What Is Overbite

  • Jialu Li Master of Science in Language Sciences (Neuroscience) UCL

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Introduction

In dental terminology, an overbite, which is also known as a Class II malocclusion, is the vertical overlap of the upper front teeth over the lower front teeth when the jaws are closed. The overlap may vary from person to person, ranging from mild to severe. This can be measured by the extent of the vertical overlap between the upper incisors and lower incisors of a mouth in a resting position.1

During a normal/healthy bite, the upper front teeth overlap slightly beyond the lower front teeth. However, in the case of an overbite, this overlap is excessive, resulting in the upper teeth significantly covering a portion of the lower teeth. The result of this may be aesthetic or functional issues like difficulty in biting, chewing, or speech/pronunciation of specific words or sounds.1,2,5

There are other dental misalignments beyond overbites which include, underbite, crossbite, open-bite, crowding or spacing. The opposite of an overbite is an underbite, which occurs when the lower front teeth protrude further than the upper front teeth of a closed jaw. A crossbite occurs when one or more upper teeth appear inside the lower teeth rather than outside during biting down. This can be seen in either the front or the back teeth. When there is a visible gap between the upper and lower front teeth do not meet in a closed jaw, it is called an open bite.

Individuals may also have insufficient space for teeth, resulting in overlapping or crooked teeth, which is called crowding. The reverse where the is excessive gaps between teeth is called spacing.5 Each of these malocclusions requires a specific dental intervention, which may be orthodontic treatments, dental appliances, or surgical correction, the purpose for which is to achieve proper dental alignment and function. Knowing and understanding overbites helps dispel misconceptions and gives people a better perspective on treatments, for example, being aware of the limitations of orthodontic interventions, especially in severe cases.15,16

Causes of overbite

Individuals may inherit some physical jaw and tooth structure such as the size and shape of the jawbone and tooth from parents and this can result in misalignments that contribute to overbites. The history of the family is a major indicator for dentists or orthodontists during the assessment of the likely cause of the condition.3,6

 Another likely cause of the condition is childhood habits and behaviours like, thumb sucking, prolonged use of feeding bottles or pacifiers and tongue thrusting. Sucking of the thumb or finger at or beyond the age when the permanent teeth start to develop can exert more pressure on the front teeth by pushing them outward thereby creating an overbite. Similarly, prolonged use of pacifiers or feeding bottles can affect the right positioning of teeth if is continued during the development of the permanent teeth. Also, the habitual thrusting of the tongue against the front teeth can contribute to the development of an overbite over a period of time. In other cases, the structural malformation of the skeletal framework can also lead to overbites.

For example, if the upper or lower jaw is excessively smaller or larger as compared to the opposite jaw, this can result in an overbite. Developmental issues or birth defects which affect the growth and formation of the jawbones can contribute to misalignments leading to overbites. Temporomandibular Joint (TMJ) Disorders can also be a major causality, that is, if there are problems with the TMJ, which connects the jaw to the skull, it can lead to jaw misalignment issues that contribute to overbites.6

Effects and complications

The complications of overbite affect the overall well-being of the individual as well as their close relations. There is usually uneven pressure distribution on teeth, which can lead to wear and tear on specific tooth surfaces where the pressure is enormous, resulting in worn enamel, chipping of the tooth, fracture and heightened sensitivity during biting or chewing.7 Overbites may contribute to difficulties in maintaining proper oral hygiene. The misaligned teeth are harder to clean, this also increases the risk of cavities, gum disease/infection, and other dental conditions.7,8 When the protrusion of the upper teeth is severe it can affect the alter the symmetry and profile of the face and can lead to self-consciousness and reduced self-esteem.

The affected individual may lack confidence about their smile and facial appearance, which will also affect their general well-being and reduced social interactions. Overbites can also interfere with the articulation of certain sounds due to the improper tongue placement during speech, affecting pronunciation and clarity. Chewing and biting can also be affected severely. The discomfort experienced while eating and may limit the ability to chew food properly, resulting in overall nutrition and digestion problems.

