Introduction

Photo of a group of teenagers (PantherMedia / Chris DeSilver)

Everyone’s set of teeth looks slightly different. But in people who have misaligned teeth or jaws, there’s a more noticeable difference. Sometimes only one single tooth is affected, and sometimes several teeth or the position of the jawbones is involved.

Severe misalignments can cause problems when you chew, speak and breathe, and also affect your psychological wellbeing. They can increase the risk of gum disease and tooth decay (cavities) too. The medical term for teeth that aren’t aligned properly is “malocclusion.”

Misaligned teeth and jaws are commonly treated with removable or fixed braces. Dental braces are mainly used in teenagers because their mouths are still growing so it’s easier to change the position of their teeth and jaws.

Symptoms

Misaligned teeth or jaws can lead to a wide range of different problems – or sometimes cause no problems at all. This will depend on the type of misalignment and how severe it is.

Severe misalignments can affect things like eating, drinking and speaking, or cause breathing problems. Sometimes teeth dig into your lips or the gums opposite when you close your mouth, which can be painful. The affected teeth may become wobbly, tooth decay may develop, and the teeth may be more prone to damage if you have an accident. After a while the joints of the jaw might start hurting and the jaw muscles may tighten.

Misaligned teeth and jaws can also affect your mental health, particularly in children and teenagers who are teased as a result. A lot of people who have crooked teeth or an uneven bite feel less attractive or less confident – particularly if it affects their speech – and they might then avoid contact with others. But the psychological effects don’t only depend on how severe the misalignment is. How you deal with it plays a role too.

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Causes and risk factors

Misaligned teeth and jaws can be caused by a problem with the development and position of certain teeth or the jawbones, but also of the tongue, lips, cheeks and muscle tissue. Genes play a role here, so it can “run in families.” Other causes include tooth loss, baby teeth falling out sooner than they would naturally, injury and bone disease.

Certain habits are considered to be risk factors: It is normal for babies and toddlers to use a pacifier (dummy, soother) or suck their thumb or a finger. But if they don’t stop doing that at around the age of three, the sucking can increase the risk of crooked teeth and misaligned jawbones. The risk is also higher if children only breathe through their mouth – for instance, because they have enlarged adenoids and can’t breathe through their nose as a result.

Prevalence and outlook

Misaligned teeth and jawbones are common. It is estimated that more than half of all children and teenagers in Germany have treatment for this problem.

Permanent teeth replace baby teeth in older children, and the jawbones can continue to grow until the end of puberty. So a misalignment of the teeth and jaws may get better – or worse – by the time the jawbones have stopped growing. But the position of the teeth can still change in adults too, for instance as a result of teeth grinding or tooth loss.

Effects

Crooked teeth – particularly protruding upper incisors (upper front teeth that stick out) – are more likely to become damaged due to things like injury. Other types of misalignment can cause the joints of the jaw to ache, make a clicking or popping sound, or become “blocked.” This can make it impossible to open your mouth wide, for instance.

Compensatory movements and teeth grinding can cause the teeth to wear each other down. Because some types of misalignment make it harder to brush one or several teeth properly, they can also lead to tooth decay and gum disease.

Diagnosis

Parents often notice themselves that their child has misaligned teeth or jaws. But sometimes doctors or dentists are the first to notice, during an examination of the mouth. To find out whether misaligned teeth or jaws need to be treated, the child is usually referred to a specialist known as an orthodontist. The orthodontist will take a close look at the child’s teeth and mouth, and also examine the rest of their head. He or she will ask about possible causes and see whether the child’s mouth opens and closes properly.

The orthodontist will usually take x-rays and make plaster models of the teeth too. To make a plaster model (a dental cast), the child is asked to bite down on two special trays filled with a soft material. This can be unpleasant and make them gag. But the material hardens after about half a minute and can then be removed from the mouth. The resultant cast is used to make a model of the child’s set of teeth, and the treatment can then be planned based on the model. It is now sometimes also possible to make a model using computers. The teeth are first scanned and then a model of the teeth is made digitally.

