Malocclusion means having crooked teeth or
a "poor bite."
Orthodontic treatment can correct the way teeth
and jaws line up. Dentists who are specially trained to correct malocclusion
are called orthodontists. They use a variety of treatment tools and techniques
(including braces) to move teeth, and sometimes the jaw, into the
What causes malocclusion?
A common cause of
malocclusion is teeth that have too much or too little
room in the jaw. If children have a small jaw, their teeth may grow into a
space that is too small. As a result, teeth may grow or drift out of
Other causes of crooked teeth include thumb-sucking,
pacifier use, and tooth loss.
What are the symptoms?
The most obvious sign is teeth that are crooked
or stick out. Malocclusion can range from mild to severe. Most of the time,
having crooked teeth is only a cosmetic problem, meaning people don't like the
way their teeth look. But in severe cases, it can cause problems with eating or
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. The American Association of
Orthodontists recommends that all children get a checkup with an orthodontist
by age 7.
An orthodontist will:
Ask questions about your or your child's past
Check the mouth and teeth.
X-rays of the face and teeth.
Take photographs of the face and
Make a plaster model of the teeth.
Start your child's trips to the dentist at age 12 months.
This will help your child get used to seeing a dentist. It will also catch any
early problems. Keep up with regular dental checkups 2 times a year.
How is it treated?
In children and
teens, the first step in treatment may be to take out certain teeth to make
room for teeth that may still grow in.
The next step is to attach
braces to teeth to straighten out the
bite. In addition to straightening teeth, braces can
help move a child's jaw into the right position.
Teeth tend to
move forward as you age, even after treatment with braces.
Retainers are devices you wear in your mouth to keep
your teeth from moving. Some people need to use retainers for many years after
Adults can successfully straighten their teeth with
braces. But the only way to straighten an adult's jaw is with surgery.
Braces and other types of orthodontic
treatment cost a lot. Most insurance plans don't pay for them. Before you start
treatment, make sure you know how much it will cost and how you will pay for
(poor bite) is usually caused by problems in the shape or size of the jaw or
teeth. If children have a small jaw, their teeth may grow into a space that is
too small. Under these crowded conditions, teeth will push each other out of
proper position. Other causes include thumb-sucking, pacifier use, and tooth
People can inherit mismatched
traits such as jaw size and tooth size. This can produce large, crowded teeth
in a small jaw or small teeth that
drift out of place in a larger jaw. In other cases, a
person may inherit a trait that results in missing teeth or teeth that erupt in
one another's place (transposed teeth). More rarely, people are born with
conditions (congenital) that can create malocclusion problems, such as a
cleft palate or a severely underdeveloped upper or
Oral habits that place ongoing or
frequent pressure on the teeth may slowly move the teeth out of place. The most
common oral habits that cause malocclusion include:
Mouth breathing (possibly). Infants and children may
breathe through their mouths because of a partially blocked airway.
Tooth loss may cause drifting of
bordering teeth into the empty space, creating a poor bite. Common causes of
tooth loss are:
Trauma, such as sports injuries and
automobile and falling accidents.
Tooth decay that leads to having
a tooth pulled (extracted) by a dentist. Poor dental hygiene promotes tooth
decay, as does a child sucking on a bottle during sleep. The sugars in milk,
juice, and formula can cause damage to teeth. For more information, see the
The most obvious sign of
malocclusion is crooked or protruding teeth. Physical
symptoms of malocclusion are uncommon but can range from mild to severe. Have
your general or pediatric dentist evaluate whether a poor bite is
Problems chewing food.
Problems with biting the
cheek or roof of the mouth.
Slurring speech, trouble saying certain
words, or other speech problems.
Pain in the facial muscles or
Permanent teeth coming in (erupting) at the wrong position.
Adult malocclusion symptoms will typically remain the same
or get worse over the years. Symptoms in a child who has mild malocclusion may
improve over time. Through the teen years, the jaw grows dramatically. This
growth period may correct mild crowding of teeth or teeth shifting as a result
Teeth that are naturally
perfectly aligned are rare. A poor fit and alignment of the teeth (malocclusion) can range from mild to severe. Mild
malocclusion causes no medical or functional problems
and little cosmetic concern. But severe malocclusion may cause difficulty
with eating and speaking. Some people are embarrassed or self-conscious about
crooked or protruding teeth.
Crowding is the most common type of
malocclusion. In children, early crowding of permanent teeth can prevent new
teeth from coming in properly or from erupting at all (impaction).
types of malocclusion may improve as a child's jaw grows and changes. But
there are many conditions that don't improve without treatment. These usually
involve the size or position of the jaw (such as an
underbite or an unusually narrow lower jaw).
With or without orthodontic treatment, the teeth have a normal tendency
to slowly drift toward the front of the jaw. This may lead to crowded lower
front teeth (incisors).
Sucking on a baby bottle during sleep. The
sugars in juice, milk, and formula can cause tooth decay.
When To Call a Doctor
Call your dentist or orthodontist immediately for a dental emergency, such as the loss of a
tooth or if a broken orthodontic device (appliance) prevents you from opening
or closing your mouth. For more information, see the topic
Mouth and Dental Injuries.
