Occlusion is the relationship of your upper teeth to your lower teeth. It also covers the relationship of your upper and lower jaw. In normal occlusion, the upper teeth protrude slightly outside and below the lower teeth.

Overbite and underbite are common examples of the misaligned jaw where the upper and lower teeth do not meet properly.

If one has a maligned jaw because of some trauma, heredity or any other factors, orthodontic treatment is carried out for its correction.

Symptoms of this include difficulty in biting, poor aesthetics and referred pain. Treatment options for misaligned jaw are braces, headgears, and even surgery.

Causes of misalignment

The relationship of the teeth and jaws is governed by so many factors that it may often be difficult to single out one problematic element. There are multiple causes of misalignment. Some of these are –

  • Genetics – The inheritance of a specific occlusion pattern or growth pattern is responsible for the jaws not aligning. A discrepancy in the ratio of the tooth size and jaw size causes crowding or irregular spacing. (1)
  • Trauma – If a child has had a history of a fall or some injury to the face, it can reflect as misalignment of the entire jaw or a part of it. This depends on the object with which the injury occurred, and also the intensity.
  • Growth Pattern – The growth pattern of the facial bones, and the facial musculature determines occlusion. If the growth of the upper jaw and lower jaw is not as per the physiology, then there are changes in the rate of growth, which in turn causes faulty alignment.
  • Habits – Childhood habits have a high influence on the development of the jaws. Habits like thumb sucking, nail biting or lip biting cause malaligned teeth because of the pressure. (2)
  • Other causes – Sometimes during a forceps delivery, the TMJ of the child is affected. This causes severely misaligned jaws. Other injuries to the TMJ, ankylosis, etc. also secondarily cause problems of occlusion.

Problems due to a misaligned jaw

The effect of misaligned jaws is not confined to the teeth alone. There are a countable number of secondary issues that arise because of the problems in alignment.

  • Chewing problems – The main trouble with having teeth that do not occlude properly is the inability to eat. Since the upper and lower teeth don’t meet as they should, the patient will be unable to bite their food correctly. There can be a deep bite with excessive contact between the teeth, or an open bite, which is incomplete contact.
  • Aesthetics – The jaws form an essential part of the facial appearance, and this is why the aesthetics are so profoundly affected when the jaw isn’t in place. Teeth may be protruding out, or too much of your gums may be visible when you smile. Failure of alignment of jaws could also mean that the front teeth are crooked, which is cosmetically displeasing.
  • Self-esteem issues – Children with orthodontic problems face ridicule from their peers in school and outside. This affects their self-confidence to an extensive level. Consequentially, they become self- conscious and their confidence level dips. Thus it is important to remember that orthodontic treatment is crucial for psychological reasons too.
  • Mouth Breathing – Due to the jaws not being in their correct position, the patient may face difficulty in closing the mouth or even nasal problems which result in mouth breathing. Mouth breathing is not beneficial and causes several oral and respiratory pathologies.

Treatment Options

Orthodontic treatment modalities for any correction depend on many interlinked factors. The age of the patient, (3) the growth pattern, the level of correction desired are some key points that your orthodontist takes into consideration before advising any treatment.

Other criteria to keep in mind include the patient compliance, the overall health status of the patient, and of course the cost factor.

Removable Plates

Some orthodontic corrections can be brought about by individual plates with appliances. Rotation or crowding involving in or two teeth or crossbites are such examples. Removable plates can also achieve minor space closure.

Habit breaking appliances are added to these plates to stop habits like thumb sucking and tongue thrusting. Expansion plates have a screw and key system.

When the arch is narrow, these plates are given to a patient to expand the arch. Your orthodontist will advise you about the schedule for turning the key, to achieve the desired expansion.

Fixed Braces

Braces are the conventional treatment option for alignment of teeth. Small brackets are attached to each tooth, and then wires are passed through them. The desired tooth movement is brought about by force application through these wires.

Braces require a disciplined approach from the patient, as regular dental visits are essential for tightening of the wire. Your dentist will also check if you need to get any extractions to make space for straightening the teeth.

Today there are many modifications for the standard metal braces. Ceramic braces, Invisalign (4) are some options that are more aesthetically favorable for children and adults.

Head Gear & Face Mask

In some cases, the malalignment is so severe that braces are not enough to bring about the desired movement. Headgears are used along with braces.

Protraction headgears bring the upper jaw forward, and retraction headgears are used to move the upper jaw backward. The headgear has straps going over the head and is most effective when the patient wears it for at least 12 hours a day. (5)

A face mask is similar to a headgear and is most commonly used with braces on the posterior teeth of the upper jaw. It is given to a patient to retract the upper jaw.

Surgery

Sometimes the growth stage is unfavorable for appliance therapy. Additionally, some orthodontic misalignments could be so severe that surgical intervention is the only favorable treatment modality.

Orthognathic surgery is the surgery of the jaws. The orthodontist and a maxillofacial surgeon are the specialists who plan and carry out this procedure.

Surgical procedures help to bring about significant movements of the bones or employ some prosthesis to correct the malocclusion. (6)

Cosmetic Treatment

Cosmetic corrections are done if a tooth is only very slightly out of its position, or there is minor rotation or spacing. A veneer or a crown placed over the affected tooth improves the appearance of the entire arch.

Cosmetic treatments are beneficial for aesthetics, but for most functional corrections, a patient has to undergo some orthodontic treatment.

Muscle Exercises

Sometimes your dentist will advise you muscle exercises to relax the jaw muscles. These, done in combination with orthodontic treatment help to improve the alignment.

Over to You

Though orthodontic treatment is a long, time consuming and often uncomfortable process, it is crucial to have your teeth well aligned, for a pleasant eating experience, and for the perfect smile!

The underbite is a common example of the misaligned jaw where the upper and lower teeth do not meet properly. Treatment options are braces, etc.