What is malocclusion?

Malocclusion means your teeth and jaw do not line up right when you bite or chew. This can occur if you have extra or missing teeth, crooked teeth, or an overbite. It can also happen when the upper and lower jaws grow at different rates. This causes the jaws to not match each other as they should. Some types of malocclusion only affect your looks. But severe types can keep you from chewing or speaking normally.

A special dentist called an orthodontist can fix your bite. This may be done by removing teeth, applying braces or other appliances, or adjusting the jaw. This is much easier in children than in adults.

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

Orthodontic treatment can correct the way teeth and jaws line up. That may help a person feel better about their appearance, and also makes the teeth easier to take care of. 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.

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 growth modification. 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.

Braces or other devices can be used to slowly move the teeth to correct the bite. This can also help move a child's jaw into the right position.

Braces or other devices can straighten an adult's teeth too.

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.

Growth modification (early treatment) is part of the first phase of two-stage orthodontic treatment of children with malocclusion (poor bite). Growth modification is only possible when bones are still growing. It is most effective during children's growth spurts.

Orthodontists use growth modification devices (appliances) to change the position, shape, length, or width of the jawbone(s). Some common devices are:

• Headgear. This is an appliance that uses pressure to guide teeth and jaw growth.
• Herbst device. This appliance is attached to the upper and lower molars. It corrects overbite caused by a small lower jaw.
• Bionator. This is a removable appliance that guides teeth and jaw growth.
• Palatal expander. This appliance corrects cross bite by widening the upper jaw.

What to think about

Ideal timing of treatment varies depending on what the condition is, when adult teeth come in, and how much growth is needed to correct the malocclusion. Many children who start growth modification in second or third grade are finished with orthodontic treatment before they start high school.

Children are often more cooperative than teens when it comes to wearing their appliances for a certain number of hours a day. And children don't seem to mind closer parental supervision as much as teens do.

Because the jaw continues to grow during childhood and adolescence, growth modification doesn't always last. Some teens and adults keep their new jaw structure and size. But others have only short-term improvement. Relapse can also occur after treatment with braces alone.

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 or digital image of the teeth.

Take good care of your teeth. Get regular dental checkups. Brush and floss your teeth every day. If you have braces, your dentist can give you a special tool for flossing. Use toothpaste that contains fluoride to keep your teeth strong. If braces cause pain, try an over-the-counter pain medicine, like acetaminophen.

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.