Malocclusion means the teeth are not aligned properly.
Crowded teeth; Misaligned teeth; Crossbite; Overbite; Underbite; Open bite
Causes, incidence, and risk factors
Occlusion refers to the alignment of teeth and the way that the upper and lower teeth fit together (bite). Ideally, all upper teeth fit slightly over the lower teeth. The points of the molars fit the grooves of the opposite molar.
The upper teeth keep the cheeks and lips from being bitten and the lower teeth protect the tongue.
Malocclusion is most often hereditary, which means the condition is passed down through families. There may be a difference between the size of the upper and lower jaws or between jaw and tooth size, resulting in overcrowding of teeth or in abnormal bite patterns.
Variations in size or structure of either jaw may affect its shape, as can birth defects such as cleft lip and palate. Other causes of malocclusion include:
Childhood habits such as thumb sucking, tongue thrusting, pacifier use beyond age 3, and prolonged use of a bottle
Extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth
Ill-fitting dental fillings, crowns, appliances, retainers, or braces
Misalignment of jaw fractures after a severe injury
Tumors of the mouth and jaw
There are different categories of malocclusion.
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.
Abnormal alignment of teeth
Abnormal appearance of the face
Difficulty or discomfort when biting or chewing
Speech difficulties (rare) including lisp
Mouth breathing (breathing through the mouth without closing the lips)
Signs and tests
Most problems with teeth alignment are discovered by a dentist during a routine exam. The dentist may pull your cheek outward and ask you to bite down to check how well your back teeth come together. If there is any problem, the dentist will usually refer you to an orthodontist for diagnosis and treatment.
The goal is to correct the positioning of the teeth. Braces or other appliances may be used. Metal bands are placed around some teeth, or metal, ceramic, or plastic bonds are attached to the surface of the teeth. Wires or springs apply force to the teeth.
One or more teeth may need to be removed if overcrowding is part of the problem. Rough or irregular teeth may be adjusted down, reshaped, and bonded or capped. Misshapen restorations and dental appliances should be repaired. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to stabilize the jaw bone. Clear braces (aligners) without wires may be used in some patients.
It is important to brush and floss your teeth every day and have regular visits to a general dentist. Plaque accumulates on braces and may permanently mark teeth or cause tooth decay if not properly cared for.
You may need a retainer to stabilize your teeth after having braces.
Problems with teeth alignment are easier, quicker, and less expensive to treat when they are corrected early. Treatment is most successful in children and adolescents because their bone is still soft and teeth are moved more easily. Treatment may last 6 months to 2 or more years, depending on the severity of the case.
Treatment of orthodontic disorders in adults is often successful but may require longer use of braces or other devices.
Discomfort during treatment
Irritation of mouth and gums (gingivitis) caused by appliances
Chewing or speaking difficulty during treatment
Calling your health care provider
Call your orthodontist if toothache, mouth pain, or other new symptoms develop during orthodontic treatment.
Many types of malocclusion are not preventable. Control of habits such as thumb sucking may be necessary in some cases. However, early detection and treatment may optimize the time and method of treatment needed.
Paul Fotek, DMD, Florida Institute for Periodontics & Dental lmplants, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.