Malocclusion: When Teeth Don’t Align

Alignment is what keeps us from biting our cheeks and lips. Properly aligned teeth also let us chew and speak properly and allow for proper cleaning to prevent decay.

Another name for badly aligned teeth is malocclusion. This simply means that the teeth of the upper and lower jaws don’t connect properly with the teeth of the lower jaw. Different types of malocclusion include overbites, underbites, and uneven bites.

Malocclusion causes many problems. These include trouble biting or chewing, speech difficulties such as lisping, mouth breathing, jaw pain, unhealthy gums, and an unattractive appearance.

Who Gets Malocclusion?

Children may inherit a family trait of malocclusion because of the size and shape of their face, jaws, and teeth. Or they can develop it from using a bottle or pacifier too long, thumb sucking, losing baby teeth too early or late, or from an accident.

Sometimes both inherited and later problems are to blame. Signs your child might have a malocclusion include crowded, misplaced, or oversized teeth; or jaws that shift or make sounds.

How Is It Diagnosed?

Your child’s dentist may notice your child’s malocclusion and refer you to an orthodontist.

Don’t wait to see an orthodontist until all your child’s permanent teeth have come in. In fact, it’s easier, faster, and less expensive to treat a malocclusion during early childhood.

To diagnose your child’s malocclusion, the orthodontist may suggest several procedures:

  • Impressions of the teeth to make plaster models. These models, taken at various times during treatment, also show progress.
  • Photographs of the face and teeth to make a record of treatment.
  • Several types of X-rays. A panoramic X-ray shows the teeth in biting position, while a special head X-ray indicates the relationship of the teeth and jaws to the face and skull.


An orthodontist may try to prevent your young child’s malocclusion from developing. Preventive treatment means leaving enough space for permanent teeth to come in. This may require a space maintainer to take the place of a baby tooth lost too early. Or the orthodontist might remove primary teeth that don’t come out on their own.

The second type of treatment, called interceptive treatment, aims to keep a developing malocclusion from getting worse. The orthodontist may guide emerging permanent teeth into alignment by:

  • Removing teeth
  • Reducing the size of teeth
  • Holding space for permanent teeth

Comprehensive orthodontic treatment means correcting a malocclusion and making sure that the jaw works well. This treatment may take place in several phases.

Two types of appliances can correct the malocclusion. Removable appliances made of wires and plastic are easy to keep clean. But to do their job, they must be worn exactly as instructed. Fixed appliances, called braces, control tooth movement better than removable appliances. But food collects around braces. So children wearing braces must be especially careful about cleaning their teeth.


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