Malocclusion of teeth


Malocclusion means the teeth are not aligned properly.


Occlusion refers to the alignment of teeth and the way that the upper and lower teeth fit together (bite). Ideally, all upper teeth fit slightly over the lower teeth. The points of the molars fit the grooves of the opposite molar.

The upper teeth keep the cheeks and lips from being bitten and the lower teeth protect the tongue.

Malocclusion is most often hereditary, which means the condition is passed down through families. There may be a difference between the size of the upper and lower jaws or between jaw and tooth size, resulting in overcrowding of teeth or in abnormal bite patterns.

Variations in size or structure of either jaw may affect its shape, as can birth defects such as cleft lip and palate. Other causes of malocclusion include:

  • Childhood habits such as thumb sucking, tongue thrusting, pacifier use beyond age 3, and prolonged use of a bottle
  • Extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth
  • Ill-fitting dental fillings, crowns, appliances, retainers, or braces
  • Misalignment of jaw fractures after a severe injury
  • Tumors of the mouth and jaw

There are different categories of malocclusion.

  • Class 1 malocclusion is the most common. The bite is normal, but the upper teeth slightly overlap the lower teeth.
  • Class 2 malocclusion, called retrognathism or overbite, occurs when the upper jaw and teeth severely overlap the bottom jaw and teeth.
  • Class 3 malocclusion, called prognathism or underbite, occurs when the lower jaw protrudes or juts forward, causing the lower jaw and teeth to overlap the upper jaw and teeth.


   Abnormal alignment of teeth

   Abnormal appearance of the face

 Difficulty or discomfort when biting or  chewing

  Speech difficulties (rare) including lisp

 Mouth breathing (breathing through the mouth without closing the lips)

Exams and Tests

Most problems with teeth alignment are discovered by a dentist during a routine exam. The dentist may pull your cheek outward and ask you to bite down to check how well your back teeth come together. If there is any problem, the dentist will usually refer you to an orthodontist for diagnosis and treatment.

Dental x-rays, head or skull x-rays, or facial x-rays may be required. Plaster or plastic molds of the teeth are often needed.


Very few people have perfect teeth alignment. However, most problems are so minor that they do not require treatment.

Malocclusion is the most common reason for referral to an orthodontist.

By treating moderate or severe malocclusion, the teeth are easier to clean and there is less risk of tooth decay and periodontal diseases (gingivitis or periodontitis). Treatment eliminates strain on the teeth, jaws, and muscles, which lessens the risk of breaking a tooth and may reduce symptoms of temporomandibular joint disorders.

The goal is to correct the positioning of the teeth. Braces or other appliances may be used. Metal bands are placed around some teeth, or metal, ceramic, or plastic bonds are attached to the surface of the teeth. Wires or springs apply force to the teeth.

One or more teeth may need to be removed if overcrowding is part of the problem. Rough or irregular teeth may be adjusted down, reshaped, and bonded or capped. Misshapen restorations and dental appliances should be repaired. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to stabilize the jaw bone. Clear braces (aligners) without wires may be used in some patients.

It is important to brush and floss your teeth every day and have regular visits to a general dentist. Plaque accumulates on braces and may permanently mark teeth or cause tooth decay if not properly cared for.

You may need a retainer to stabilize your teeth after having braces.  

Outlook (Prognosis)

Problems with teeth alignment are easier, quicker, and less expensive to treat when they are corrected early. Treatment is most successful in children and adolescents because their bone is still soft and teeth are moved more easily. Treatment may last 6 months to 2 or more years, depending on the severity of the case.

Treatment of orthodontic disorders in adults is often successful but may require longer use of braces or other devices.

Possible Complications

  • Tooth decay
  • Discomfort during treatment
  • Irritation of mouth and gums (gingivitis) caused by appliances
  • Chewing or speaking difficulty during treatment

When to Contact us

Call  us if toothache, mouth pain, or other new symptoms develop during orthodontic treatment.


