The teeth are meant to sit in a specific spot on the jaw bone. When the teeth don’t come in properly, or sit in the correct place on the bone, we call this a dental problem. But what if the teeth are perfectly straight and still don’t come together correctly? This may be a skeletal or jaw problem. If the jaws don’t align, the teeth won’t align either. Both dental and skeletal issues contribute to bite problems. Part of an orthodontist’s role is to diagnose the problem, what is causing it, and treat it based on the etiology. Severe skeletal issues may require jaw surgery to correct the problem. The most common bite issues are listed below.
An overbite is where the top teeth cover the bottom teeth. This type of bite can lead to wear on the anterior teeth, especially in patients who grind their teeth. Overbites are a vertical problem that can have either a skeletal or dental component so it must be evaluated by an orthodontist. The cause of the overbite will determine the treatment you receive.
An overjet is a horizontal problem where the top teeth stick out further than the bottom teeth, Similar to the overbite, this is a problem that can have either a skeletal or dental component so it must be diagnosed by our orthodontist to determine the best treatment plan to address it. In cases of significant flaring, the upper front teeth have been shown statistically to have a higher risk of trauma and/or breakage. Early treatment can minimize this risk.
In a normal bite, all of the top teeth are outside of the bottom teeth. In an anterior crossbite, this is reversed and a bottom teeth will sit outside the top teeth. This can cause trauma to the teeth and, in more severe cases, gum recession. Dr. Renick will plan the best way to treat this issue based on whether the problem originates dentally or skeletally.
A posterior crossbite is defined when an upper back tooth sits inside a lower back tooth (left side of picture), which is the reverse of a normal bite (right side of picture). This is generally a dental issue if a single tooth is involved. If more than one permanent tooth is involved, this can be related to lack of growth of the width of the upper jaw, presenting a skeletal problem. The skeletal problems are often addressed with a maxillary palatal expander. Dr. Renick will determine whether or not the patient is a candidate for skeletal expansion.
In an anterior openbite, the top teeth do not touch the bottom teeth. This creates a functional problem and can limit the ability to eat certain foods. Biting into an apple or eating lettuce can create a challenge. If the problem is dental related, it may come from a habit such as thumb sucking or tongue thrusting. If the problem is a skeletal problem, this can be a much more difficult and involved treatment. It can be cause be the direction the jaw grows or from systemic issues such as rheumatoid arthritis and other TMJ degenerative diseases. Dr. Renick will evaluate the bite at the consult appointment and advise the patient on the treatment direction.
This type of problem is more commonly a dental problem and is often one of the more difficult problems to treat. It can be caused by a tongue habit in which the habit must be terminated to fix the problem. The more difficult etiologies that cause this problem involve bone problems or lack of eruption of teeth. In these cases, comprehensive treatment plans with other specialists may be required and Dr. Renick will orchestrate the appropriate timing and treatment.
Most people will schedule an appointment with our orthodontist, Dr. Renick, because they notice crowding or overlapping of their teeth. This problem creates an obstacle to proper brushing, flossing and good oral hygiene care for the teeth involved. By correcting crowding, we make it easier for you to keep your teeth clean and healthy through regular oral hygiene care. This simple alignment will help our patients avoid decay, scarring and gum disease. If gum recession is a risk, you may require treatment with a periodontist. Skeletal constriction may need to be addressed if this is the heart of the problem.
Spacing, or gaps, between the teeth are often caused by forces on the teeth pushing them forward, such as with thumb habits, tongue thrusts or excessive lower jaw growth. While it seems like a simple thing to just pull the teeth together to close the space, this may not be as easy as it sounds. For instance, if the lower teeth are in the way due to an overbite, the space will not close. Dr. Renick will investigate the cause of the spacing and what will be necessary to close the gaps appropriately. These options will be discussed at the consultation appointment .
Ectopic Eruption of Teeth
This problem is one of the only true dental problems that has very little to do with skeletal issues, except in the case of skeletal crowding or syndromes. “Ectopic” means that the teeth are not erupting where they belong. Permanent teeth usually follow their precursor. For instance, the permanent teeth should follow the same path as the baby teeth. Once in a while, however, these teeth dance to the beat of their own drum and do not erupt where they are supposed to. In these situations we intervene to guide them into the proper place, often to avoid damage to neighboring teeth. This treatment is often sequential and may require an expose and tie procedure. Dr. Renick will be glad to guide you through the steps.
The prognathic maxillary occurs when the upper jaw outgrows a normal lower jaw. This is not a very common occurrence, but our job usually involves holding the upper jaw orthopedically from growing further while the lower jaw catches up.
The retrognathic maxilla occurs when the upper jaw doesn’t grow enough compared to a normal lower jaw. This creates what we call a midface deficiency and creates a concave appearance to the face. You may see flat cheeks and dark circles under the eyes. It is often seen in cleft palate patients where the growth of the upper jaw is abnormally affected. We can often successfully treat this orthopedically at an early age.
This bite happens when the lower jaw outgrows the normal upper jaw. This is one of the most challenging bites an orthodontist may come across, particularly because the growth is very unpredictable. In mild cases, we can be successful with an orthopedic appliance and/or selective tooth extractions. In the more severe cases as shown here, jaw surgery is often recommended to directly address the skeletal problem by reducing the lower jaw’s overgrowth. Dr. Renick will carefully evaluate the lateral cephalometric X-ray to determine the correct course of treatment and offer the most predictable treatment path to a good oral result
One of the more common skeletal problems is when the lower jaw doesn’t grow enough and lags behind the growth of the upper jaw. Many factors are considered in the diagnosis and treatment plan for this type of problem. At the exam and records appointments, Dr. Renick will assess the severity of the problem, determine how much growth may be left, and decide the proper course of action. Options may include growth modification, dental extractions, and or jaw surgery if the case is severe enough.
If you would like more information about any of these bite problems, please don’t hesitate to call Renick Orthodontics at 740-936-5003 to schedule a consultation. We will be happy to provide a comprehensive exam and consult to diagnose the problems and find the right solution for you.
We are pleased to welcome patients from Sunbury as well as the surrounding areas of Westerville, Galena and Johnstown, Ohio.