A misaligned bite, formally known as malocclusion, occurs when the upper and lower teeth do not properly fit together when the mouth is closed. This misalignment can range from minor tooth crowding to severe jaw discrepancies, affecting both appearance and function. Advancements in orthodontic and surgical techniques mean a corrected bite is an achievable goal for people of all ages. Addressing this issue preserves long-term oral health and function. Understanding the nature of the misalignment is the first step toward determining the most effective path to correction.
Identifying Common Bite Issues
Malocclusion is categorized based on the relationship between the upper and lower jaws and teeth. A Class II Malocclusion, or overbite, is characterized by the upper front teeth overlapping the lower front teeth by an excessive vertical amount. An exaggerated overbite can lead to jaw pain and tooth wear.
Conversely, an Underbite, or Class III Malocclusion, presents when the lower jaw and teeth protrude beyond the upper jaw and teeth. This causes the lower front teeth to sit in front of the upper teeth, often creating a concave facial profile. Underbites are challenging to correct due to the underlying skeletal component.
A Crossbite occurs when one or more upper teeth bite on the inside of the lower teeth. This misalignment can lead to uneven wear on the enamel and may cause the jaw to shift when closing. An Open Bite occurs when the upper and lower teeth do not meet, leaving a gap even when the jaws are closed, which affects chewing and sometimes speech.
Non-Surgical Orthodontic Solutions
Most bite issues can be corrected by repositioning the teeth within the existing jaw structure using orthodontic appliances. Fixed appliances, known as traditional braces, consist of brackets bonded to the teeth and connected by an adjusted wire that applies continuous, gentle pressure. Braces are highly effective for comprehensive tooth movement, including rotation and correcting severe crowding, with treatment typically lasting between 18 and 36 months.
Removable clear aligners offer a nearly invisible alternative to fixed braces, appealing to many adults and older teens. These custom-made trays are changed every one to two weeks, gradually guiding the teeth into alignment. Clear aligners are best suited for mild to moderate malocclusions and may achieve results faster, typically within 12 to 18 months, provided patient compliance is high.
Adjunctive appliances are sometimes used alongside or before braces or aligners to facilitate movement. A palatal expander is used primarily in growing patients to widen a narrow upper jaw, which helps correct a crossbite. For minor skeletal discrepancies, orthodontic elastics (rubber bands) can help move the upper and lower dental arches into a better relationship.
Addressing Severe Skeletal Discrepancies
When malocclusion is caused by a significant mismatch in the size or position of the jawbones, a combined approach is necessary. This often occurs with severe Class II or Class III malocclusions where the skeletal structure is disproportionate. For these complex issues, surgical orthodontics is the definitive treatment, involving a partnership between an orthodontist and a maxillofacial surgeon.
The process begins with pre-surgical orthodontic treatment, where fixed braces align the teeth within each jaw arch independently, a phase that often takes around 18 months. This initial alignment ensures the teeth will fit together precisely once the bones are moved. The surgeon then performs orthognathic surgery (jaw surgery) to physically reposition the maxilla (upper jaw), mandible (lower jaw), or both.
The surgeon makes controlled cuts (osteotomies) and moves the jaw segments into the corrected position, securing them with small plates and screws. This procedure directly addresses the skeletal discrepancy, restoring balance to the facial structure and establishing a correct bite. A final, shorter phase of orthodontics follows the surgery to fine-tune the tooth positions.
Consequences of Delaying Treatment
Choosing not to correct a misaligned bite can lead to functional and health complications that worsen over time. The most immediate consequence is uneven tooth wear, as misaligned teeth create abnormal contact points and excessive friction during chewing. This results in premature enamel breakdown, chipping, and cracks, which increases tooth sensitivity and the risk of decay.
A poor bite also places undue stress on the muscles and joints responsible for jaw movement, potentially leading to Temporomandibular Joint (TMJ) disorders. Symptoms of TMJ issues include chronic jaw pain, headaches, and difficulty opening or closing the mouth fully.
Crowded or overlapping teeth are inherently more difficult to clean effectively, creating spaces where plaque and food particles accumulate. This difficulty in maintaining hygiene increases the risk of developing periodontal disease and tooth decay. Severe malocclusions can also interfere with the ability to chew food properly.