What Causes Malocclusion (a Bad Bite)
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Malocclusion means the upper and lower teeth do not meet the way they should. Most of it comes down to a mismatch between the size of your jaws and the size of your teeth, which is largely inherited, with childhood habits and early tooth loss accounting for much of the rest. Some malocclusion needs treating and some genuinely does not. Here is how to tell.
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The Main Causes
Genetics does most of the work. Jaw size and tooth size are inherited separately, so you can end up with your father's jaw and your mother's teeth. When the teeth are larger than the arch that has to hold them, they crowd. When the arch is larger, gaps appear. Neither is anyone's fault.
After that, in rough order of how often it matters:
• Prolonged thumb sucking or pacifier use past about age three, which can push the upper front teeth forward and create an open bite.
• Tongue thrusting, where the tongue pushes against the front teeth on swallowing.
• Chronic mouth breathing, often from enlarged tonsils or adenoids or persistent nasal obstruction, which changes tongue posture during growth and is associated with a narrow upper arch.
• Early loss of a baby tooth. Baby molars hold space for the adult teeth behind them. Lose one at six and the neighboring teeth drift into the gap, so the adult tooth arrives to find no room.
• Extra, missing or abnormally shaped teeth.
• Jaw injury or fracture that heals out of position.
• Cleft lip and palate, and some craniofacial conditions.
Adults get a slower version. Teeth drift for a lifetime, so a bite that was fine at 25 can be crowded at 45, particularly after a molar is lost and never replaced.
The Three Classes, Explained Plainly
Orthodontists classify bites by how the first molars meet. It sounds technical and it is genuinely useful.
Class I. The molars line up correctly. This is the most common classification and it covers most people, including plenty with crowding or spacing. The jaws relate normally to each other; the teeth are the issue.
Class II. The lower jaw sits behind where it should relative to the upper. This is what people mean by an overbite or an overjet, and it is the most commonly treated. It can be dental, meaning the teeth are tipped, or skeletal, meaning the lower jaw is genuinely set back.
Class III. The lower jaw sits forward of the upper, producing an underbite. Less common, and more likely to have a skeletal component.
Separately from class, we look at crossbite, where upper teeth bite inside the lower ones, and open bite, where the front teeth do not touch at all when the back teeth close.
The reason this matters to you is that dental problems can usually be fixed by moving teeth, while true skeletal problems in an adult may need surgery to fully correct.
When It Actually Needs Treating
Not every imperfect bite needs correcting, and we will tell you when yours does not.
Reasons to treat:
• You cannot clean the teeth properly. Crowded, overlapping teeth trap plaque where a brush cannot reach, which is a direct route to decay and gum disease.
• The wear is uneven. Teeth meeting wrongly wear flat, chip at the edges, or notch at the gumline. That damage does not reverse.
• There is jaw pain, clicking or headaches that track with your bite.
• You cannot chew or bite properly. An open bite makes tearing a sandwich genuinely difficult.
• Speech is affected.
• A tooth is being traumatized, for example a lower tooth biting into the palate.
• It bothers you when you look in the mirror. That is a legitimate reason and nobody here will dismiss it.
Reasons to leave it alone: a slight rotation on one tooth, a small overlap that cleans easily, no wear, no symptoms. Treating that is optional, and we will say so.
What Happens If It Is Left
Mild malocclusion left alone often does nothing at all for decades. That is worth saying, because the alternative framing is scaremongering.
Moderate to severe malocclusion is different. Over years it tends to produce accelerated wear on the teeth taking the load, gum recession where a tooth sits outside its bony housing, fracture of overloaded teeth, decay in the crowded areas that cannot be cleaned, and in some cases strain on the jaw joint.
The consequences accumulate slowly, which is why people are often surprised when a molar cracks at 50.
The practical point: a bad bite in a healthy mouth is not an emergency. It is a good reason to get an assessment, so you know which category you are in.
How It Gets Diagnosed
An orthodontic exam takes about half an hour and is more than a look in the mouth.
We check how the molars meet, measure overjet and overbite in millimeters, look for crossbites and open bites, and check midlines. We take photographs, a panoramic X ray to see unerupted teeth and the joints, and often a lateral cephalometric X ray, which is the side view that shows whether the problem is dental or skeletal. A digital scan replaces the plaster models.
That combination answers the question that matters: can this be fixed by moving teeth, or is the position of the jaws itself the issue.
