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What is a Malocclusion?

A malocclusion is an incorrect relationship between the maxilla (upper arch) and the mandible (lower arch), or a general misalignment of the teeth.  Malocclusions are so common that most individuals experience one, to some degree.  The poor alignment of the teeth is thought to be a result of genetic factors combined with poor oral habits, or other factors in the early years.

Moderate malocclusion commonly requires treatment by an orthodontist.  Orthodontists are dentists who specialize in the treatment of malocclusions and other facial irregularities.

The following are three main classifications of malocclusion:

• Class I.  The occlusion is typical, but there are spacing or overcrowding problems with the other teeth.
  
• Class II.  The malocclusion is an overbite (the upper teeth are positioned further forward than the lower teeth).  This can be caused by the protrusion of anterior teeth or the overlapping of the central teeth by the lateral teeth.
  
• Class III.  Prognathism (also known as “underbite”) is a malocclusion caused by the lower teeth being positioned further forward than the upper teeth.  An underbite usually occurs when the jawbone is large or the maxillary bone is short.

Reasons for treating a malocclusion

A severe malocclusion may lead to skeletal disharmony of the lower face.  In a more extreme case, the orthodontist may work in combination with a maxillofacial dentist to reconstruct the jaw.  It is never too late to seek treatment for a malocclusion.  Children and adults alike have completed orthodontic realignment procedures and have been delighted with the resulting even, straight smile.

Here are some of the main reasons to seek orthodontic treatment for a malocclusion:

• Reduced risk of tooth decay.  A malocclusion often causes an uneven wear pattern on the teeth.  The constant wearing of the same teeth can lead to tooth erosion and decay.
  
• Better oral hygiene.  A malocclusion can be caused by overcrowding.  When too many teeth are competing for too little space, it can be difficult to clean the teeth and gums effectively.  It is much easier to clean straight teeth that are properly aligned.
  
• Reduced risk of TMJ.  Temporomandibular jaw syndrome (TMJ) is thought to be caused by a malocclusion.  Headaches, facial pains and grinding teeth during sleep all result from the excessive pressure to the temporomandibular joint.  Realigning the teeth reduces pressure, and eliminates these symptoms.

How is a malocclusion treated?

A malocclusion is usually treated with dental braces.  The orthodontist takes panoramic x-rays, conducts visual examinations and bite impressions of the whole mouth before deciding on the best course of treatment.  If a malocclusion is obviously caused by overcrowding, the orthodontist may decide an extraction is the only way to create enough space for the realignment.  However, in the case of an underbite, crossbite or overbite, there are several different orthodontic appliances available, such as:

• Fixed multibracket braces.  This type of dental braces consists of brackets cemented to each tooth, and an archwire that connects each one.  The orthodontist adjusts or changes the wire on a regular basis to train the teeth into proper alignment.
  
• Removable devices.  There are many non-fixed dental braces available to treat a malocclusion.  Retainers, headgear and palate expanders are amongst the most common.  Retainers are generally used to hold the teeth in the correct position whilst the jawbone grows properly around them.
  
• Invisalign^®.  These dental aligners are removable and invisible to the naked eye.  Invisalign works in much the same way as fixed dental braces, but do not impact the aesthetics of the smile.  Not all patients are candidates for Invisalign^®.