Many types of malocclusion are not preventable. Control of habits such as thumb sucking may be necessary in some cases. However, early detection and treatment may optimize the time and method of treatment needed.

Hover here to Read More on Crooked Teeth

 Crooked teeth Malocclusion

There are several reasons why some people's teeth grow in crooked, overlapping, or twisted all this wrong positioning of teeth is technically termed Malocclusion.

-Some people's mouths are too small for their teeth, which crowds the teeth and causes them to shift. This leads to either a variety of irregular teeth arrangement or may lead to protrusion of front teeth.

-  In other cases, a person's upper and lower jaws aren't the same size or are malformed, resulting in either anoverjet, when there is excessive protrusion of the upper jaw, or an reverse bite, when the lower jaw protrudes forward causing the lower jaw and teeth to extend out beyond the upper teeth. Sometimes such a deformity when occurs among the back teeth with a total in-out overlap of upper with lower teeth is called a Scissor bite.

Most often crooked teeth,  are inherited or congenital traits just as the color of youreyesor size of your hands. Other causes of misaligned bites are

- early loss of baby or adult teeth;

- improper fit of dental restorations (for example, fillings or crowns);

-gingivitis(gum disease);

-undue pressure on the teeth and gums;

-misalignment of the jaw after an injury; tumors of the mouth or jaw;

-or commonoral health problems in childrensuch as thumb sucking,tonguethrusting,pacifieruse beyond the age of three, or prolonged use of a bottle.

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Crooked teeth and misaligned bites can:

  • Interfere with proper chewing.
  • Make keeping teeth clean more of a challenge, increasing the risk oftooth decay,cavities, and gingivitis.
  • Strain the teeth, jaws, and muscles, increasing the risk of breaking a tooth.
  • Make people feel self-conscious about their appearance and affect their self-esteem.
  • Abnormal alignment of teeth
  • Abnormal appearance of the face
  • Difficulty or discomfort when chewing or biting
  • Speech difficulties, including a lisp

While you can see for yourself if teeth are crooked, your dentist can determine if the problem warrants treatment. Your dentist will look for the following signs:

Your dentist will usually refer you to an orthodontist -- a dentist who specializes in the diagnosis and treatment of crooked teeth and misaligned jaws.


The orthodontist will likely takeX-rays, photographs of your face, and teeth impressions to determine if and what type of treatment is needed. X-rays provide information on the position of your teeth and roots and if any teeth have yet to come through the gums. Special cephalometrics or panoramic X-rays show the relationship of the teeth to the jaws and the jaws to the head. Your orthodontist may also want to take regular photographs of your face to further examine the relationship between the teeth, jaws, and head. Finally, impressions may be made of your teeth. This is done by having you bite down on a soft material that is later used to create an exact copy of your teeth.


Once a diagnosis is made, your orthodontist can decide the best treatment for your teeth or misaligned bite. For some people, a removable retainer (to stabilize the new position of teeth) will be all that's needed to correct the problem. Removal of one or more teeth may be required if overcrowding is the main problem. For most people,bracesare necessary to correct the problem. In rare and extreme cases, such as an extreme overbite or underbite, an surgical operation may be necessary.

Hover here to Read More on Causes of Crooked Teeth

Insights into Malocclusion

Insights into true cause of malcocclusion:

Scientists have suggested several different theories over the decades as to what causes crooked teeth in humans. When my Dad started medical school in the late 1940′s, he was taught that racial mixing (Italians marrying Irish for example) was the cause of crooked teeth. Malocclusions had just started to reach epidemic proportions in children at that time.

Of course, this theory of racial mixing causing crooked teeth which was incidentally presented as fact to the wide eyed medical students of the time is completely ridiculous and has long since been disproven.

Other theories include thumb sucking and consuming soft foods which are suppositions subscribed to by many orthodontists.   The soft food theory suggests that because humans don’t exercise their jaw muscles enough that our jaws have become weak and narrowed over time.

