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In most cases, the main culprit is genetics. If you inherit a relatively small jaw and relatively large teeth, your teeth literally must jostle for position in your mouth. Oral habits, such as nail-biting, finger-sucking or chewing on clothing, can aggravate crowding, especially among children.
Crowding can eventually lead to pain and clicking of the jaw joint—temporary-mandibular joint disorder (TMJ)--but it is difficult to predict which children will be affected when they get older.
Adults with crowded teeth may experience no problems at all. However, if you cannot thoroughly clean your teeth because they are too close together or overlap, you are at increased risk for decay and periodontal disease, which can lead to tooth loss. Getting your teeth straightened gives you and your dentist better access to cleaning your teeth well.
A functional appliance called an "expander" can help resolve crowding of the upper teeth. By turning a screw in the appliance every night, the expander slowly widens the upper jaw to make room for all the adult teeth. Fixed and removable expanders are available, and it generally takes about four months for the expansion process to be completed. Afterward, the expander remains in the mouth for a total of six to nine months. Then a retainer is worn to ensure that the expansion is permanent.
Adults with crowding receive a full or partial set of braces, depending on the severity of the abnormal tooth positions and how many teeth are involved.
The average length of treatment with braces is about 18-24 months, but it can take 3 years if the crowding is severe or is accompanied by a significant malocclusion.
A crossbite occurs when some of the teeth wind up on the "wrong side of the track," meaning the bottom teeth are shifted to one side or shoved forward or backward. If, for example, when you bite down, your top teeth fall inside your bottom teeth on one side, you have a "unilateral posterior crossbite." If your top front teeth fall behind your lower front teeth when you bite down, then you have an "anterior cross bite," which is similar to an underbite.
There are many reasons why crossbites occur. One is jaw size and heredity. Another is delayed loss of baby teeth. Some people keep their baby teeth so long that their permanent teeth come in behind their baby teeth, like a second row of teeth. If this happens in your upper jaw, the permanent top front teeth may wind up sitting behind the lower front teeth when you bite down. This can happen on one side (unilaterally) or on both sides (bilaterally).
Mouth breathing by children can also spur the development of a cross bite. Normally, children breathe through their nose; the mouth is closed, and the tongue sits on the roof of the mouth. This tongue position is very important because it causes the upper jaw to grow out laterally, or sideways, as it should. Children who have big adenoids and tonsils tend to breathe almost exclusively through their mouth, especially while asleep. Snoring is another symptom.
When children are forced to breathe through their mouth all the time, their tongue drops from the roof of the mouth, and lateral growth of the upper jaw becomes inadequate. Adult teeth growing in a narrow upper jaw can become squeezed inward and land behind the bottom front teeth whenever the child bites down.
Tipped off by this telltale pattern of malocclusion, an orthodontist often is the first health-care professional to notice that a child's adenoids and tonsils are too large. The orthodontist generally refers the patient to an ear, nose and throat specialist.
Aside from mouth breathing and snoring, parents should suspect a crossbite if their child slides his/her lower jaw to the left or right in order to chew comfortably, or if their child's chin appears off-center.
Orthodontic treatment to correct a crossbite in children should begin as early as possible. If enlarged tonsils and adenoids are at the root of the problem, they probably should be evaluated for removal.
The first step, "maxillary expansion," broadens the upper jaw with an appliance called an "expander." Fixed to the roof of the mouth, the expander is widened each night for about 1 or 2 months with the turn of a key. The expander remains in the mouth for about 3 more months to allow the bone to harden in its new position. Braces may be put on the top teeth while expansion is going on to eventually close a "gap-tooth grin" that will develop as the upper jaw is being expanded.
Once the expansion is complete, the patient may need to wear a full set of braces for 1 to 2 years to achieve an ideal bite.
The main reason to correct a crossbite in children is to prevent temporo-mandibular joint disorder (TMJ)--a misalignment or malfunction that causes excess pressure on the jaw joint. TMJ can lead to head and cheek pain, a clicking or popping sound when you open and close your mouth, limited range of motion of the jaw joint and other symptoms. In adults, orthodontic treatment can often improve TMJ symptoms.
