Types of Bites: Causes, Consequences and Treatment

There are different types of bites that can affect teeth alignment and oral health. Let’s explore some of the most common malocclusions, or misalignments, including overbites, underbites, spacing, crowding, and more. We’ll discuss the characteristics of each type of impaired bite, their potential causes, and the problems they create. We’ll also overview the orthodontic treatment options available to correct these dental issues, from braces to surgery.

Crossbite

A crossbite is a type of malocclusion (misalignment of teeth) in which the upper teeth do not align properly with the lower teeth when the jaws are closed. In a crossbite, some or all of the upper teeth may sit inside the lower teeth, whereas in a normal bite, the upper teeth should slightly overlap the lower teeth.

There are different types of crossbites, which can affect various areas of the mouth. Here are the common types of crossbites:

Anterior Crossbite: In an anterior crossbite, the misalignment occurs in the front teeth, specifically the incisors (front teeth). This means that one or more upper incisors sit behind the lower incisors when the jaws are closed. Anterior crossbites can affect both the front and back teeth, depending on the severity.
Posterior Crossbite: A posterior crossbite involves the back teeth, typically the premolars or molars. It occurs when the upper teeth on one side of the mouth are positioned inside the lower teeth on the same side. This can affect one side of the mouth (unilateral) or both sides (bilateral).

Causes of Crossbite

Crossbites can result from a combination of inherited genetic factors and environmental factors. The common causes include:

Genetics: A familial history of dental misalignments can predispose an individual to develop crossbite.
Thumb Sucking: Prolonged thumb sucking can contribute to the development of crossbite.
Mouth Breathing: Chronic mouth breathing can lead to narrow dental arches, which may result in a crossbite.
Tongue Thrusting: An abnormal tongue posture or thrusting can push the teeth out of alignment, causing crossbite.
Abnormal Tooth Eruption: Irregular tooth eruption patterns, where teeth emerge in positions that deviate from the normal alignment, can lead to crossbites.
Jaw Size Discrepancy: A difference in the size or shape of the upper and lower jaws can result in crossbites. For example, a narrow upper jaw or a wide lower jaw can contribute to this condition.
Dental Crowding: Overcrowding of teeth can cause them to shift out of their natural positions, leading to crossbites.
Premature Tooth Loss: The early loss of baby teeth without proper alignment of the permanent teeth can result in crossbites.

Consequences of Untreated Crossbite

Untreated crossbite can lead to various complications:

TMJ Disorder: Temporomandibular joint (TMJ) disorders can develop due to the uneven pressure on the jaw joint, causing pain and discomfort.
Tooth Wear: Abnormal contact between upper and lower teeth can cause excessive wear on tooth enamel, leading to sensitivity and other dental problems.
Gum Recession: Crossbite may result in teeth becoming loose, leading to gum recession and an increased risk of periodontal disease.
Speech Problems: Misaligned teeth due to crossbite can lead to speech difficulties, affecting self-esteem and confidence.

Underbite

An underbite, also known as a Class III malocclusion or mesiocclusion, is a dental condition in which the lower teeth protrude forward beyond the upper teeth when the jaws are closed. This misalignment can affect the appearance and function of the teeth and jaws.

There are different types of underbites, and they can vary in severity. Here are the common types of underbites:

Dental Underbite: A dental underbite, also known as a dental class III malocclusion, is primarily related to the misalignment of the teeth themselves. In a dental underbite, the lower front teeth protrude beyond the upper front teeth due to the positioning of the teeth rather than the jawbones. Dental underbites can vary in severity and may be mild, moderate, or severe.
Skeletal Underbite: A skeletal underbite, also known as a skeletal class III malocclusion, involves the misalignment of the jawbones themselves. In this type of underbite, the lower jaw (mandible) is positioned forward in relation to the upper jaw (maxilla), leading to the protrusion of the lower teeth beyond the upper teeth. Skeletal underbites often have a more significant impact on facial aesthetics and can result in functional issues like difficulty with chewing and speech.

