Malocclusion in Children

Overview

Malocclusion is when a child's teeth become crooked or crowded. The child may also have a problem with their bite. That means the teeth of the upper jaw don't meet normally with the teeth of the lower jaw when the jaw is closed.

Causes

Malocclusion can sometimes be caused by an injury to the jaw. But it's often the result of many different things. It may be from genes, the environment, or both. Malocclusion can develop as a child grows. Malocclusion may also be seen in people who grind their teeth often. Teeth grinding (bruxism) may be seen in people with stress, anxiety, or anger issues.

Risk Factors

Children who suck their thumbs or fingers after age 5 have a greater chance of developing malocclusion. Children who often push their tongue up against their front teeth can cause a malocclusion over time. Children with a very small space between their baby teeth are at risk, too. They may have problems with malocclusion when their permanent teeth come in. This is because the permanent teeth are larger and need more space. Also, loss of permanent teeth can cause the nearby teeth to shift position.

Symptoms

A child with malocclusion has crowded or crooked teeth. They may also have 1 of these bite problems:

• Overbite. The front teeth in the upper jaw stick out over the teeth in the lower jaw.
• Underbite. The teeth in the lower jaw stick out over the teeth in the upper jaw.
• Open bite. The front teeth don't meet when the jaw is closed.
• Crossbite. The top teeth sit behind the bottom teeth.

Malocclusion may cause a child to have:

• Problems eating or speaking
• Teeth grinding
• Loss of baby teeth too soon or very late
• Mouth breathing
• Tooth decay
• Gum disease
• Jaw joint problems

Diagnosis

Your child's healthcare provider can often diagnose malocclusion with a full health history and physical exam. They will likely refer your child to a dentist or an orthodontist for complete evaluation and treatment. Orthodontists are specially trained dentists. They treat the irregularities of the teeth, bite, and jaws.

Your child may also need:

• X-rays. This test makes images of internal tissues, bones, and teeth.
• Impressions of the teeth. These are imprints of the teeth made with plaster poured in a mold. They help evaluate the malocclusion.

There is no specific system to say how much misalignment is too much. Your child's orthodontist will decide if your child's bite needs to be fixed.

Treatment

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is.

The goal of treatment is to straighten the teeth, correct the bite, and improve the look of your child's smile. Treatment is sometimes done in phases depending on the extent of the malocclusion. It may include:

• Tooth removal. Your child's baby teeth may need to be taken out to make room for the permanent teeth. Some permanent teeth may also be removed.
• Jaw surgery. In some cases, your child may need jaw surgery to fix the bite problem when the bones are affected.
• Mouth appliances. These may be removable (a retainer or plastic tooth aligners). Or they may be fixed (braces). A retainer is made of wires and plastic. Tooth aligners are made of clear plastic. They both can be put in and taken out. It must be cleaned on a regular basis. Braces are small brackets attached to the teeth and connected with a wire. By tightening the wire over time, the orthodontist is able to slowly straighten the teeth and correct the bite. Braces can also be made of ceramic and look enamel-like in color so they're less noticeable.

If your child needs a mouth appliance, they may need to limit some activities. Discuss this with your child's dentist or orthodontist. Your child shouldn't eat the following foods while wearing any type of mouth appliance:

• Gum
• Sticky foods
• Peanuts or other nuts
• Popcorn
• Ice

Key Points

• Malocclusion is when a child's teeth are crooked or crowded.
• It causes the upper and lower jaws to not meet correctly when closed. The child may also have a problem with their bite.
• Many different things often help lead to malocclusion, such as genes. Children older than age 5 who suck their fingers are more at risk for it.
• It may cause trouble eating, breathing, and speaking. Some children may also have gum disease and jaw joint problems.
• X-rays and impressions of the teeth can help diagnose malocclusion.
• Treatment may include tooth removal and a mouth appliance.

Next Steps

Tips to help you get the most from a visit to your child's healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also, know what the side effects are.
• Ask if your child's condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child's provider after office hours. This is important if your child becomes ill and you have questions or need advice.