Usually
the best and simplest way of bringing a smile to your face is by treating the teeth. And in that regard, orthodontics provides a number of
options; everything from deterring bad habits such as thumb sucking to
realigning teeth using braces.
But
for over 10 million Americans who suffer from severe jaw imbalance,
that is not enough.
Jaw
imbalance occurs when the upper and lower jaws do not fit with each other - one
jaw might stick out; another might recede. This could be caused by injury, or
birth defect, or simply because the upper and lower jaws grew at different
rates.
As
a result, you may suffer from a "toothless smile" at one extreme or a
"gummy smile" at the other. Jaw imbalance can also cause an "underbite," an "overbite" and even an
"open bite (space between upper and lower front or back teeth when the mouth is closed)."
Other
problems caused by jaw imbalance include:
- Difficulty chewing or biting food
- Difficulty swallowing
- Excess wearing of teeth
- Inability to make lips meet
without effort
- Chronic jaw pain
- Speech problems
- Receding jaw
- Protruding chin
- Chronic mouth breathing with dry
mouth
- Sleep apnea (breathing problems
while sleeping)
To
correct a misaligned jaw in a non-growing person requires orthognathic surgery performed by an oral or maxillofacial surgeon and orthodontics
"usually meaning braces" provided by an orthodontist.
"Orthognathic" means "straight jaws." The
object of orthognathic surgery is to move all or part
of the maxilla (upper jaw) and/or the mandible (lower jaw) into a more
favorable position. For example, the entire jaw can be cut and moved backward
if it's too large or forward if it's too small. After the jaws are moved into a
more desirable position, they're secured in place with screws and plates. The
procedure will give your jaws a more balanced and enhanced appearance.
"Orthodontics"
means "straight teeth." And because moving the jaws also means moving
the teeth, you probably will need to wear braces for a period of time before,
during and after surgery in order to achieve a proper "bite."
If
you do decide to take this dramatic step, however, you'll find that correcting
jaw imbalance will produce a significant improvement in your facial appearance,
enhance your ability to chew, breathe and speak normally and even renew your
self-confidence.
And
that's something to smile about.
Overbite
is a malocclusion (bad bite) that is commonly known as "buck teeth."
Some 70 percent of all children develop an overbite, making it the most common
malocclusion seen by orthodontists.
There
are two types of overbites:
vertical overbite
Where the top teeth overlap the
lower teeth too much vertically
horizontal overbite
Also known as "overjet," this is where the top teeth protrude too
much. Some people have features of both types of overbite.
Genetics and certain oral habits can both contribute to this
condition.
Genetics: Everyone inherits the size of their teeth
and the shape of their jaw from both parents. So if you inherit your mother's
jaw and your father's teeth, with a little bit of your grandfather's and
great-aunt's toothy attributes sprinkled in, it is easy to understand why overbite (and other malocclusions) are so common.
Habits: If thumb- or finger-sucking continues past age 2, the habit not
only moves the teeth but may also shape the jaw incorrectly, leading to both a
dental and orthopedic (bone) problem. Nail-biting and pencil-chewing also can
contribute to overbite and other malocclusions, especially if the behavior is
chronic and continues for years. Some children have another habit that can
create or aggravate an overbite: tongue thrusting. Tongue thrusters push their
tongue against the back of their teeth each time they swallow. The tongue is a
very strong muscle, and many children swallow 1,000 to 2,000 times a day.
Severe overbites can lead to permanently damaged front teeth.
Front teeth that stick out are prime targets for trauma. For example, children
with an overbite who are very active or involved in sports are at higher risk
for fracturing or otherwise injuring their top front teeth.
If you have a deep vertical overbite--where your top teeth
significantly overlap your bottom teeth--your bottom teeth can literally hit
the roof of the mouth every time you bite down. These small but continuous
traumas can eventually damage your gums or even the roots of your upper front
teeth. Some children who have this problem complain of mouth pain and have
trouble biting into chewy foods, like pizza. An orthodontist should evaluate
all children at age 7 so steps can be taken to alleviate pain and prevent
long-term damage.Sometimes, an overbite or other
malocclusion can create jaw problems, such as clicking in the jaw joint.
Unfortunately, there is no way to predict which child will develop jaw problems
later in life if their malocclusion is not corrected.
