An uneven bite can cause tooth pain and often goes unrecognized as the source of discomfort. When the upper and lower teeth do not align correctly, this misalignment—known as malocclusion or an occlusal discrepancy—places undue mechanical stress on the entire dental system. This imbalance is a frequent cause of unexplained tooth sensitivity, pain, and damage.
Understanding What an Uneven Bite Is
An uneven bite occurs when the top and bottom teeth fail to meet in a harmonious and evenly distributed manner when the mouth is closed. In a healthy bite, forces from chewing and clenching are spread across all teeth. Malocclusion disrupts this ideal arrangement, causing certain teeth to strike prematurely or with greater intensity than others. These high-contact points are known as premature contacts.
Bite discrepancies are categorized by the relationship between the upper and lower dental arches. An overbite occurs when the upper front teeth protrude excessively over the lower teeth. An underbite is the reverse, with the lower teeth sitting in front of the upper teeth. A crossbite happens when some upper teeth sit inside the lower teeth. Even a single ill-fitting dental restoration, such as a high filling or crown, can create an occlusal interference.
This misalignment introduces destructive horizontal or shearing forces instead of forces being directed vertically along the long axis of the tooth. This abnormal force distribution creates persistent trauma that requires a professional dental evaluation to pinpoint the exact locations of the forceful contacts.
How Excessive Force Leads to Tooth Pain
The application of excessive and misdirected force to a tooth leads to a condition known as occlusal trauma, which is the direct cause of the resulting pain. Teeth are anchored in the jawbone by the periodontal ligament (PDL), a specialized tissue that acts as a natural shock absorber. When the force on a tooth exceeds the PDL’s adaptive capacity, the ligament becomes inflamed and injured.
Chronic stress on the PDL causes it to widen, a change often visible on dental X-rays, as the body attempts to dissipate the force. This inflammation and the resulting bone resorption can cause a dull, persistent ache that patients may describe as a generalized soreness in the jaw or a specific tooth. The pain is often worse upon biting or chewing, as this action compresses the stressed PDL fibers.
Another primary pathway for pain involves the dental pulp, the soft tissue inside the tooth that contains the nerves and blood vessels. Repetitive forces from an uneven bite irritate the pulp, sometimes leading to a temporary or chronic pulpitis. This irritation often results in hypersensitivity to temperature, particularly cold, or a sharp pain when the tooth is released from biting pressure. This pain can be diffuse and difficult for the patient to accurately locate.
The continuous irritation from occlusal trauma can also cause microscopic cracks to form in the tooth structure, known as craze lines or fractures. These defects allow external stimuli like temperature changes to reach the underlying dentin and pulp more easily, heightening the sensitivity. By addressing the underlying occlusal trauma, the pressure on both the periodontal ligament and the dental pulp can be relieved, allowing these tissues to heal.
Treatment Options for Correcting Bite Alignment
Correcting an uneven bite requires professional intervention focused on restoring harmony to the occlusal surfaces and eliminating the points of premature contact.
Occlusal Adjustment (Bite Equilibration)
For minor discrepancies, the most common and conservative approach is occlusal adjustment, also known as bite equilibration. This procedure involves the careful, selective reshaping and polishing of small amounts of tooth enamel to smooth down high spots and evenly distribute the biting forces. The dentist uses a colored articulating paper to precisely identify where the teeth are hitting hardest, resulting in a more stable and balanced bite.
Restorative Correction
In cases where the uneven bite is caused by an existing dental filling, crown, or bridge, the solution may involve restorative correction. A poorly fitted restoration can act as a significant occlusal interference, and the dentist will need to adjust, replace, or remake the restoration to ensure it conforms properly to the surrounding teeth and the opposing arch.
Orthodontic Treatment
More significant malocclusions, such as severe overbites or crossbites, typically require comprehensive orthodontic treatment using braces or clear aligners. These appliances systematically move the teeth into positions that correct the skeletal or dental misalignment over a period of many months. Orthodontics addresses the root cause of the uneven bite by physically repositioning the teeth and sometimes the jaw relationship, leading to a permanent resolution of the occlusal trauma.
Dental Appliances
Dental appliances like custom-made night guards or splints are often used as a temporary or diagnostic measure to manage pain. These devices cover the biting surfaces of the teeth, creating a uniformly smooth surface that prevents the teeth from locking into a traumatic position. While a night guard provides immediate relief by protecting the teeth and relaxing the jaw muscles, it does not permanently correct the underlying occlusal discrepancy.