Causes of Underbite

Several factors can contribute to the development of an underbite:

Genetics: If one or both parents have an underbite, there’s a higher likelihood that their children may also develop this condition.
Skeletal Issues: Skeletal underbites result from discrepancies in the size, shape, or positioning of the upper and lower jawbones. These issues can occur due to genetic factors, abnormal growth patterns, or developmental conditions.
Thumb-Sucking or Pacifier Use: Prolonged thumb-sucking or pacifier use in childhood can affect the alignment of the teeth and jaw, potentially contributing to the development of an underbite.
Malpositioned Teeth: Irregular tooth positioning, crowding, or missing teeth can disrupt the normal bite relationship and lead to an underbite.
Childhood Habits: Certain childhood habits like tongue thrusting (pushing the tongue against the front teeth during swallowing) or reverse swallowing can affect the development of the bite.
Trauma or Injury: Trauma to the face or jaw can cause misalignment of the jawbones and teeth, potentially resulting in an underbite.
Tumor or Growth: In rare cases, the presence of tumors or abnormal growths in the jaw area can lead to the development of an underbite.
Neuromuscular Disorders: Some neuromuscular disorders can affect the proper functioning of the jaw muscles and lead to bite misalignment.

Consequences of Untreated Underbite

Leaving an underbite untreated can lead to several complications, affecting both oral health and overall well-being:

Difficulty in Chewing and Speech: The misalignment can cause difficulty in biting, chewing, and speaking clearly.
Increased Risk of Tooth Decay and Gum Disease: The abnormal tooth positioning makes it difficult to clean teeth properly, increasing the risk of cavities and gum issues.
Temporomandibular Joint (TMJ) Disorders: Strain on the jaw joint can lead to pain, discomfort, and even TMJ disorders.
Aesthetic Concerns: Severe underbites can affect facial appearance and cause self-esteem issues.

Overbite

An overbite, also known as a Class II malocclusion or distocclusion, is a dental condition in which the upper front teeth overlap or extend over the lower front teeth when the jaws are closed. In a normal bite, there is a slight vertical overlap of the upper front teeth over the lower front teeth. However, in an overbite, this overlap is more pronounced, and the upper teeth may excessively cover the lower teeth.

There are two main types of overbite:

Dental Overbite: A dental overbite is primarily related to the misalignment of the teeth themselves. It occurs when the upper teeth are positioned too far forward relative to the lower teeth, without a significant jaw discrepancy.
Skeletal Overbite: A skeletal overbite involves the misalignment of the jawbones. In this type of overbite, the upper jaw (maxilla) may be positioned forward in relation to the lower jaw (mandible).

Causes of Overbite

Several factors can contribute to the development of an overbite. Here are some common causes of overbites:

Genetics: Family history plays a significant role in the development of overbites. If parents or close relatives have an overbite, there’s a higher likelihood that it may be inherited by their children.
Childhood Habits: Certain childhood habits, such as tongue thrusting, using a pacifier, or reverse swallowing, can affect the positioning of the teeth and contribute to overbites.
Malocclusion: Other types of dental misalignments, such as crowding or spacing of teeth, can create conditions that predispose a person to develop an overbite.
Premature Tooth Loss: The early loss of baby teeth without proper alignment of the permanent teeth can result in an overbite.
Jaw Size Discrepancy: Differences in the size, shape, or positioning of the upper and lower jaws can lead to the development of an overbite.
Mouth Breathing: Habitual mouth breathing, often due to allergies or other respiratory issues, can affect the positioning of the tongue and contribute to overbites.

Consequences of Untreated Overbite

If left untreated, an overbite can cause various problems. It can lead to:

Difficulty Chewing and Eating: An untreated overbite can make chewing and eating challenging.
Increased Risk of Tooth Decay: Overbites often result in improper tooth alignment, making it difficult to clean the teeth effectively. This can lead to an increased risk of tooth decay.
Increased Risk of Gum Disease: Poor oral hygiene due to difficulties in cleaning the teeth can also elevate the risk of gum disease (periodontal disease). Gum inflammation and infection may occur if plaque and bacteria are not adequately removed.
Cracked or Chipped Teeth: Overbites can cause uneven pressure distribution in the mouth. This imbalance can lead to the teeth being subjected to abnormal forces during biting and chewing, potentially resulting in cracked or chipped teeth.
Temporomandibular Joint Disorder (TMJ): In severe cases of untreated overbite, the improper alignment of the jaws can lead to temporomandibular joint disorder (TMJ). This condition can cause jaw pain, discomfort, and difficulty in opening and closing the mouth. TMJ disorder can significantly impact a person’s quality of life and oral function.

A study in the European Journal of Paediatric Dentistry shows that malocclusion prevalence among youths is highest in Africa (81%) and Europe (72%), with America (53%) and Asia (48%) following.

