An open bite is a type of dental malocclusion that can cause significant problems with eating, talking, or even simply sealing the mouth. Fortunately, various devices and techniques are available to correct an open bite, including orthodontic braces, selective tooth extraction, and jaw surgery.
What Is an Open Bite?
An open bite is an orthodontic condition where the upper and lower teeth do not make contact when the mouth is closed. The severity of an open bite is influenced by the skeletal structure of the face and jaws, the formation of the teeth and gums, and certain lifestyle habits. This condition is relatively common, occurring in approximately 16% of African Americans and 4% of Caucasians in the United States.
This article will explore the types and causes of an open bite, how it is diagnosed, and the treatment options available to correct it.
The Specifics
Terminology Used with Open Bite
Understanding these terms will help you grasp the details of open bite causes, types, and treatments.
- Malocclusion: Imperfect positioning of the teeth when the mouth is closed.
- Orthodontist: A doctor who specializes in treating misaligned teeth and jaws.
- Incisor: One of the four narrow-edged teeth in each jaw used for cutting food.
- Central Incisor: The two upper and lower teeth at the front of the mouth.
- Lateral Incisor: The two upper and lower teeth on either side of the central incisors.
- Overjet: A condition where the top teeth and jaw overlap the bottom teeth and jaw horizontally.
- Overbite: A condition where the top teeth and jaw overlap the bottom teeth and jaw vertically.
- Underbite: A condition where the lower teeth and jaw protrude in front of the top teeth and jaw.
Causes and Reasons for Open Bite
Most cases of open bite are hereditary, meaning they often run in families. However, an open bite can also result from mismatched sizes of the upper and lower jaws or differences between the sizes of the jawbones and teeth.
According to the American Academy of Pediatric Dentistry, other possible causes of an open bite include:
- Impacted, abnormally shaped, missing, or extra teeth
- Oral habits like tongue thrusting and thumb sucking
- Facial trauma that alters the shape of the jaws
- Poor-fitting dental restorations
- Prolonged bottle feeding
- Excessive pacifier use
- Jaw or mouth tumors
Types of Open Bite
Open bites commonly cause abnormal bite patterns and overcrowding of the teeth. Other symptoms include mouth breathing, discomfort or pain when biting or chewing, speech impediments like lisps, and an abnormal facial appearance.
There are four primary classifications of open bite:
- Dental Open Bite: Diagnosed when the patient’s anterior teeth do not meet when the mouth is closed, with no skeletal deformity causing it. Signs include no gummy smile, normal height of the lower front face, underdevelopment of upper incisors, overdevelopment of lower incisors, and proclination (forward tilt) of both upper and lower incisors.
- Anterior Open Bite: Occurs when the upper and lower front teeth do not touch, and there is no overlap between the upper and lower incisors. Often caused by habits during early childhood like thumb sucking and tongue thrusting. It can lead to flaring of the upper and lower teeth and an increased overjet.
- Skeletal Open Bite: Often associated with a combination of dental open bites, leading to “long face syndrome” or adenoid face, characterized by an open mouth, vertically extended face, snoring, and chronic mouth breathing. Other symptoms include a high arch in the palate, increased height of the lower front face, narrow nostrils, prominent anterior upper teeth, possible gummy smile, prominent upper jaw, teeth crowding, and an upturned nose.
- Posterior Open Bite: This occurs when the upper and lower posterior teeth (premolars and/or molars) fail to meet when the mouth is closed, often caused by certain teeth failing to erupt through the gums.
Diagnosis of an Open Bite
An open bite is most often diagnosed by a dentist during a routine examination. If recognized, the dentist may refer you to an orthodontist for further evaluation and treatment. The orthodontist may take dental x-rays, a skull x-ray, and/or a facial x-ray to determine the specific type of malocclusion.
Grades of Malocclusion
Like overjet, overbite, and underbite, an open bite is one of the various types of dental malocclusions. All malocclusions can be categorized into one of three classes:
- Class I Malocclusion: Marked by a slight overlap of the top teeth to the lower teeth. The bite is still normal, and this type of malocclusion is very common.
- Class II Malocclusion: Characterized by a severe overbite, called retrognathism. Excessive overjets are often placed in this category.
- Class III Malocclusion: Marked by severe underbites where the lower front teeth and jawbone protrude past the upper jawbone and teeth.
