Occlusion is a term that refers to the general alignment of teeth, or the way the teeth come together in the mouth to create a bite. Ideally, the upper teeth should fit slightly over the bottom teeth, and the back molars should fit on top of the lower back molars almost like puzzle pieces. When teeth are not aligned properly in the mouth, dental and orthodontic professionals refer to it as malocclusion. Only about 35% of adults in the US are born without some form of malocclusion, meaning that the majority of people would benefit from some kind of orthodontic intervention to fix their poor bite patterns.
Usually, the most common forms of malocclusion are noticed in childhood, once primary teeth are lost and permanent adult teeth set in. By the time kids become teenagers, about 80% of girls and 78% of boys will have bite problems due to malocclusion and often receive their first set of braces around the age of 12 or 13. However, many adults who find themselves with crooked teeth or bite issues did have braces previously as teens, but their teeth have shifted since then, causing them to experience malocclusion once again.
Many think that straightening teeth is simply a cosmetic issue, but it’s much more complex beyond the scope of aesthetics. People with malocclusion often have bite issues, as well as crooked teeth, which can bring about a number of complications like plaque buildup, jaw pain or TMJ, sleep apnea, tooth and gum erosion and more.
Most Common Causes of Malocclusion
For better or worse, genetics highly affect the outcome of people’s facial skeletal characteristics, including the way their teeth are aligned. Most people’s teeth will resemble their parents’, and often times, if their parents had crooked teeth, they will too. Malocclusion can be a combination of genetic, and environmental or lifestyle factors, however, so early awareness for parents can tell mitigate some issues later on. Other causes include:
- Cleft palate or lip
- Pacifier use or thumb sucking past the age of 3
- Prolonged bottle-feeding
- Chronic sinusitis or rhinitis
- Tongue thrusting when swallowing
- Tumors in mouth or on jaw
- Misshapen teeth
- Injury to mouth or jaw
- Improper dental or orthodontic care such as crowns, fillings, or braces
- Removal of adult teeth too early before orthodontic care
The effects of malocclusion can be experienced in a variety of ways depending on which form it is, but the most common symptoms are:
- Lisp or speech problems
- Biting cheeks or tongue
- Facial asymmetry
- Jaw clicking
- Mouth breathing
- Teeth crowding
Cases of Malocclusion
Everyone has a unique bite pattern, but most malocclusion issues fall into three categories:
- Class I: This is the most common kind of misalignment affecting about 60% of people. The bite is normal, but the upper teeth slightly overlap the bottom teeth and are often crowded.
- Risks: Though this bite pattern may not pose any large risks structurally, the crowding of teeth can make proper dental care difficult. Teeth that overlap create small tight spaces where plaque and bacteria hide and build-up, despite regular brushings. The level of buildup that occurs often needs to be removed by a dental professional with regular cleanings. Those who don’t regularly attend the dentist may suffer from severe decay, in these cases, sometimes leading to tooth loss and even dangerous gum infections, gingivitis, or periodontal disease.
- Treatment: Luckily, the most common form of malocclusion is also the often times the easiest to fix with simple braces, either traditional metal or clear aligner trays. These devices can expand the palate to allow for teeth to fall into place to undo crowding. Sometimes, teeth are removed to make this process easier, especially if there are impacted wisdom teeth.
- Class II: Often called an overbite or retrognathia, this occlusion is when the lower jaw is underdeveloped, making it look as though the upper jaw protrudes forward. Sometimes refer to this as having “buck teeth,” and it affects about 32% of individuals.
- Risks: People with this misalignment will often be unhappy with the way their teeth and jaw look, as they often feel that they appear to have a weak chin due to the underdevelopment of the bottom teeth and jaw. They also will be unhappy with their smiles because of the protrusion of their front teeth. The issues here, however, are more than cosmetic as they often are not able to use their front teeth properly. Uneven wear of the front lower teeth is not uncommon and can also bite into the gum tissue of the palate, causing rum irritation or infection.
- Treatment: An orthodontist will attempt to level the front and back teeth to align to help them function properly using braces. The treatment time depends on the severity of the overbite as well as the treatment option that is recommended and used.
- Class III: The lower jaw is larger than the upper jaw, giving the mouth the effect of an underbite. Only about 8% of people have this issue and often cannot go without some form of orthodontics or surgery.
- Risks: Back teeth are not used correctly with this misalignment, and jaw joint dysfunction is very common and can be quite painful. The abnormal wear on teeth can cause irreversible damage that will later require extensive work like implants or bridges. Aesthetically, people find this case to be much more noticeable than class I or II and can be quite unhappy with their appearance.
- Treatment: To fix this bite, an orthodontist will often work with a maxillofacial surgeon to align the jaws before braces are done. There will often also be palate expansion and extraction of teeth if necessary to create balance between upper and lower jaws.
Less common bite issues:
- Open bite: This is also referred to as anterior open bite and is often caused by non-genetic factors like thumb or pacifier sucking, tongue thrusting, TMJ, or skeletal issues caused by genetics or injury. The upper and lower teeth do not meet at all and give the appearance of open space between the teeth when the jaw is shut.
- Risks: People with this bite issue often find that they cannot use their front teeth at all, and the wear on their back teeth is often extreme. They will also often suffer from jaw pain and clicking while chewing.
- Treatment: This will require both behavior modification and some form of braces. Sometimes, if the jaw is not malformed, surgery is suggested if the patient is an adult. Tongue thrusting appliances can be installed, and exercises can be done to help modify the thrusting behavior, often developed from thumb sucking well past the age of 3.
- Crossbite: When upper teeth are biting on the inside of lower teeth, it means they’ve “crossed,” which can happen on the sides of the mouth as well as the front.
- Risks: Abnormal wear on the teeth is inevitable with this condition that can lead to asymmetrical development of the jaws, causing dysfunctional chewing patterns and TMJ. Gum injury is common and can also lead to infection and periodontal disease.
- Treatment: Crossbites should be treated early on in children as their palates are still very malleable and can easily be expanded. Braces can be used to align the teeth if more than one is crossing over. It’s essential to fix this issue due to the impact it can have on jaw growth into adolescence.
If you feel you may have bite issues, go into your dental office today for an orthodontic referral. With x-rays and an exam, you can learn more about your options for fixing malocclusion as an adult.