Call for an appointment with your orthodontist or dentist if
nonprescription pain relievers don't ease appliance-related pain or if your
appliance has loose brackets or bands, distorted wires, or wires that are too
long and irritate the inside of your cheeks.
Start your child's dental visits at a young age, both to
help your child become familiar with a dentist and to watch for any early
malocclusion problems. Keep up with regular dental
checkups (twice a year). For more information, see the topic
Basic Dental Care.
Watchful waiting is when you and your doctor
watch symptoms to see if a health condition improves on its own. If it does, no
treatment is needed. If symptoms don't get better or get worse, then it's
time to take the next treatment step.
Watchful waiting is often
fine for children who have malocclusion. Keep in mind that the early years, when
the jawbone is still growing, are the best time for
braces. Some people wait until they are adults before
straightening their teeth. After you talk with a dentist or orthodontist about
your or your child's situation, it's usually up to you to decide the timing of
Who to see
dentist or a pediatric (children's) dentist can give
dental care, a first checkup for orthodontic treatment, and simple orthodontic
Dentists who have 2 years or more of extra training
in a specific area treat more complex dental problems. Dental specialists who
treat different aspects of malocclusion are:
During routine dental visits, your
dentist typically looks for developing
malocclusion. Talk with your dentist about any oral
habits (such as a child's use of a pacifier) or problems with speech,
chewing, or pain. Your dentist may suggest an orthodontic evaluation.
Asks questions about your or your child's
medical and dental history. He or she may ask if you have any allergies,
especially to latex or nickel.
Conducts a clinical exam, looking at
Condition of teeth and
Placement of the teeth in the
Fit between the upper and lower teeth.
dental X-rays, including panoramic (full view) and
profile X-rays, to check the jawbone and dental structure and to identify:
Where the permanent teeth are in relation
to the primary (baby) teeth.
Any missing teeth or teeth that are
blocked and unable to come in properly (impacted).
The condition of
The amount of bone supporting the teeth.
Estimates a child's skeletal age and projected
growth using an X-ray image of the wrist.
Photographs the face and
Creates a plaster model of the teeth.
Orthodontic treatment uses appliances, tooth removal, or surgery to fix the way
teeth and jaws are aligned. There are many ways to treat poor bite (malocclusion). Expert opinions differ about when to
start treatment. Your dentist or orthodontist may give you a choice between
early or later treatment or may prefer one specific approach.
general categories of orthodontic devices (appliances) are functional and
Functional appliances use the
muscle action from speaking, eating, and swallowing to create forces that move
teeth and align the jaws. See a picture of a
Some functional appliances are removable, while
others are bonded to the teeth.
A functional appliance may fit
between the upper and lower teeth (a splint) or may span across the mouth
between the molars, pressing the bone outward.
Fixed orthodontic appliances are
sets of wires and brackets cemented to the teeth. These are commonly called
braces. Over a period of about 24 to 28 months, the
wires are tightened and adjusted, gradually applying enough force to move the
teeth (bone movement).
Retainers are removable
appliances made of molded plastic and wire. They hold the teeth in place after
braces are taken off. If the teeth start to move back out of position, the
orthodontist may bond a short retaining wire to the back of some teeth. This
wire will hold the teeth in place.
Child and teen treatment
The aim of
treatment in the childhood and teen years is to move permanent teeth into
place. The orthodontist will time the treatments to match your child's natural
Treatment for crowding, the most common
malocclusion problem, may mean removing (extracting) some permanent teeth. But
orthodontists avoid removing permanent teeth when they can.
malocclusion treatments for children and adolescents are:
(serial removal). Removing some baby teeth may ease
This involves wearing fixed or functional appliances during the day and night
to move the jaw into a better position.
Fixed appliances (braces) gradually move the teeth. For
children and teens, this treatment phase usually lasts about 24 months; for
adults, about 28 months.
Retainers. Retainers hold the teeth in
place after orthodontic treatment. Some orthodontists recommend that retainers
be worn for many years, because teeth have a natural tendency to drift out of
Space maintainers, made of metal or plastic. Spacers keep
the surrounding teeth from moving (drifting) into open spaces created when
teeth are pulled or lost in an accident.
Orthodontic treatment for
malocclusion is a popular option for adults, due in part to better technology.
In the past, wide silver bands held braces in place. Today they are less
obvious. Instead of the wide bands, a small metal or ceramic fastener is bonded
to each tooth, and a narrow wire passes through the fasteners.
New options include:
Clear plastic instead of silver
Lingual braces. These braces attach to the back of the front
Removable clear plastic aligners (Invisalign). These are
molded specifically for you.
Lingual braces and aligners don't work for everyone. They
aren't options for children. Your orthodontist can tell you the best choices
for your situation.