Diagnosis

It is advisable for individuals in this condition to seek professional help as early as possible. Dentists or orthodontists usually conduct a detailed visual/physical assessment of the patient's bites, tooth alignments, and overall dental condition. This examination may also include checking the jaw's range of motion, assessing the bite function, and observing any signs of temporomandibular joint (TMJ) issues that may be a risk factor for the overbite.8

Dental X-rays, such as panoramic or cephalometric X-rays, can also provide a comprehensive view of both the upper and lower jaw as well as the position of the individual teeth and any underlying structural issues contributing to the overbite. A dental impression can also be taken. This is the creation of moulds or models of the teeth using impression materials for a physical representation of the dental arcs to aid in assessing the extent of misalignment, tooth positioning, and potential treatment planning. A cone-beam computed tomography (CBCT) scans, is used to provide three-dimensional(3D) images of the teeth and jaws. It allows for accurate evaluations of bone structure, tooth positioning, and any skeletal irregularities contributing to the overbite. Combining a thorough physical examination by a dental professional and the utilization of diagnostic tools enables a in-depth assessment of the condition.4,7

Treatment options

Selecting treatment for overbite is dependent on the severity, age of the person and individual preferences, and dentists and orthodontists formulate personalized treatment plans to address their specific needs.7 For mild and moderate cases metal or ceramic braces are used for correcting overbites. This is made up of of brackets bonded to teeth and connected by wires. The wires are adjusted to gradually shift the teeth into proper alignment, over time, correcting the overbite. Invisalign is an example of clear aligners, which is a custom-made, removable trays gradually reposition the teeth.

People with overbite condition receive a series of aligners, each of which is slightly adjusted to push or move the teeth until the overbite is corrected.8 Devices, like headgear or Herbst appliances, can occasionally be used, in younger patients whose jaws are still developing so that the device can correct the jaw during the development process. Severe cases where the overbite with significant malfunctioning of the jaw may require orthognathic surgery. This is surgical repositioning the upper or lower jaw (or both) to correct the misalignment and for optimal results, it is combined with other orthodontic treatments.

Although rarely, complex cases may require extensive jaw reconstruction surgeries. In certain situations, where the cause is as a result of overcrowding or teeth contributing to the overbite, the teeth is extracted to create space for the remaining teeth to align in the right order. The affected teeth can also be reshaped. Odontoplasty is the minor adjustments made to reshape or contour the affected teeth to improve their intended functions.8

Preventive measures

Early monitoring and assessment of a child's dental development by orthodontists will help identify any anomalies that might lead to overbites or other malocclusions then an early intervention, can be made to guide proper tooth eruption and jaw development using the right orthodontic devices or techniques, to avoid severe overbites later in life.9,10 Parents should encourage their children to cease thumb sucking and pacifier use before their permanent teeth develop. Also, habitual tongue thrusting against the front teeth should be discouraged to mitigate the risk. Transitioning children to solid foods at the appropriate age can shorten the period of bottle feeding and prevent overbites caused by prolonged sucking habits.9

Regular brushing of teeth and flossing are good oral hygiene practices, that promote healthy tooth and gum development and reduce the risk of dental problems which might contribute to overbites.10 Ideally, regular visits to the dentist for check-ups help early detection of any emerging dental problems or anomalies in tooth alignment, allowing for prompt intervention.9

Coping strategies for any discomfort or social implications

Living or coping with overbite involves adopting strategies to manage the discomfort or social implications while prioritizing oral health. Orthodontic Treatments or interventions help correct overbites, alleviating discomfort associated with biting, chewing, or speech. Common pain relievers which can be purchased “over-the-counter” may help manage discomforting pain associated with tooth sensitivity or jaw strain caused by an overbite. Speech therapists should be consulted to assist individuals experiencing speech difficulties due to an overbite to improve pronunciation and articulation and boost self-confidence in social interactions. Seeking professional counselling can help individuals manage any negative self-image associated with their physical appearance due to an overbite.11,12 A balanced diet can also support oral health care. Therefore individuals should eat nutritious food, and avoid hard or sticky foods that might intensify the discomfort associated with the condition or damage orthodontic appliances.12,13,14

Frequently asked questions (FAQs) about overbites

Can overbites cause headaches or jaw pain?

Yes, severe cases of overbites may cause headaches or jaw pain due to strain on the jaw muscles and temporomandibular joint (TMJ).

Is an overbite genetic?

Yes, genetics can be a risk factor in the development of overbites. Family history often influences jaw structure and tooth alignment.

Can overbites cause breathing problems?

Severe overbites may contribute to difficulties in breathing, especially if the overbite impacts jaw positioning and obstructs the airway.

Can overbites lead to speech problems?

Yes, overbites might affect the articulation of some sounds and words this happens by altering the placement of the tongue in the process of speaking.

Can overbites cause ear pain?

In some individual cases ear pain can be associated with overbites, especially if the jaw misalignment affects the temporomandibular joint, causing referred pain to the ears.

