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Open Bite – Causes, Symptoms & Treatment

An open bite is a dental misalignment where the upper and lower teeth do not meet when the mouth is closed. It most commonly affects the front teeth.

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Things worth knowing about "Open Bite"

An open bite is a dental misalignment where the upper and lower teeth do not meet when the mouth is closed. It most commonly affects the front teeth.

What is an Open Bite?

An open bite is a type of malocclusion (dental misalignment) in which the upper and lower teeth do not make contact when the jaws are fully closed. A visible gap remains between the upper and lower dental arches even though the jaw is shut. The most common form is the anterior open bite, which affects the front teeth, but the condition can also occur in the back of the mouth (posterior open bite), involving the molars and premolars.

Types of Open Bite

Anterior open bite: The front teeth of the upper and lower jaw do not touch. This is the most frequently occurring form.
Posterior open bite: The back teeth (molars) do not meet while the front teeth are in contact.

Causes

An open bite can develop due to a variety of factors:

Oral habits: Prolonged thumb sucking or pacifier use beyond the age of three is one of the most common causes in children.
Tongue thrust: Repeatedly pressing the tongue against or between the front teeth during swallowing or speaking can push the teeth out of alignment over time.
Genetic factors: Inherited jaw structure or bone patterns can predispose a person to an open bite.
Skeletal causes: Abnormal vertical growth of the jaws, particularly excessive downward development of the upper jaw, can result in an open bite.
Mouth breathing: Chronic mouth breathing, often due to nasal obstruction, can affect tongue posture and jaw development.
Temporomandibular joint (TMJ) disorders: Changes in the jaw joint can contribute to the development of an open bite.

Symptoms and Effects

An open bite can cause a range of functional and aesthetic problems, including:

Difficulty biting and chewing food effectively
Speech difficulties, particularly with sounds such as "s" or "z" (lisping)
A visible gap between the front teeth when smiling or at rest
Aesthetic concerns and potential psychosocial impact
Excessive wear on the back teeth due to the lack of front tooth contact
Jaw joint pain or discomfort in some cases

Diagnosis

An open bite is diagnosed by an orthodontist or a dentist. The following assessments are commonly used:

Clinical examination: Visual and manual assessment of tooth alignment and bite
X-rays: Lateral cephalometric radiographs and panoramic X-rays to analyze jaw and tooth structure
Dental models: Plaster casts or digital scans for precise measurement of the dental arches
Functional analysis: Evaluation of the jaw joint and chewing muscles

Treatment

Treatment depends on the underlying cause, the severity of the condition, and the age of the patient:

Orthodontic Treatment

Removable appliances: In children, removable plates or functional orthodontic devices are often used to guide jaw growth.
Fixed braces: Brackets and wires apply controlled forces to move teeth into the correct position.
Clear aligner therapy: Transparent aligners (e.g., Invisalign) may be suitable for mild to moderate cases.
Vertical elastics: Intermaxillary rubber bands can help encourage closure of the open bite.

Myofunctional Therapy

When tongue thrust is an underlying cause, myofunctional therapy is often recommended. This involves targeted exercises to retrain tongue posture and swallowing patterns.

Surgical Treatment

In adults with a severe skeletal open bite caused by jaw structure abnormalities, orthognathic surgery (corrective jaw surgery, also known as osteotomy) may be required. This procedure repositions the upper and/or lower jaw to achieve proper alignment.

Habit Control

Breaking oral habits such as thumb sucking is a key part of treatment in children. Specialized appliances, sometimes called habit breakers or cribs, can be used to discourage these behaviors.

Prognosis

When treated early, especially during the growth phase in childhood and adolescence, the prognosis for correcting an open bite is generally very good. Treatment begun later in life may be more complex and time-consuming. Regular follow-up care and the use of retainers after active treatment are essential to prevent relapse.

References

Proffit WR, Fields HW, Sarver DM: Contemporary Orthodontics. 6th Edition, Elsevier, 2018.
Ngan P, Fields HW: Open bite: a review of etiology and management. Pediatric Dentistry, 1997; 19(2): 91-98. PubMed PMID: 9103116.
World Health Organization (WHO): Oral Health. www.who.int/health-topics/oral-health

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