Orthodontic treatment for adults may also
Removal (extraction) of teeth to create more
Adjustments, such as grinding
of high tips of teeth, to prevent continued or increased malocclusion for
Most adults have little or no jaw growth. This means
that surgery is the only way to correct jaw-related bite problems. Some adults
may benefit from simply camouflaging, or hiding, a jaw-related problem. Using
braces, the orthodontist can move the teeth so that they fit together, despite
the jaw discrepancy. But surgery is the best way to treat more severe jaw
What to think about
Some cases of malocclusion
clearly require orthodontic treatment to straighten teeth. In many cases,
though, the decision is a matter of personal choice. Besides looking nice,
straight teeth can improve how you bite, chew, and speak. They are also less
prone to decay, gum disease, and injury.
timing of treatment is ultimately up to you and your
child or teen. Talk with your orthodontist about the pros and cons of treatment
Orthodontic treatment isn't an exact science. The
average treatment time is about 2 years, but it can take longer than planned.
Usually, adult treatment takes longer than a child's treatment. The treatment
time can vary, so ask your dentist how long it may last for you.
After treatment ends, teeth often begin to shift. Molded plastic
retainers, usually worn at night, help prevent this tooth movement. You may
need a retainer for an indefinite amount of time.
treatment is costly. Most medical and dental insurance plans don't pay for
orthodontics. Before deciding on treatment, ask about the projected cost, terms
of payment, and terms of the treatment contract.
treatment doesn't pose risks to adults who have healthy teeth and gums. But adults
gum (periodontal) disease must first get
treatment from a periodontist to avoid possible gum damage or tooth loss.
Orthodontic treatment sometimes can make preexisting gum conditions
You can take steps to prevent tooth loss,
which can lead to
Prevent tooth decay by practicing
good oral hygiene and getting regular dental cleanings. For more information,
see the topic
Basic Dental Care.
Avoid putting a baby or
toddler to bed with a bottle. The sugars in the liquid can cause tooth
See your dentist right away (within 2 hours) if you lose a
Early dental visits are needed for good preventive dental
care. And it can help your child feel more comfortable at the dentist's office
The American Academy of Pediatric Dentistry recommends that
children be first checked for developing malocclusion between the ages of 2 and
The American Association of Orthodontists recommends
that children have an orthodontic screening by age 7. A pediatric dentist may
refer a child to an orthodontist when a dental evaluation suggests the need for
Your orthodontist will give you instructions on
caring for your teeth during treatment. These may include:
Avoiding sticky and hard foods, such as gum,
taffy, and nuts.
Taking vitamins with fluoride.
retainer—a piece of molded plastic and wire
(orthodontic appliance) worn in the mouth to hold the teeth in place after
orthodontic treatment—as often and as long as recommended.
Carefully brush your teeth after meals and snacks.
If your child has crooked or protruding teeth from an oral
habit such as
thumb-sucking, his or her teeth may begin to return to
normal position when the habit stops. You can help your child stop an oral
habit. For more information, see the topic
For tooth pain from newly installed or adjusted braces for
malocclusion, take regular doses of nonprescription
pain medicine, such as
acetaminophen, for 3 to 5 days. Be safe with medicines. Read and follow all instructions on the label. Do not give aspirin to anyone younger than 20 without
a prescription because of the risk of Reye syndrome, a serious illness that can
cause severe liver and brain damage.
Surgery may be the only viable
treatment for severe jaw-related problems. Surgeons only perform jaw surgery on
adults, after the jaw has stopped growing.
Before deciding on
orthognathic surgery, consider getting a
second opinion from another surgeon or
Some adults with
malocclusion may prefer to replace all or part of a
tooth by having restorative dentistry, which is less costly and less
time-consuming than orthodontic treatment.
Other treatment choices
crown (restorative dentistry) can improve the
appearance of front permanent teeth (incisors) that are properly spaced but
What to think about
The timing of treatment is
ultimately up to you. If you have different treatment options, interview your
orthodontist or dentist about the pros and cons of each option.
Orthodontic treatment isn't an exact science. Treatment can sometimes
take longer than planned. If teeth are likely to move after
braces are removed, you may need to use a
retainer for several months or years.
Other Places To Get Help
American Academy of Pediatric
211 East Chicago Avenue
Chicago, IL 60611-2637
The American Academy of Pediatric Dentistry (AAPD) is
the membership organization representing the specialty of pediatric dentistry.
The AAPD parent resource center has information about how to prevent and treat
child and adolescent dental problems.
American Association of
401 North Lindbergh Boulevard
St. Louis, MO 63141-7816
This website offers answers to frequently asked
questions about orthodontics, information about financing dental care, a
glossary of orthodontic terms, and links to other orthodontic Web sites. It
also has before-and-after photos of people who have had braces.
American Dental Association
211 East Chicago Avenue
Chicago, IL 60611-2678
The American Dental Association (ADA), the professional
membership organization of practicing dentists, provides information about oral
health care for children and adults. The ADA can also help you find a dentist
in your area.
KidsHealth for Parents, Children, and
Nemours Home Office
10140 Centurion Parkway
Jacksonville, FL 32256
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
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: http://www.aapd.org/media/Policies_Guidelines/G_DevelopDentition.pdf.
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.
How this information was developed to help you make better health decisions.