Do overbites get worse with age?

Yes, an untreated overbite will worsen over time, especially during periods of jaw growth in children or due to natural wear on teeth in adults.

Can overbites be corrected without braces?

Mild overbites might be corrected with clear aligners or other orthodontic appliances. However, severe cases may require braces or even surgical interventions.

Can wisdom teeth impact overbites?

Wisdom teeth may aggravate the problems caused by the condition when it exerts pressure on existing teeth, affecting alignment.

Are overbites more common in children or adults?

Overbites can occur at any age depending on the cause, but management or treatment is easier in children due to ongoing jaw development.

Can overbites affect digestion?

When overbites affect the proper chewing of food, the digestion process will be affected due to inadequate breakdown of food particles.

Summary

good dental health significantly contributes to an individual's overall well-being therefore addressing overbites not only enhances oral function and aesthetics but also alleviates discomfort, boosts confidence, and positively impacts social interactions. Seeking regular professional dental check-ups, early interventions, and accepting treatments allows individuals to take charge of their oral health and overall well-being.

References

  • Wylie WL. The relationship between ramus height, dental height, and overbite. American Journal of Orthodontics and Oral Surgery. 1946 Feb;32(2):57–67.
  • Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep and Breathing [Internet]. 2006 Nov 29 [cited 2019 Jul 6];11(1):1–22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1794626/
  • Kaur H, Pavithra U, Abraham R. Prevalence of malocclusion among adolescents in South Indian population. Journal of International Society of Preventive and Community Dentistry. 2013;3(2):97.
  • Khosravi R, Cohanim B, Hujoel P, Daher S, Neal M, Liu W, et al. Management of overbite with the Invisalign appliance. American Journal of Orthodontics and Dentofacial Orthopedics. 2017 Apr;151(4):691-699.e2.
  • Pullinger AG, Seligman DA. Overbite and overjet characteristics of refined diagnostic groups of temporomandibular disorder patients. American Journal of Orthodontics and Dentofacial Orthopedics. 1991 Nov;100(5):401–15.
  • Moimaz SAS, Garbin AJÍ, Lima AMC, Lolli LF, Saliba O, Garbin CAAS. Longitudinal study of habits leading to malocclusion development in childhood. BMC Oral Health. 2014 Aug 4;14(1).
  • Pancherz H, Bjerklin K, Lindskog-Stokland B, Hansen K. Thirty-two-year follow-up study of Herbst therapy: A biometric dental cast analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2014 Jan;145(1):15–27.
  • Mirabella D, Giunta G, Lombardo L. Substitution of impacted canines by maxillary first premolars: A valid alternative to traditional orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics. 2013 Jan;143(1):125–33.
  • Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of Infective Endocarditis. Circulation. 2007 Oct 9;116(15):1736–54.
  • Sischo L, Broder HL. Oral Health-related Quality of Life. Journal of Dental Research [Internet]. 2011 Mar 21 [cited 2019 Jun 13];90(11):1264–70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318061/
  • Krämer S, Lucas J, Gamboa F, Peñarrocha Diago M, Peñarrocha Oltra D, Guzmán‐Letelier M, et al. Clinical practice guidelines: Oral health care for children and adults living with epidermolysis bullosa. Special Care in Dentistry. 2020 Nov;40(S1):3–81.
  • Horswell BB, Sheikh J. Evaluation of Pain Syndromes, Headache, and Temporomandibular Joint Disorders in Children. Oral and Maxillofacial Surgery Clinics of North America. 2018 Feb;30(1):11–24.
  • Kirschen R. Maurice Berman—Straight Wire Myths. British journal of orthodontics. 1988 Feb 1;15(1):57–61.
  • van. Sheldon Friel Memorial Lecture 2007: Myths and Legends in Orthodontics. European Journal of Orthodontics. 2008 Aug 27;30(5):449–68.
  • Pahkala R, Seppä J, Myllykangas R, Tervaniemi J, Vartiainen VM, Suominen AL, et al. The impact of oral appliance therapy with moderate mandibular advancement on obstructive sleep apnea and upper airway volume. Sleep & Breathing = Schlaf & Atmung [Internet]. 2020 [cited 2022 Dec 6];24(3):865–73. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426308/
  • Fichera G, Martina S, Palazzo G, Musumeci R, Leonardi R, Isola G, et al. New Materials for Orthodontic Interceptive Treatment in Primary to Late Mixed Dentition. A Retrospective Study Using Elastodontic Devices. Materials. 2021 Mar 30;14(7):1695.

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