion can cause TMJ, which are disorders that affect your jaw joints and surrounding muscles and ligaments.

What are typical symptoms of malocclusion?

Your appearance is the most common symptom of malocclusion. You might have a noticeable overbite or underbite. Overbite or overjet (retrognathism) happens when teeth in your lower jaw are too far behind teeth in your upper jaw. Underbite happens when your upper front teeth are too far behind your lower front teeth. Other symptoms are:

• Difficulty or discomfort when biting or chewing.
• Speech difficulties (rare), including lisp.
• Mouth breathing (breathing through the mouth without closing the lips).
• Inability to bite into food correctly (open bite).

How is malocclusion diagnosed?

Healthcare professionals typically check to see if your teeth are aligned as part of your regular dental visits. They might take dental X-rays to learn more about your condition or make impressions of your teeth. Your regular provider will refer you to an orthodontist for malocclusion treatment.

What are malocclusion classes?

There are three classes of malocclusion. The classes are based on your bite and whether your upper or lower teeth are misaligned:

• Class 1 malocclusion is the most common. The bite is normal, but the upper teeth slightly overlap the lower teeth.
• Class 2 malocclusion, called retrognathism or overbite, occurs when the upper jaw and teeth severely overlap the bottom jaw and teeth.
• Class 3 malocclusion, called prognathism or underbite, occurs when the lower jaw protrudes or juts forward, causing the lower jaw and teeth to overlap the upper jaw and teeth.

How do you fix malocclusion?

Treatment for malocclusion might include:

• Placing braces on your teeth that will gently pull them into alignment. The braces’ gentle consistent tug on your teeth reshapes the underlying bone in your tooth socket so your teeth are permanently shifted.
• Tooth aligners. These are clear plastic appliances that gradually move your teeth into alignment.
• Removing teeth to ease overcrowding.
• Performing surgery on your jaw to correct issues you inherited or fix jaw fractures that didn’t heal properly.

Can I prevent malocclusion?

Most malocclusion is hereditary and cannot be prevented. You prevent malocclusion in your children by discouraging them from sucking their thumbs. You can develop malocclusion if you lose teeth. If you’ve lost teeth, consider replacing the missing teeth with dental implants or dental bridges.

What can I expect if I have malocclusion?

If you have malocclusion, it can take time for your teeth to realign. You might be wearing braces and then retainers for several years. The length of time varies from person to person, depending on:

• Severity of the problem.
• Amount of room available in the mouth.
• Distance the teeth must be moved.
• Health of the teeth, gums and supporting bone.
• How closely instructions are followed.

How often should I see my orthodontist?

Your orthodontist will schedule regular appointments to check your braces, and if needed, tighten your braces.

How often should I see my provider for my regular dental care?

You should see your provider for regular dental check-ups at least every six months. These check-ups will be in addition to seeing your orthodontist for malocclusion treatment.

How do I take care of myself?

Treating malocclusion takes time. You probably will have braces on your teeth for several months to more than a year while your teeth are gently realigned. You might have to change your personal habits to accommodate your braces and ensure your overall dental health isn’t affected by your braces. Talk to your healthcare provider about taking care of your teeth while wearing braces.

When should I see my healthcare provider?

If you wear braces to correct malocclusion, you should contact your provider if your braces start to hurt or are damaged.

What questions should I ask my doctor?

• What’s wrong with my teeth?
• What does it mean to have overbite or underbite?
• How will you fix my teeth?
• If I need braces, how long will I have to wear them?
• Is there an alternative to wearing braces?

A note from Cleveland Clinic

Having malocclusion – when your upper and lower teeth don’t line up – can affect everything from your dental health to your mental health. Left untreated, malocclusion increases the chance you’ll develop cavities or gum disease. People with malocclusion often struggle with self-esteem and social anxiety. Fortunately, it’s never too late for treatment.