Overjet

Overjet is a type of malocclusion or misalignment in which the upper teeth point outward, creating a larger distance between the upper and lower front teeth. This condition is colloquially known as buck teeth and is different from an overbite where the upper teeth overlap the lower teeth vertically.

Causes of Overjet

There are several factors that can contribute to the development of overjet. These include:

Genetic Factors: Overjet can be inherited from parents who also have the condition.
Childhood Habits: Habits like thumb sucking or prolonged pacifier use can push the upper front teeth forward.
Tongue Thrusting: A habit of thrusting the tongue against the upper front teeth can cause them to protrude.
Jaw Discrepancies: A mismatch in the size of the upper and lower jaw can contribute to overjet development.

Consequences of Untreated Overjet

If left untreated, overjet can lead to various complications and issues, such as:

Increased Risk of Tooth Damage: Protruding teeth are more likely to be injured during accidents or sports-related incidents.
Speech Difficulties: Overjet can result in a lisp or other speech impairments.
Chewing and Biting Problems: Overjet can prevent full contact between the upper and lower arches when biting down, causing excessive stress on the properly aligned teeth.
Self-Esteem Issues: Many people with overjet may feel self-conscious about their appearance, which can negatively impact their confidence and social interactions.

Open Bite

An open bite is a type of malocclusion where some teeth do not meet when biting down. It mainly occurs during the transition from milk teeth to permanent teeth but can persist into adulthood.

Open bite is often seen in two forms: anterior and posterior, with anterior open bites being more common:

An anterior open bite occurs when there is a gap or space between the upper front teeth (incisors) and the lower front teeth (incisors) when the jaws are closed. In other words, the front teeth do not make contact when the mouth is closed, leaving an open space in the front of the mouth.
A posterior open bite is characterized by a gap or space between the upper and lower teeth in the back (premolars and molars) when the jaws are closed. In this type of open bite, the front teeth may touch while the back teeth do not make contact.

Causes of Open Bite

Open bites can be a result of various factors, including:

Tongue Thrusting: This occurs when a person pushes their tongue between their upper and lower front teeth while speaking or swallowing.
Thumb Sucking: This habit may lead to an open bite if it persists beyond the age of 2 or 3.
Mouth Breathing: Breathing through the mouth can change the shape of the palate and teeth alignment, leading to an open bite.
Excessive Pacifier and Bottle Use: Prolonged use of pacifiers and bottles can affect the position of the teeth.
Myofunctional Issues: Abnormal muscle movements in the tongue and lips, such as during swallowing, can lead to an open bite.

Consequences of Untreated Open Bite

If left untreated, an open bite can cause several problems, such as:

Difficulty in Biting and Chewing: An open bite may make it harder to bite into food and chew properly, which can affect nutrition.
Speech Issues: An open bite can lead to lisping and other speech difficulties, as the teeth do not meet properly when forming certain sounds.
Increased Risk of Tooth Damage: The absence of even pressure distribution during biting may cause excessive wear and tear on the remaining contacting teeth, leading to premature tooth damage.
Aesthetics Concerns: An untreated open bite can affect one’s appearance and self-confidence.

Crowding

Crowding occurs when there is insufficient space in the mouth to accommodate all teeth, causing them to grow improperly, overlap, or twist. It can affect a single twisted tooth or the entire row of teeth, making it challenging to maintain proper oral hygiene.

Causes of Crowding

Several factors can contribute to crowding, including:

Genetic Factors: Jaw shape and size are partly inherited, predisposing some people to develop misaligned teeth.
Late Tooth Eruption: The delayed eruption of permanent teeth can create insufficient space for them.
Early Loss of Baby Teeth: Premature loss of baby teeth can cause adjacent teeth to drift into empty spaces, causing crowding.
Thumb-Sucking or Pacifier Use: Prolonged oral habits can disrupt normal tooth alignment, contributing to crowding.
Lack of Space in the Jaw: A narrow jaw or abnormal jaw growth can lead to insufficient space for teeth, resulting in crowding.

Consequences of Untreated Crowding

Leaving crowding untreated can result in various consequences, such as:

Gum disease: Due to difficulty in cleaning misaligned teeth, plaque and bacteria can accumulate, increasing the risk of gum disease.
Tooth Decay: Overlapping teeth can create hard-to-reach crevices, causing tooth decay.
Early Enamel Wear: Abnormal tooth positioning can lead to increased friction and wear on the enamel.
Difficulty Chewing: Misaligned teeth can affect the bite and make it difficult to chew food properly.