You sometimes have to go to see other specialized doctors too: For instance, if your airways are narrow as well, it’s a good idea to see an ENT (ear, nose and throat) specialist too.

Prevention

To prevent young children’s teeth from becoming crooked, you can try to help them stop bad habits like sucking their thumb. For instance, some children suck their thumb less if you draw a face on it or put an unpleasant-tasting cream or polish on it. To wean children off their pacifier (dummy or soother), you can talk to their dentist about replacing it with a special pacifier alternative. In Germany, this is sometimes paid for by statutory health insurers. The special pacifier looks like a normal pacifier from the outside, but inside the mouth there’s a plastic screen between the teeth and lips. Taking good care of the baby teeth is important too, so they stay in the mouth long enough to “show” the permanent teeth where to grow out.

Treatment

Misaligned teeth and jaws are usually treated by an orthodontist. Orthodontic treatment mainly involves wearing a fixed or removable braces in your mouth. Sometimes both types of braces are used: Then you might wear removable braces at first, followed by fixed ones. The aim of this treatment is to correct the position of the teeth and align the upper and lower jaw to improve the bite.

It is usually done between the ages of 12 and 16. By that time the baby teeth have already been replaced by permanent teeth, but the jawbones are still growing. Sometimes children already have treatment with braces between the ages of 6 and 8 (early treatment).

The active treatment phase, when fixed or removable braces are worn, lasts about two years. After that, you use something known as a retainer to prevent the teeth from moving back to their original position. The retainer may, for instance, consist of a wire glued to the back of the front teeth. The active treatment and retention phases usually take about 3 to 4 years in total. A retainer may have to be worn for longer in some cases, depending on the type of misalignment.

Orthodontic treatment is mainly done if the teeth or jaws are more than just a little misaligned – for instance, if the upper front teeth stick out over the lower front teeth by more than 3 millimeters, or if teeth at the side of the mouth don't touch each other when the person bites. But sometimes people wish to have orthodontic treatment for more minor misalignments because they don't like the way it looks. It’s not clear whether orthodontic treatment is really needed as often as it is recommended nowadays. There's a lack of research into things like how many people need braces to prevent tooth problems or other medical problems and how many people wear them because they would like to have a more attractive smile.

Young children and adults rarely have orthodontic treatment. If they do, it is usually because they have a severe misalignment – for instance, due to a birth defect such as a cleft lip and cleft palate. They then generally need surgery, sometimes in combination with a dental brace. That type of severe defect isn't covered here.

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Further information

Dental braces can help to correct misaligned teeth and jaws, improving problems related to the misalignment. But the treatment can also be associated with problems itself: Wearing braces can be painful at first because it pulls the teeth in a certain direction. Children and teenagers who have fixed braces also have to be careful when eating: For example, apples should be cut into small pieces because biting into an apple can cause the brackets to break off. The brackets are the small metal parts of the braces that are stuck to the teeth. People who wear fixed braces should avoid eating very chewy sweets too. And although braces are often considered to be “cool” nowadays, some children and teenagers find them embarrassing – especially when they’re eating – or they might be afraid of damaging them while eating.

Treatment with braces can only work if children and teenagers use them properly. In other words, if they keep their teeth and braces clean and wear removable braces as often as instructed. Going for check-ups and being shown how much their teeth have already improved can motivate them to keep up the good work.

In Germany, statutory health insurers cover the cost of orthodontic treatment in children and teenagers under the age of 18 if their teeth or jaws are misaligned beyond a certain extent. But you have to pay for some of it yourself at first, and then get the money back once the treatment has been completed as planned. The treatment can be more expensive if you would like something other than the standard braces, such as braces with less visible wires or braces made with colorful or sparkly plastic. Treatment for more minor misalignments is considered to be cosmetic (not medically necessary) and you have to pay for the whole treatment yourself.

Many people go to the dentist regularly for check-ups rather than just when they have toothache. Read about how to find the right dentist, how to prepare for the appointment and what to remember.