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 What sounds like a scary term for a lurking dental health-related illness is actually a fairly common term used by orthodontists and simply means that the teeth are not aligned properly. The upper teeth are supposed to land slightly over the lower teeth when a person bites their teeth together. Each molar should fit correctly in the grooves of it's opposite facing molar. The upper fitting into the lower and vice-versa. 

Why is it important for our mouth and teeth to align in this way? Though many people prefer to have the upper and lower teeth fitting together properly for aesthetic reasons, this is also the truly optimal placement of the teeth as it prevents dental problems such as shifting or loosening of the teeth. 

A person that has malocclusion often ends up consulting with an orthodontist after getting a referral from their general dentist. Orthodontists are dentists that specialized their training in correcting and preventing irregular teeth, correct abnormal bites and problems originating with the jaws such as TMJ. Other types of specialized training that orthodontists endure include diagnosing irregularities in facial structure and facial abnormalities. 

Symptoms

Symptoms of malocclusion can vary from person to person and depending on the classification but some commonalities stand out. These include misaligned teeth, abnormal wear and tear on chewing surfaces of the teeth, difficulty chewing or biting food, mouth or jaw pain, and frequent biting of the inside of the cheek when chewing. In addition, a person may also have a facial malformation and could develop a lisp or other speech problems. 

Causes

There is no single cause of malocclusion and often times it's hereditary. The underlying cause may be a size difference between the upper and lower jaws or it might be a result of thumb sucking after the age of five. The shape of the jaw could also be the cause of malocclusion or it might be a result of a birth defect of the mouth like a cleft lip. 

Children that have very little space between their baby teeth are at a higher risk for malocclusion due to there not being enough room when the permanent teeth come in. Malocclusion may occur due to: 

  • Thumb sucking
  • Pacifier use or prolonged use of a bottle for babies 
  • Overcrowding of the teeth 
  • An abnormal bite pattern
  • Extra teeth 
  • Tumors of the mouth or jaw
  • Impacted teeth 
  • Lost teeth from accident or injury 
  • Abnormally shaped teeth or jaw 
  • Ill-fitting crowns, retainers, braces, or other devices. 

Malocclusion Categories

There are varying types of malocclusion so there are now several categories that have been identified for them to fall into. 

Class 1 

This is the most common type of malocclusion where the bite is normal, but the teeth slightly overlap the lower teeth more than they normally should.

Class 2 

This is commonly referred to as an overbite. This occurs when the upper jaw and teeth severely overlap the bottom teeth. 

Class 3 

This is typically referred to as underbite or prognathism. This type of malocclusion happens when the lower jaw juts forward, causing the lower teeth to overlap the upper teeth.

Each type of malocclusion requires a different type of orthodontic device to correct the problem. There are several common types of malocclusions, including:

Overcrowding

This is a common type of malocclusions caused by a lack of space that results in overlapping, crooked teeth. This is the most common type of malocclusion that prompts adults to seek orthodontic treatment.

Overjet

This comes about due to the top teeth extending too far beyond the bottom horizontally. This condition is not considered an overbite; it can result in problems with normal eating and speech.

Overbite

This type of malocclusion occurs when the overlap of the lower front teeth extends beyond what is considered normal. If this type of problem is severe, it could cause the front teeth to hit the gums when a person bites their teeth together.

Crossbite

This occurs when the upper teeth bite down inside the lower teeth; it can occur on one or both sides of the jaw and can involve the anterior (front) or posterior (back) teeth.

Anterior Crossbite

This is also known as an underbite, this is a crossbite that impacts the front teeth.

Spacing

This involves open spaces or gaps between one or more teeth. It can be caused by missing teeth, tongue thrusting, teeth that are too small, thumb sucking, or an impacted tooth, which is unable to erupt normally through the gum.

Open Bite

This occurs when the front teeth do not properly overlap the lower teeth (in the front, this is called anterior open bite).

Diagnosis

Malocclusion is usually diagnosed after a dental history and examination is taken by a dental healthcare provider. They often refer a child to a dentist or orthodontist for a complete assessment. After the dentist or orthodontist will establish treatment goals for milestones to meet in their dental health plan. Tests that help to diagnose malocclusion may include X-rays and impressions. 

Treatment

The exact type of treatment that is ordered for malocclusion is determined by the treating dentist or orthodontist on an individual basis. Several factors are considered, including the age of the person/child, their overall health, their medical history, as well as the severity of the condition.

In addition, the person's tolerance of the patient to endure various treatment modalities (including procedures and therapies) are taken into account in addition to the patient’s or parent’s expectations.

Treatment for malocclusion is often done in phases. 

For example, the initial phase may involve extractions to create more space, the second phase could include braces, and the final phase could involve a functional appliance to keep the teeth in place after treatment.

There are several different treatment modalities for malocclusion, depending on the type of malocclusion and the severity of the problem, these include:

  • fixed appliances (braces) to fix the incorrect position of the teeth
  • tooth extraction to alleviate overcrowding
  • capping, bonding, or reshaping teeth
  • surgery to shorten the jaw or reshape it (performed by a maxillofacial surgeon)
  • plates or wires to stabilize the jaw bone
  • removable mouth appliances to maintain a new position of the teeth (such as after braces), or in some cases to promote the growth of the jaws for an improvement in the alignment of the bite

In Closing 

The National Institutes of Health reports that very few people have perfectly aligned teeth, but in most instances, the malocclusion is so minor, that treatment is not needed. Many orthodontists recommend getting an initial consultation by age seven if a child is suspected of having a malocclusion. This is when problems such as overcrowding, or an uneven bite may be diagnosed. Waiting too long could result in fewer options for treatment as the child gets older. 


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