Malocclusion

A healthy occlusion refers to teeth and jaws that are well aligned and in functional harmony. When a malocclusion, more commonly referred to as a “bad bite” is present, either the teeth, the jaws or both are not in the correct positions or proper relationships.

There are many dental issues, which can affect the positions of the teeth and jaws that require orthodontic treatment to resolve. A malocclusion may be due to crowding, spacing, problems with jaw development, or the failure of certain teeth to erupt into their proper positions. Harmful oral habits such as finger sucking or tongue thrusting can also cause bite problems as well as the drifting of teeth into the unrestored spaces left by dental extractions or tooth loss. Sometimes, teeth develop in the jawbone facing in directions that prevent them from erupting at all. These teeth are referred to as impacted.

Both genetic and environmental factors contribute to the development of a malocclusion. Injuries that cause a misalignment of the jaws and diseases such as oral tumors can also play a role in changing the occlusion.

In children, most problems involving the alignment of the teeth and the growth of the jaws can be detected by the time they are in the first or second grade. That is why the American Association of Orthodontists recommends that all children have a check up with an orthodontic specialist no later than age 7. For children, most orthodontic treatment begins between the ages of 9 and 14. However, earlier and interceptive care is sometimes required at a younger age. Likewise, in cases of significant problems involving jaw relationships, orthodontic care may involve treatment throughout growth and development.

It is important to note that a malocclusion can be treated at any age. Today greater numbers of adults are actively seeking treatment for either crooked teeth or jaw problems that have bothered them since childhood, as well as to address teeth that have shifted over time due to extractions, habits, or abnormal bite patterns.

While malocclusions can be observed with a clinical exam, a more comprehensive assessment is required to make a complete diagnosis and to develop the most appropriate plan of care.

There are two temporomandibular joints that connect the left and right sides of the lower jaw to the temporal bone. Both joints and their associated muscles, ligaments and tendons work together to allow for all manner of oral function as the jaw moves up and down, front to back and from side to side. Containing a shock-absorbing, soft disc that sits between the rounded condyles of both sides of the lower jaw and the corresponding concavities in the skull’s temporal bone, the TMJ makes chewing, speaking, yawning and all jaw movements possible.

Since the TMJ is a joint with both up and down hinge-like movements, as well as side to side and front to back sliding motions to perform, it is often considered one of the most complicated joints in the body and one of the most difficult to treat when problems arise.

TMJ disorders can fall into one or more of the following three categories:

The risk for developing a TMJ problem is greater in the presence of long-term teeth grinding or bruxism, a jaw injury or various types of arthritis such as rheumatoid arthritis and osteoarthritis. Furthermore, the manifestations of a TMJ disorder can vary from person to person with a wide range of symptoms possible, including earaches, ringing in the ears (tinnitus), headaches, back and neck pain, vertigo, muscle spasms and joint tenderness as well as jaw pain, popping or grating sounds with jaw movement, jaw locking and limited jaw movement. For some people a TMJ disorder can be resolved within a relatively short period of time, while for others it will continue to persist despite extensive therapy.

When evaluating for the presence of a TMJ disorder, the dentist will perform a thorough clinical assessment of joint symptoms and function. Special radiographic imaging and other diagnostic tests will be ordered as needed. The treatment of a TMJ disorder may include oral appliances such as night guards or stabilization splints to alleviate strain on the joints. Other types of therapy may include steroid injections, occlusal adjustments as well as orthodontic or prosthodontic treatment to improve occlusion. In cases of persistent and serious TMJ problems, surgery may be recommended.

Methods of self-care can be helpful in alleviating some of the symptoms of a TMJ disorder. Patients are typically advised to eat soft foods, avoid extreme jaw movement such as wide yawning and gum chewing, to practice stress reduction and relaxation techniques and applying ice packs or moist heat as directed. If recommended, a patient should follow the dentist or therapist’s instruction for gentle stretching exercises. The short-term use of over-the-counter, non-steroidal, anti-inflammatory drugs and pain medications may provide relief. If not the dentist or physician may prescribe stronger pain or anti-inflammatory drugs, muscle relaxants or anti-depressants.