Treatment Options for Open Bite
Nearly everyone has some degree of dental malocclusion. Misalignment of the teeth is the most common reason dentists refer their patients to orthodontists. However, in most cases, it causes no aesthetic or functional problems, and orthodontic treatment isn’t necessary.
There is a tendency toward relapse in many patients treated for an open bite, making it one of the most challenging dentofacial deformities that orthodontists and orthognathic surgeons deal with. The main reason for relapse is that many patients continue habits like tongue thrusting, which likely contributed to causing the open bite initially. Unless the habit is reversed, the malocclusion will likely redevelop.
Other patients have an underlying genetic trait that causes the tongue to have a low posture. An orthodontist may recommend a tongue crib appliance to help correct this and thereby help avoid relapse after treatment for the open bite.
The goal of open bite treatment is to correct the alignment of the teeth, thereby:
- Reducing temporomandibular joint disorder (TMJ) symptoms when applicable
- Decreasing the risks for gingivitis and periodontal disease (gum disease)
- Relieving strain on the facial muscles, jaws, and teeth
- Reducing the risk of a tooth breaking
- Making it easier to clean the teeth
There are various treatment options to correct open bites, including selective tooth extraction, mini-implants, mini-plates, palatal cribs, orthodontic braces, and orthognathic surgery. Developing the best treatment plan for an open bite in any patient depends on an accurate diagnosis and an understanding of the underlying cause.
Early Intervention for Open Bite
Preventing an open bite can be achieved by discouraging poor oral habits like thumb sucking, tongue thrusting, or using a pacifier or bottle past the age of eighteen months. These habits place unnatural pressure on the soft tissues and structural tissues inside the mouth. In developing children, this repetitive pressure alters the natural formation of muscles, jawbones, and teeth, often resulting in an open bite or another type of malocclusion.
Interceptive orthodontic care is based on identifying and treating dental malocclusions before a child begins developing permanent teeth while they still have their baby teeth. Early detection and diagnosis of an open bite are crucial for maximum treatment success.
Treatment Options for Dental Malocclusions
The following are some of the most common treatments for dental malocclusions. You’ll need to discuss the best options for you or your child with your orthodontist.
Traditional Metal Braces
Traditional metal braces remain one of the most affordable and effective options for correcting teeth crowding in patients with open bites. This orthodontic system uses metal brackets and archwires, and elastic ligatures (bands) to gradually reposition the teeth and jaw. They require regular adjustments from an orthodontist as the treatment progresses, typically lasting between one and three years.
Damon Braces
Damon braces, while typically more expensive than traditional metal braces, feature a self-ligating bracket system that allows for faster orthodontic results with fewer adjustments. Palatal expansion and teeth extractions are not typically required with Damon braces.
Lingual Braces
Lingual braces are unique because they are placed on the side of the teeth where the tongue rests, hence their name. This hard-to-see system of dental braces can work well for correcting an open bite in some patients.
Clear Aligners
Clear aligners are custom-made plastic trays that gradually shift teeth into a more comfortable and aesthetically pleasing position. Clear aligners are increasingly popular since they are not immediately noticeable when eating or smiling. However, they may not be recommended for those with open bites caused by anomalies of the jawbone. While effective in correcting teeth position, clear aligners cannot adjust the jawbone.
Orthognathic Surgery
Severe cases of open bite may require orthognathic surgery. An oral and maxillofacial surgeon can perform this type of procedure to improve or correct several dentofacial deformities, including open bite, underbite, overbite, and other misalignments of the teeth and/or jaws.
The Takeaway
Conclusion
An open bite occurs when the upper and lower teeth fail to meet when the mouth is closed. This can cause problems with eating, drinking, speaking, and keeping the mouth sealed. Open bites and other dental malocclusions can also lead to various psychological issues, including low self-esteem, social isolation, and depression.
Most people have some degree of dental malocclusion, but an open bite is more serious. When an open bite causes a lower quality of life, various treatments are available that an orthodontist or orthognathic surgeon can provide.
The best treatment plan will be based on various factors unique to each patient. Working with your dentist or orthodontist to develop the best
approach for you is crucial.
By understanding the causes, types, and treatment options for open bites, patients can make informed decisions to improve their oral health and overall well-being. Whether through early intervention, orthodontic treatment, or surgical procedures, addressing an open bite can lead to a more functional and aesthetically pleasing smile.