For children, the American Association of Orthodontists recommends a first orthodontic check around age seven. That is not because treatment starts then, but because that is when a growing jaw can still be guided, and problems like a crossbite or a lost space are much cheaper to fix early.
How Malocclusion Is Treated
• Braces. The broadest range for real bite correction, rotations and complex movement, and the value option of the full treatments here.
• Invisalign. Excellent for crowding, spacing and mild to moderate bite correction. As the discreet option it carries a higher fee than metal braces.
• Space maintainers in children, when a baby tooth is lost early. Small, inexpensive, and they prevent a much larger problem.
• Expanders in growing patients with a narrow upper arch or a crossbite.
• Extraction, when there is genuinely not enough room, though modern orthodontics avoids this more often than it used to.
• Orthognathic surgery for true skeletal discrepancies in adults, planned jointly by an orthodontist and an oral surgeon.
Retainers hold whatever is achieved, and they are not optional. For today's exact fee on any of these, call (713) 322-7474 or see the treatment pages.
Getting Your Bite Assessed in Midtown Houston
Our orthodontist at Omega Dental Specialists in Midtown Houston is Dr. Bernard Boback, Harvard trained. If a case turns out to need a surgical component, our oral and maxillofacial surgeons are in the same building, including Dr. Jonathan Rosenstein, who is board certified and a Diplomate of the American Board of Oral and Maxillofacial Surgery. That combination is unusual outside a hospital and it means a complex bite gets planned by both specialties in one place.
The consultation is free and includes the records. You will leave knowing your classification, whether it needs treating, and what it would take.
We are at 106 W Gray St in Midtown, minutes from Montrose, River Oaks, Downtown, the Museum District and the Texas Medical Center, with Saturday appointments.
Call (713) 322-7474 or book online.
Frequently asked
What causes malocclusion?
Mostly genetics, because jaw size and tooth size are inherited separately and a mismatch produces either crowding or gaps. Other causes include prolonged thumb sucking or pacifier use past about age three, tongue thrusting, chronic mouth breathing from enlarged tonsils or nasal obstruction, early loss of a baby tooth allowing neighbors to drift into the space, extra or missing teeth, and jaw injury.
What are the three classes of malocclusion?
Class I means the first molars meet correctly and the jaws relate normally, even if individual teeth are crowded or spaced. Class II means the lower jaw sits behind where it should, producing what people call an overbite, and it is the most commonly treated. Class III means the lower jaw sits forward of the upper, producing an underbite. Crossbite and open bite are described separately from class.
Does malocclusion always need treatment?
No. A slight rotation or a small overlap that cleans easily, with no wear and no symptoms, can reasonably be left alone. Treatment is warranted when crowding prevents proper cleaning, when teeth are wearing or chipping unevenly, when there is jaw pain or difficulty chewing, when speech is affected, or when the appearance bothers you. An orthodontic exam tells you which category you are in.
Can malocclusion be fixed without braces?
Often yes. Invisalign handles crowding, spacing and mild to moderate bite correction. In growing children, expanders and space maintainers correct developing problems without full braces. True skeletal discrepancies in adults, where the jaws themselves are misaligned rather than the teeth, may need orthognathic surgery in addition to orthodontics, which is planned jointly by an orthodontist and an oral surgeon.
At what age should a child see an orthodontist?
The American Association of Orthodontists recommends a first orthodontic check at around age seven. Treatment usually does not start then. The point is that a growing jaw can be guided and problems such as a crossbite, a narrow upper arch, or space lost from an early baby tooth extraction are far simpler and cheaper to address while growth is still happening.
What happens if malocclusion is not treated?
Mild malocclusion often causes no problems for decades. Moderate to severe malocclusion tends to produce accelerated and uneven tooth wear, chipping, gum recession where a tooth sits outside its bone, decay in crowded areas that cannot be cleaned properly, fracture of overloaded teeth, and in some cases strain on the jaw joint. The damage accumulates slowly, which is why it often surprises people in their forties and fifties.
Can adults fix a bad bite?
Yes. Teeth move at any age, and a substantial share of our orthodontic patients are adults. Both braces and Invisalign are options for adults, with the fee for each put in writing at a free consultation. The one limitation is that a true skeletal discrepancy cannot be grown out of once you are done growing, so full correction of a significant Class II or Class III jaw relationship in an adult may require surgery alongside orthodontics.