What is Malocclusion? Causes, Symptoms, & Treatments

Centuries ago, our ancestors had jaws that were much larger and could comfortably accommodate all the 32 teeth with proper alignment, making it an ideal occlusion. But due to dietary and genetic changes, the size of the jaw shrunk over time, and it became difficult to provide space for all the teeth to erupt.

Today, one among every five people experience malocclusion due to malalignment of the teeth in the jaw. (1) Often these malalignments do not cause any significant dental problems, but in some cases, it may require a referral to a dental specialist to correct it.


Severe malocclusions translate destructive forces from the misaligned teeth into the ligaments and bone that hold the teeth in place and negatively affect oral health. Correct alignment and a functional occlusion are essential to maintain the oral health and longevity of vital teeth in the mouth. Let’s learn about malocclusion and its effects on oral health and look out for various treatments available to correct it.

What is malocclusion?

Occlusion refers to the alignment of teeth in the jaw. Ideally, the teeth should easily fit in the jaw without the presence of crowding or spacing.

The upper teeth overlap the lower teeth, helping the pointed ridges of molars to fit into the grooves of opposite molars.

Malocclusion is referred to as a misalignment or improper relation between the teeth in the two dental arches that are the maxilla and the mandible.

This condition produces a change in the bite while closing the jaws. (2)

Several types of misalignments may lead to a change in ideal occlusion –

What causes malocclusion?

Malocclusion is hereditary and can be inherited from one generation to the next. Some other factors that may lead to misalignment and eventually malocclusion may include –

  • Congenital deformities like cleft lip and palate
  • Prolonged use of bottle feeding and pacifiers after the age of three years
  • A habit of thumb sucking
  • A difference in the size of the jaw and the teeth
  • Dental trauma or injuries that may change the alignment of the teeth
  • Tumors in the jaw
  • Impacted teeth or abnormally shaped teeth
  • Improper dental restorations, ill-fitting crown, and bridges
  • Enlarged tonsils or adenoids that may cause a habit of mouth breathing

What are the symptoms of malocclusion?

Proper alignment of the teeth aids in effective chewing as the biting force equally distributes all over the teeth. Also, properly aligned teeth protect the health of the surrounding oral tissues.

Any disturbance in this ideal balance causes malocclusion which may lead to fracture of teeth and deteriorate the health of the gums and the underlying bone over time.

The effects of malocclusion on oral health depends on its severity. Typically, a malocclusion may cause –

  • Improper alignment of the teeth causing crowding and rotation of the teeth
  • Increased tooth wear and sensitivity
  • Change in the ideal bite
  • Alteration in the appearance of the face
  • Muscle pain and discomfort while chewing
  • Increased incidence of cheek and tongue biting
  • Speech problems that may often include the development of a lisp
  • A habit of mouth breathing
  • Chronic headaches

How is malocclusion diagnosed?

A complete dental examination will determine the contribution of malocclusion to the surrounding teeth and gums.

This may include the presence of chipped or fractured teeth, fractured fillings and rotated or crowded teeth.

The dentist may require a series of dental x-rays, photographs, and impressions to make a study model of the jaws.

In the case of TMJ pain, a CT scan may be required to detect the area of the problem.

With the help of these records, the dental professional can form a treatment plan to improve the occlusion and eliminate all the dental problems effectively.

What are the types of malocclusion?

The malocclusion may typically be diagnosed and classified into 3 major classes –

Class I malocclusion

Class I malocclusion is the mildest of the three types and is the most common type of malocclusion among the population.

In this type, the bite remains ideal, i.e., the upper teeth properly overlap the lower teeth, but there may be minor tooth rotations and mild crowding of the teeth in each dental arch.

Class II malocclusion

Class II malocclusion, also referred to as Retrognathia, can be diagnosed when there is a severe overbite.

In this type the lower front teeth are placed significantly behind the upper front teeth, giving the appearance of buck teeth or protruded upper teeth. (3)

Such malocclusion often changes the appearance of the face. Also, it initiates the habit of mouth breathing and significantly affect the health of the upper front teeth.

Class III malocclusion

Class III malocclusion also referred to as Prognathia is diagnosed when there is a severe underbite. In this, the lower front teeth may overlap the upper front teeth. This type of occlusion is also called as a crossbite. (4)

The chin becomes prominent as the lower jaw is positioned ahead of the upper jaw and affects the facial profile of the patient.

How can it be treated?

The treatment of the malocclusion depends upon the severity and type of misalignment present in the mouth.

Often mild malocclusions may not require any dental intervention. However, in case of severe malocclusions, a dentist may refer you to an orthodontist to correct the bite and misalignments.

Typically, orthodontic treatment may include –

  • Use of orthodontic braces to correct the crowding, rotations, and alignment of all the teeth (5)
  • Removal of particular teeth, mostly the first premolars to provide space for the braces to work effectively
  • Reshaping, bonding or capping of individual teeth to straighten them
  • Orthognathic surgery to correct the shape and position of the jaw that may include the use of wires and plates to stabilize the corrected jaw (6)

Whatever the type of treatment may be, it is always mandatory to maintain oral hygiene to the best possible standard.

Take away message

Occlusion is the relationship between upper and lower teeth since they come in contact while biting. The way these opposing teeth surfaces occlude together affects the health of the teeth, surrounding gums and the underlying bone.

Malocclusions also affect the health of the muscles of the mouth and TMJ joint.


Usually malocclusions are left undetected and they destruct the tooth structure over time.

Therefore, regular dental visits are advised to keep a check on any change in the alignment of the teeth and detect the underlying habits that may interfere with a healthy smile.

It is never too late to address the issue of a malocclusion. A dentist or an orthodontist are trained to help people of any age and correct their malocclusion to provide them with a healthy and beautiful smile.


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