You can't change a child's genetics, but you can try to break your
child of oral habits, such as thumb-sucking and pencil-chewing.
Treating children early with a "functional appliance"--a
fixed or removable system of plastic and wires (similar to a retainer)--can be
another effective way of lessening the severity of an overbite. For example, if
the lower jaw is growing more slowly than the upper jaw, a functional appliance
can facilitate additional bone growth in the lower jaw. Functional appliances
can be used in children as young as 7, 8 or 9. The child then wears a retainer
until receiving a standard set of braces a few years later.
Wearing a functional appliance round the clock for about a year
offers several benefits:
Standard treatment braces may become shorter and less radical. In
some cases, the patient can avoid braces altogether.
Tooth extraction can often be avoided.
The aesthetic result is often better because the patient's profile
is more balanced. Classic orthodontic treatments for an
overbite with braces lasts about 2 years and is divided into 2 stages of
roughly equal duration. Both stages require a full set of braces, which consist
of brackets on the front and back teeth.
Stage 1, called "leveling and aligning," gets all the
teeth straight by using braces to correct any turning or twisting.
Stage 2 works specifically on the overbite, pushing all the top
teeth, including the molars, back where they belong. At the same time, the
bottom teeth may need to be nudged forward to achieve a proper bite.
It can take 6 months to 2 years for both stages of treatment to be
completed, with the average case taking 1 1/2 to 2 years. In complicated cases,
the patient may need to wear braces for as long as 3 years.
If you have a child 3 or 4 years old or younger who habitually sucks his or her thumb, don't worry about it. In fact, most experts agree that if you ignore the problem, it'll probably go away. Harm to permanent teeth will be negligible and any possible tooth alignment problems that do arise will probably self-correct.
It's only when children continue to suck their thumbs after age 3 or 4 that you should intervene. That's because by that age, their permanent teeth are coming in. And persistent thumb sucking could cause damage that will require active orthodontic treatment - such as braces - to correct.
Thumb sucking can cause:
·
Narrowing of the upper jaw
·
Crowding of the lower teeth
·
Flared upper front teeth
·
Prevention of the nose from growing down (and so it is tipped up)
·
Crossbite
·
Open bite
·
Altered facial growth
·
Speech problems
Thumb sucking also might lead to tongue thrusting, which can
result in even more serious problems.
Thumb sucking is natural for children. Most babies begin to suck
on their thumbs and fingers even before they're born. It is one of the first
means they have of making contact with and learning about their world.
Research indicates that 80% to 95% of all infants suck their
thumbs. These percentages decline to 30% to 50% for children in preschool
years, 14% of 6-year-olds and 6% of 11-year-olds (a small percentage of teenagers
as old as 18 and even some adults also suck their thumbs).
On the other hand, experts agree that criticizing or ostracizing a
preschool-age child because of thumb sucking can cause psychological damage.
Unreasonable demands and punitive actions work to negatively reinforce and
instill a sense of failure in the child, along with shame, rejection,
inadequacy, guilt, unworthiness, inferiority and low self-esteem. Instead,
patience and tolerance is highly encouraged.
If you suspect your child is developing a thumb-sucking habit that
time and patience isn't going to break, contact Dr. Shehee.
Don't wait until what seems like a small problem, becomes a much bigger one.
The opposite of crowding, spacing simply means there is more space
than necessary between the teeth. Spacing can affect all or some teeth;
sometimes just the upper or lower teeth are affected. You can see the most
famous example of spacing each time talk show host David Letterman displays his diastema, or gap-tooth smile, to millions of television
viewers.
Genetics plays a major role in how teeth are spaced. For example,
spacing occurs if you inherit a large jaw from one parent and small teeth from
the other. Chronic thumb- or finger-sucking can also create or widen spaces
between the teeth. About 5 to 10 percent of the general population has abnormal
gaps between their teeth.
As long as spaces between your teeth are not large enough to
significantly affect your bite or your ability to chew, there is no medical
reason to close the spaces. In fact, some spaces between the teeth facilitate
cleaning and therefore indirectly reduce your risk for cavities and gum
disease. If, however, food chronically gets stuck in the spaces, problems can
ensue.
Adults who seek treatment usually do so for aesthetic
reasons--they want a beautiful smile.
