The proper term for misaligned teeth or a “bad bite” is malocclusion, a common condition where the upper and lower teeth do not align correctly when the mouth is closed. This misalignment can range from minor crowding that is mostly a cosmetic concern to severe jaw discrepancies that affect daily function. Malocclusion is a prevalent issue, affecting a majority of children and adolescents, though not all cases require treatment. The significance of malocclusion lies in its potential to create a ripple effect of physical, functional, and even psychosocial problems.
Understanding Malocclusion and Its Causes
Malocclusion is often the result of a complex interplay between inherited traits and environmental factors. Traits like jaw size, tooth size, and bite patterns can be passed down through families. For example, a person may inherit a small jaw size from one parent and large teeth from the other, which inevitably leads to dental crowding.
Environmental and behavioral factors can influence the severity of the misalignment. Prolonged habits during childhood, such as thumb sucking, pacifier use beyond early toddlerhood, or tongue thrusting, can put pressure on the developing jaws and teeth, altering their position. The premature loss of baby teeth or trauma to the mouth can also disrupt the normal eruption path of permanent teeth, causing them to shift or become impacted. Other factors, like mouth breathing often caused by enlarged tonsils or adenoids, can also contribute to changes in jaw structure and subsequent malocclusion.
How Misalignment Impacts Oral Health and Function
The difficulty in maintaining proper oral hygiene is a direct health consequence of malocclusion. Crooked or crowded teeth create numerous nooks and crannies that are difficult to reach with a toothbrush or dental floss. Food particles and plaque easily accumulate in these hard-to-clean areas. This buildup increases the risk of both dental caries (cavities) and periodontal disease (gum disease).
When plaque is not removed effectively, it irritates the gums, leading to inflammation known as gingivitis. If gingivitis is left unaddressed, it can progress to periodontitis, a more severe infection that can damage the bone supporting the teeth, potentially resulting in tooth loss. This abnormal contact can lead to the uneven wear of tooth enamel, chipping, or fracturing over time.
An improper bite can interfere with the efficiency of chewing, or mastication, which can potentially strain the digestive system if food is not adequately broken down. Misalignment may also contribute to jaw pain and the development of temporomandibular joint (TMJ) disorders, which can cause headaches and discomfort. Furthermore, the position of the teeth and jaws can affect speech, sometimes leading to lisping or other speech impediments.
The appearance of misaligned teeth can have an impact on a person’s mental well-being. Individuals may feel self-conscious about their smile, leading them to avoid social situations or cover their mouth when speaking or laughing. Addressing visible misalignment is often a significant part of the motivation for seeking treatment, as improving self-esteem and social confidence is an important aspect of overall health.
Options for Correction
A thorough orthodontic assessment by a dentist or orthodontist is often recommended for children by age seven. This evaluation uses X-rays and other diagnostic tools to determine the precise type and severity of the misalignment. For many patients, the goal is to gently move the teeth into better alignment using constant, controlled pressure.
Traditional metal braces remain a highly effective method for correcting a wide range of malocclusions. They use brackets bonded to the teeth and connected by wires that are adjusted periodically to guide the teeth into their correct positions. Clear aligners, such as those made of removable, transparent trays, offer a more discreet alternative that is popular with adults. Aligners must be worn for a majority of the day, typically 20 to 22 hours, requiring a high degree of patient compliance.
Auxiliary Appliances and Procedures
Other appliances are sometimes used, including palatal expanders to widen a narrow upper jaw or headgear to influence jaw growth in younger patients. In some instances of severe dental crowding, the removal of one or more teeth may be necessary to create the space required for proper alignment.
Surgical Correction and Retention
For the most severe skeletal misalignments, where the jawbones themselves are improperly sized or positioned, orthognathic (jaw) surgery may be necessary. This procedure is often performed in conjunction with orthodontic treatment to achieve the best functional and aesthetic result. Retainers are a final, non-negotiable step, as they are worn post-treatment to maintain the corrected position of the teeth and prevent them from shifting back.