Malocclusion and Orthodontics

Topic Overview

What is malocclusion?

Malocclusion means having crooked, crowded, or protruding teeth or a "poor bite ." Bite refers to the way the upper and lower teeth line up. In a normal bite, the upper teeth sit slightly forward of the lower teeth. Very few people have a perfect bite.

Crooked teeth can be hard to take care of, which may lead to tooth decay or tooth loss. When malocclusion is severe, it can even cause problems with eating or speaking.

Orthodontic treatment can correct the way teeth and jaws line up, and that may help a person feel better about his or her appearance. Dentists who are specially trained to correct malocclusion are called orthodontists. They use a variety of tools and techniques to move teeth, and sometimes the jaw, into the right position.

What causes malocclusion?

Malocclusion is usually caused by problems with the shape or size of the jaw or teeth. A common cause is having too much or too little room in the jaw. If a child's jaw is small, the teeth may grow in crowded or crooked. If there's too much space in the jaw, the teeth may drift out of place.

Other causes of malocclusion include thumb-sucking, pacifier use, and tooth loss. Long-term mouth breathing seems to be linked to malocclusion too, but how isn't exactly clear.

What are the symptoms?

The most obvious sign is teeth that are crooked or stick out. But there are many different types of malocclusion. For example, some people have buck teeth (called an overjet). This means that the upper front teeth are pushed outward. Some people have an underbite. Their lower front teeth sit farther forward than their upper front teeth.

How is malocclusion diagnosed?

A dentist usually checks for malocclusion in children during regular dental visits. If the jaw or teeth are out of line, the dentist may suggest a visit to an orthodontist.

An orthodontist will:

  • Ask questions about your or your child's past health.
  • Check the mouth and teeth.
  • Take X-rays and photos of the face and teeth.
  • Make a plaster model of the teeth.

Start taking your child for dental checkups within 6 months of the eruption of the first tooth or at 12 months of age, and get regular checkups as your child grows. This will help the dentist find any problems early. It will also help your child get used to seeing a dentist.

How is it treated?

In children and teens, crowding in the mouth is the most common problem. So the first step in treatment may be to remove some baby teeth to make room for the permanent teeth to grow in. Orthodontists avoid removing permanent teeth when possible.

Some children may need an early treatment called functional appliances. For this, the child wears a device that helps move the jaw into a better position. This treatment works best during a child's growth spurts.

The next step is to attach braces. Braces slowly move the teeth to correct the bite. They can also help move a child's jaw into the right position.

Braces can successfully straighten an adult's teeth too. But the only way to correct an adult's jaw problem is with surgery.

Teeth naturally tend to drift out of place, even after treatment with braces. So you may need to wear a device in your mouth called a retainer to keep your teeth from moving. Some people need to use retainers for many years after treatment.

What else should you know about orthodontic treatment?

Orthodontic treatment often takes about 2 years, but it can take longer than planned. Treatment usually takes longer for an adult than for a child. Ask your dentist how long treatment may last for you.

If your orthodontist says you need surgery for a jaw problem, think about getting a second opinion from another oral surgeon or orthodontist. This can give you more information and help you make a decision that feels right for you.

Braces and other types of orthodontic treatment cost a lot. Many dental insurance plans will cover some of the cost. Before you start treatment, make sure you know how much it will cost and how you will pay for it. Ask if your orthodontist offers a payment plan that can help you fit the expense into your budget.


Other Works Consulted

  • American Academy of Pediatric Dentistry (2011). Guideline on management of the developing dentition and occlusion in pediatric dentistry—Revised 2009. Pediatric Dentistry, 33(6 Reference Manual): 229–241. Also available online:
  • Christensen JR, et al. (2005). Oral habits. In JR Pinkham et al., eds., Pediatric Dentistry: Infancy Through Adolescence, 4th ed., pp. 431–439. St. Louis: Elsevier Saunders.
  • Sarver DM, Proffit WR (2005). Special considerations in diagnosis and treatment planning. In TM Graber et al., eds., Orthodontics: Current Principles and Techniques, 4th ed., pp. 3–70. St. Louis: Elsevier Mosby.


Adaptation Date: 9/23/2021

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC

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