One orthodontist once told me (while I struggled to keep a straight face) that wisdom teeth were being genetically “selected out” of the gene pool because they are no longer needed because of the different foods that humans now eat compared with ancestral societies.

Now comes a variation of the “soft food causes crooked teeth” theory which was recently described in a study published in the online edition of the Proceedings of the National Academy of Sciences.

This new theory states that the move of humans from primarily hunter-gatherers to farmers around 10,000 years ago put us on the inevitable road to the orthodontist’s chair.

To test this hypothesis, Noreen von Cramon-Taubadel, an anthropologist at the University of Kent in the UK, examined the skull and jaw shapes of ancient skeletons housed in museums that originated from Africa, Australia, Europe, and North/South America.  Six of the populations lived by farming and five were hunter-gatherers.

A significant correlation existed between how a population obtained its food and the shape of the jaw. Hunter-gatherers had narrower and more jutting lower jaws whereas those of the agriculturalists were shorter and wider.

The shape of the upper jaw and palate also varied somewhat between the farmers and hunter-gatherers.

Von Cramon-Taubadel concludes by suggesting that the transition to farming and an increase in food processing both of which led to consumption of softer foods resulted in a shorter and weaker human jaw.   Jaw shortening leads to greater crowding of the teeth.

To lend support to her theory, von Cramon-Taubadel refers to preliminary studies of animals which show that those that are raised on softer more processed foods develop smaller jaws than those raised on fresh, unprocessed diets.

Katerina Harvati, an anthropologist at the University of Tubingen in Germany says that this recent paper by von Cramon-Taubadel is a “well thought out piece of research and an important contribution” to understanding how the way humans live affects their body shape.

She goes on to say, “These findings confirm long-held ideas that the dietary shift to softer foods was an important influence affecting facial and dental morphology.”

The Soft Food Theory Ignores Contradictory Evidence

Strong contradictory evidence to the soft food theory as a reason for crooked teeth is presented in Dr. Weston A. Price’s book Nutrition and Physical Degeneration.  How such convincing evidence was completely ignored as part of this supposedly “well thought out piece of research” is rather surprising and I would think, downright embarrassing for the author.

While hunter-gatherers certainly had strong jaws which allowed them to consume hard foods, the strength did not come from greater exercising of the jaw muscles!   As suggested by Sally Fallon Morell, President of the Weston A. Price Foundation, such a theory makes the critical mistake of confusing muscle with bone.

A narrowed jaw and palate, for example, can be identified in babies at birth long before they have chewed anything!

Dr. Price also correctly pointed out that when the jaw and palate are narrowed, other parts of the skeleton are correspondingly narrowed as well such as the pelvic opening which causes greater difficulty in childbirth and the chest cavity which crowds the vital organs.

The Swiss farmers studied by Dr. Price subsisted on very soft foods and yet had beautifully broad palates with perfectly straight teeth.   Moreover, the South Sea Islanders photographed by Dr. Price with perfectly straight teeth consumed primarily seafood and poi, both soft foods with poi, in particular, a very soft and sticky staple carbohydrate in their diet.

The Truth About Crooked Teeth

Von Cramon-Taubadel did get one aspect of her paper correct.  The rise of food processing did indeed contribute to the modern epidemic of crooked teeth, but not because such foods are softer than unprocessed foods.

Rather, processed and industrialized foods are devoid of the critical nutrients necessary to produce a broad and sturdy jaw with correspondingly straight teeth.

Dr. Price’s research compellingly argues that a lack of jaw development and crooked teeth is entirely nutritional in origin such as attempting to build a wide bridge with substandard materials.

Without essential nutrients in the form of minerals and the fat soluble activators A, D, and K2 which were abundant in primitive diets, the jaw and palate cannot form with enough strength to support a broad facial structure.  Hence, narrowing of the face and crooked teeth are the result no matter how hard the food that is chewed.

Anthropologists of all people should realize that chewing rocks will not produce a broad jaw and straight (albeit broken) teeth!





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