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Malocclusion: Causes, Symptoms & Treatment

Malocclusion refers to a misalignment of the teeth or jaws, where the upper and lower teeth do not fit together correctly. It can affect chewing, speech, and oral health.

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Things worth knowing about "Malocclusion"

Malocclusion refers to a misalignment of the teeth or jaws, where the upper and lower teeth do not fit together correctly. It can affect chewing, speech, and oral health.

What is Malocclusion?

Malocclusion is a dental term derived from Latin meaning “bad bite.” It describes a misalignment of the teeth or jaws in which the upper and lower teeth do not come together in the correct position when biting or chewing. Malocclusion is one of the most common dental and orthodontic conditions worldwide, affecting people of all age groups.

Causes

Malocclusion can result from a variety of factors:

Genetic factors: Inherited jaw size or tooth shape that does not match properly.
Early loss of baby teeth: Premature loss of primary teeth can cause permanent teeth to grow into incorrect positions.
Childhood habits: Prolonged thumb sucking, pacifier use beyond age two, or tongue thrusting can influence tooth alignment.
Injuries: Accidents that fracture or displace the jaw or teeth.
Tumors or cysts: Rarely, growths within the jaw can cause displacement of teeth.
Abnormal breathing patterns: Chronic mouth breathing can interfere with proper jaw development.

Classification by Angle

The most widely used classification system for malocclusion was developed by orthodontist Edward Angle and divides cases into three main classes:

Class I (Neutrocclusion): The molars are correctly aligned, but individual teeth are misaligned (e.g., crowding, spacing).
Class II (Distocclusion / Overbite): The lower jaw is positioned too far back; the upper jaw protrudes. Often visible as protruding upper front teeth.
Class III (Mesiocclusion / Underbite): The lower jaw is positioned too far forward; lower teeth overlap the upper teeth.

Symptoms and Consequences

Malocclusion does not always cause pain, but depending on its severity it may lead to various complaints:

Difficulty chewing or biting
Speech difficulties or articulation problems
Jaw pain or temporomandibular joint disorders (TMD / CMD)
Headaches and neck pain
Increased risk of tooth decay due to hard-to-clean areas
Gum disease and periodontitis
Psychological impact due to aesthetic concerns

Diagnosis

Malocclusion is diagnosed by a dentist or orthodontist using several methods:

Clinical examination: Visual and manual assessment of tooth alignment and bite
X-rays: Panoramic radiography (OPG) and lateral cephalometry to evaluate jaw and tooth positions
Dental impressions or digital scans: Used to create models for detailed analysis
Functional analysis: Assessment of jaw joint function and chewing mechanics

Treatment

Treatment depends on the type and severity of malocclusion and the age of the patient:

Orthodontic Treatment

Fixed braces (brackets): Gradually move teeth into the correct position over a period of typically 1 to 3 years.
Removable appliances: Particularly used in children during growth phases.
Clear aligners: An aesthetically discreet alternative to traditional braces.
Retainers: Used after active treatment to maintain the new position of the teeth.

Surgical Treatment

In cases of severe skeletal discrepancies that cannot be corrected by orthodontics alone, orthognathic surgery is required. This involves surgically repositioning the jaw bones to achieve correct alignment.

Additional Measures

Tooth extraction in cases of severe crowding
Occlusal splints for jaw joint-related symptoms
Speech therapy for articulation difficulties caused by the misalignment

Prevention

Regular dental check-ups from the first year of life and avoiding prolonged harmful habits such as thumb sucking or mouth breathing can reduce the risk of malocclusion. Early orthodontic assessment in childhood allows for more effective intervention and treatment outcomes.

References

World Health Organization (WHO): Oral Health Fact Sheets. Geneva, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/oral-health
Proffit WR, Fields HW, Sarver DM: Contemporary Orthodontics. 6th edition. Elsevier Mosby, 2018.
Angle EH: Classification of malocclusion. Dental Cosmos, 1899;41:248–264. Historical original source of the Angle classification system.

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