Introduction

Malocclusions also known as bite problems, are the misalignment of teeth and the jaw that can lead to serious oral complications in the future. Malocclusion can be treated with orthodontics or braces; however, serious complications may require surgery.

There are three classes of malocclusion based on teeth misalignment:

1. Class I: This is the most common type referring to the normal molar relationship and positioning of the jaw.
2. Class II refers to an overbite and is characterised by upper molars that are too far forward compared to the lower molars.
3. Class III: Refers to an underbite or a prognathism when the lower jaw protrudes forward.

Read on to learn the classifications of bite problems, their causes, and their treatments.

Types of bite problems

Types of Bite	What is it?	Causes	Complications	Example 3
Underbite	Occurs when lower teeth extend beyond the top teeth2	- Genetics - Injury - Tumour - Bad habits in childhood i.e, sucking the thumb	They can cause problems with your teeth and jaw which may even lead to trouble speaking and chewing.
Overbite	When upper and lower teeth come in contact with each other5	- Genetics - Teeth grinding - Using a pacifier past the age of 3	Overbite can lead to health complications such as jaw pain, earaches, headaches, gum disease and tooth decay.
Crossbite	Occurs when your upper teeth bite inside your lower teeth or they bite into an incorrect overlapping position1	- Genetics - Baby teeth did not fall out during primary years. - Adult teeth are delayed	Issues that can arise with a crossbite are sleep apnea, tooth decay, difficulty speaking and temporomandibular joint (TMJ) disorders.

Diagnosis of bite problems

Diagnosing the type of bite involves a comprehensive evaluation by a dentist or an orthodontist. The diagnostic process requires evaluation of the dental and skeletal structures, as well as functional assessment and analysis of bite dynamics.

Clinical examination

During a clinical examination, the orthodontist or dentist will visually inspect the misalignment of the upper and lower teeth. They will examine your bite when your mouth is at rest (static) and when you're biting and chewing (dynamic). Moreover, they will assess jaw movement by observing the range of motion and signs of TMJ, including clicking and tenderness. This will provide a clear understanding and identification of the presence of the type of bite you have and its severity.

Medical and dental history

Dental history will illuminate previous orthodontic treatment, habits or conditions that may have contributed to the bite you have.

X-rays and imaging

Extraoral X-rays such as panoramic, cephalometric and CT scans may be taken to provide a detailed view of the teeth and jaw structures. This is when a film or sensor is outside your mouth.

• Panoramic X-ray will show the overview of the structure in your mouth on a single image ⁴.
• Cephalometric X-ray will reveal the location of your teeth in relation to your jaw by showing your entire head from the side ⁴.
• Cone beam CT scan will provide a three-dimensional visualisation of the teeth and jaws confirming the presence of anomalies, impactions or tumours contributing to the malocclusion ⁴.

Treatment process

Treatment options are dependent on its severity, individual factors and the patient's age. These are the treatment options for each type of malocclusion:

Overbite⁵

• Orthodontic braces: Traditional braces are beneficial in treating overbites. They can be used to gradually move the teeth in proper alignment, reducing the severity of the overbite. The braces consist of brackets attached to the teeth and are connected by archwires. They are adjusted periodically to achieve the desired results.
• Invisalign: Clear aligners that offer a discreet alternative to traditional braces. These are custom-made, removable aligners that are worn over the teeth to gradually shift teeth into the correct position. They can be removed for brushing, flossing, and eating.
• Surgical correction: In severe and complicated cases of overbites due to skeletal discrepancies, surgery may be recommended.  This is performed by a maxillofacial surgeon who can reposition the upper and lower jaws to achieve proper alignment.

Underbite²

• Braces: Similarly to the treatment of an overbite, braces are also used to treat an underbite.
• Tooth extraction: If there are too many lower teeth, causing them to protrude. The orthodontist may recommend having extra teeth pulled to fix your underbite. 
• Upper jaw expander: A wire-frame device across your palate will be fitted. A key will be used to widen the expander, gradually causing the upper jaw to widen until the lower teeth can no longer close against the outside. This is typically worn for a year and replaced with a retainer.
• Chin Augmentation: In specific cases where the lower jaw is disproportionately small, chin augmentation with implants may be recommended to improve the facial profile and fix the underbite.

Crossbite¹

• Palatal expanders: Widening the upper jaw palatal expanders if a small upper jaw is not fitting well with the lower jaw resulting in a crossbite.
• Tooth removal: Extracting teeth to create more room to move the lower teeth may be recommended by the orthodontist before fitting braces.
• Headgear: The headgear is attached to your head and face. This will apply gentle pressure on the teeth with wires. The pressure on the teeth and jaw can increase the jaw's growth.

Treatment for malocclusions is individualised and may involve a combination of orthodontic treatment or surgical intervention to correct the alignment of your teeth. It is important to undergo a thorough examination by an orthodontist or oral surgeon to determine the most appropriate treatment plan for each patient. Do not try to fix your own teeth without seeking guidance as this can complicate procedures and lead to unnecessary risks towards your health.

After care maintenance

After undergoing treatment for bite problems, it is crucial to follow the guidelines of aftercare to ensure long-term stability. It is important to attend your regular check-up appointments to allow the orthodontist to monitor your progress and make any necessary adjustments.  Proper aftercare and maintenance will preserve the results and promote overall oral health.

Oral hygiene practices

It is crucial to continue to practise excellent oral hygiene by brushing teeth at least twice a day with fluoride toothpaste and flossing to clean around orthodontic appliances. This will support the healing process and maintain the results of the treatment by preventing the growth of bacteria thus preventing tooth decay.

Dietary considerations

During your recovery period after application of orthodontic devices or surgery stick to a soft or liquid diet. Avoid food that is hard or excessively sugary as this can damage appliances and cause discomfort. It is essential to reduce the risk of cavities and enamel erosion, particularly around orthodontic appliances ⁴.

Emergencies

Any damage to orthodontic appliances should not be attempted to be fixed by the patient as this can lead to significant complications.  Contact your orthodontist for guidance.

Retainer care and maintenance

Patients may be prescribed to wear retainers after orthodontic treatment to maintain the corrected bite and prevent relapse. It is important to clean retainers regularly using a soft toothbrush and mild soap to prevent bacterial growth and odours. Store retainers properly when not in use.

By following these aftercare guidelines and maintaining good oral hygiene practices, patients can see the outcomes of their treatments for bite problems and remove symptoms they were previously experiencing. 

Summary

Overall, malocclusions vary depending on the individual and it is essential to address these problems. It is crucial to seek guidance from professionals when seeking treatment to correct the alignment of your teeth. Through comprehensive diagnosis and personalised treatments, patients can achieve lasting results.  When undergoing your treatment, it is essential to follow the guidelines your orthodontist has instructed to achieve the desired results; however successful treatment outcomes depend on the patient's compliance and commitment to following aftercare practices.