Spacing

Spacing refers to gaps or spaces between the teeth, which can occur naturally or develop over time due to various factors. These gaps can appear anywhere in the mouth, affecting both the upper and lower arches of teeth.

Causes of Spacing

There are several factors that can contribute to the development of spacing between teeth:

Genetics: Some individuals may inherit traits that lead to larger gaps between teeth, such as a wide dental arch or disproportional jaw size.
Missing Teeth: Tooth loss can result in spaces between the remaining teeth, as they may shift to fill the gap.
Childhood Habits: Prolonged thumb-sucking or tongue-thrusting habits in childhood may cause the front teeth to be pushed forward, creating gaps.
Gum Disease: Advanced gum disease can lead to the loosening of teeth and the development of spaces between them.
Abnormal Tooth Size: Teeth that are smaller than average in proportion to the dental arch can lead to noticeable spaces.
Thumb-Sucking or Pacifier Use: Prolonged thumb-sucking or pacifier use during childhood can push the front teeth forward, creating gaps or spacing.
Lip or Tongue Tie: In some cases, a condition called lip or tongue tie, where there is an abnormal attachment of the lip or tongue to the gums, can create gaps or spacing between teeth.
Orthodontic Relapse: After orthodontic treatment, if patients do not consistently wear their retainers as recommended, there can be a relapse, leading to the reopening of gaps.

Consequences of Untreated Spacing

If left untreated, spacing between teeth can lead to several consequences:

Difficulty Chewing: Spaces between teeth can interfere with proper chewing, which may impact digestion and overall health.
Speech Difficulties: Gaps between teeth may cause speech problems such as lisping and difficulty pronouncing certain sounds.
Gum Disease and Cavities: Food particles can become trapped in the spaces between teeth, increasing the risk of gum disease and tooth decay.
Aesthetic Concerns: Spacing between teeth can affect one’s confidence, as it can create an unbalanced and less attractive smile.

Treatment

A variety of orthodontic treatments exist today to realign teeth and correct different types of malocclusions or misalignments. Let’s overview some of the most common and effective options currently available from orthodontists to straighten crooked teeth and improve bite issues.

Braces

Braces are a common treatment for bite problems and involve attaching brackets to the teeth and using wires to gradually shift their positions. Braces are effective in correcting a variety of bite issues, including overbites, underbites, and crossbites. The treatment duration varies depending on the severity of the bite problem, but typically, patients wear braces for 1-3 years.

Aligners

A popular alternative to traditional braces is clear aligners, such as Invisalign or Byte. Aligners are custom-made, removable trays that are worn over the teeth to gradually shift their positions. They are discreet and typically less noticeable than braces. Aligners are suitable for treating mild to moderate bite issues, but may not be effective for severe bite problems or complex cases.

Surgery

In some cases, orthodontic treatment alone may not be enough to correct severe bite problems. In these situations, patients may require orthognathic surgery to reposition the jaw and correct the bite. This treatment option is typically reserved for cases where braces or aligners are not sufficient to achieve the desired results. Surgery can be combined with orthodontic treatment to optimize outcomes and ensure long-lasting results.

Frequently Asked Questions

What are common dental malocclusions?

Dental malocclusions are misalignments of the teeth that can lead to various oral health issues. Some common types of malocclusions include overbites and underbites. Overbites occur when the upper front teeth extend beyond the lower front teeth, while underbites are characterized by lower front teeth protruding beyond the upper front teeth.

How do overbites affect oral health?

Overbites can lead to a range of oral health issues. Due to the misalignment of the teeth, individuals with overbites may experience difficulty biting and chewing, speech problems, or increased wear on tooth enamel due to uneven pressure distribution. Additionally, overbites may cause self-consciousness or discomfort in social situations.

What issues can underbites cause?

Underbites can pose several challenges to an individual’s oral health. The misalignment of the teeth caused by underbites may lead to difficulty in biting and chewing, speech problems, and a higher risk of tooth decay or gum disease due to inadequate cleaning and uneven pressure on the teeth. Furthermore, underbites can cause discomfort and affect a person’s appearance, potentially leading to self-consciousness and reduced confidence in social situations.

How is a deep bite different from a normal bite?

A deep bite differs from a normal bite in the way the upper and lower front teeth overlap. In a normal bite, the upper front teeth slightly overlap the lower front teeth. However, a deep bite occurs when the upper front teeth cover the lower front teeth more than expected. This excessive overlap can lead to problems such as gum disease, early enamel wear, and even

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