Open bite malocclusion

Open bite malocclusion

Your life may be an open book, but you don’t want your bite to be that way. An open bite is a type of malocclusion, or “bad bite,” that may require orthodontic interception to correct. This is not to be confused with overbite.

An open bite is a term used to describe when the upper and lower teeth are unable to make physical contact with each other when the jaws are closed. In an ideal bite, the upper teeth should slightly overlap lower teeth in the vertical dimension by about 25 percent.

The prevalence of dental open bites in children in the United States is 16 percent in the African American population and 4 percent in the Caucasian population, according to the American Academy of Pediatric Dentistry. All children experience anterior open bites during the time period when the permanent teeth erupt after the baby teeth fall out.

There are three general reasons why an open bite can be present: dental, skeletal, or due to a habit. Whether treatment is necessary is determined by the cause of the open bite. Sometimes the cause is genetic and involves skeletal issues, such as excessive development of the molars or jawbones that grow away from each other. This is called a hyperdivergent or skeletal open bite, and it is the most common type of an open bite.

Another type of an open bite is called a simple open bite, and that can be the result of a child in the mixed dentition – having some baby teeth mixed in with adult teeth.

An open bite also can be caused by poor oral habits such as:

  • Sucking of the lower lip
  • Thumb sucking– babies have a natural instinct to suck, and they often suck thumbs and fingers in their infancy to comfort themselves. Studies researched at major dental institutions have shown the ideal time to stop thumb sucking is around age 3 or 4. There are many pediatric dentists who claim alterations to your child’s bite caused by thumb sucking are reversible if the child stops before the permanent teeth begin to develop, which happens around age 5 or 6. Continuing the habit beyond this age can result in the need for orthodontic correction.
  • Tongue thrusting (also known as infantile swallow)- a poor swallowing pattern where the tongue protrudes through the front teeth during swallowing, speech, and while the tongue is at rest.
  • Tongue forward posture- the tongue is too far forward when it’s at rest, which pushes against the teeth and creates open bite over time. Mouth breathing also can cause your child to have a tongue forward posture.

Open bites that don’t include skeletal components or prolonged poor oral habits sometimes self-correct as your child grows. Spontaneous correction happens in as many as 80 percent of open bite cases in patients who still have a mixture of baby teeth and adult teeth, according to an article in Elsevier Science.

How do you determine if your child’s open bite will self-correct? This is where the importance of orthodontic evaluations at age 7 comes into play. I wrote about these evaluations back in March, and invite you to check out that blog post once again.

In a nutshell, your child should be evaluated at this age because they have a mixture of baby and adult teeth. Age 7 is definitely the best time to evaluate if there will be enough space for all of the permanent teeth and to ensure that the jawbones are growing properly. At this time, I am able to determine if interceptive treatment is needed to correct any problems that exist, or if your child just needs to continue being monitored periodically to determine if and when orthodontic treatment will be necessary.

If something such as open bite is detected, I may recommend more frequent monitoring appointments so I can watch and see if it appears the malocclusion will correct itself.

Children with an open bite that doesn’t self-correct will most likely need orthodontic intervention. Otherwise, the back teeth can easily wear faster than normal due to an increase in tooth-to-tooth contact points with the back teeth, and chewing could become painful for your child. Speech impairment is another common result of untreated open bite. When your child has an open bite, it also can be difficult – or even impossible, depending on the severity – to prevent food or liquids from escaping when swallowing if the tongue isn’t placed in the gap between the upper and lower teeth. This action can exacerbate the problem.

Blue Grass

Roller appliance. Photo credit: Accutech Orthodontic Laboratory

Open Bite Treatment Options
How we treat children with an open bite is determined by numerous factors. Following are some of the appliances and treatments I often use to correct this type of malocclusion:

  • Roller appliance – A roller appliance is a small roller-type bead that is placed on a small wire connected to two braces on the upper molars. The bead encourages patients to keep their tongue behind the appliance and away from their front teeth. The bead also helps strengthen the muscles of the tongue, which can help to maintain an optimal resting tongue position.
  • High-pull headgear – This is a dentofacial orthopedic appliance I use to guide jaw growth and improve alignment of the jaws. It is worn outside the mouth and is attached to the upper jaw, as well as the back and top of the head, where it directs force.
  • Bite block – This is a plastic appliance that can be placed over the molars to help adjust and move the back teeth to correct open bite.
  • Vertical chin cup – This appliance helps me control the growth of the lower portion of the face by preventing the chin from growing downward and back. This unfavorable growth can cause the chin to become recessed.
  • Mini anchors – Mini anchors can be used to intrude the back teeth in the upper jaw to experience an auto-rotation of the lower

    Vertical chin cup. Photo credit: adenta

    jaw along its hinge. As the lower jaw auto-rotates, the front teeth increasingly overlap in a vertical dimension. This approach, when indicated, tends to be the most stable way of actively correcting an anterior open bite.

  • Open bite surgery – Surgical correction sometimes is the only option if I’m dealing with an adult who has a severe open bite, or a child whose growth has completed. This surgical procedure involves an oral surgeon placing the upper jaw in a new position, then securing it in place with plates and screws.

Roller appliances, high-pull headgear, bite blocks and vertical chin cups are excellent tools for correcting open bite, provided your child is still growing. They enable us to control and guide the growth. At the risk of belaboring the point, this is another argument for why it is beneficial to have your child evaluated at age 7 to determine if interceptive treatment can prevent the need for more invasive treatment later in life. Most parents would agree that if they could take measures now to prevent their children from needing surgery in the future, they would do it.

Additional Therapies
If your child’s open bite is the result of poor oral habits, I may need to work in cooperation with other health professionals to ensure those oral habits don’t reverse the orthodontic correction, once complete. For example, speech therapy or myofunctional therapy may be necessary to correct a tongue thrust.

If your child has difficulty breaking the thumb sucking habit, I may need to install an appliance that takes away the pleasant sensation derived from sucking the thumb. Once the habit is broken, corrective treatment can commence.

At the end of the day, you can take comfort in knowing that regardless of the cause, orthodontic treatment can correct this type of malocclusion and give your child a smile to be proud to show off.

Please don’t wait- call today if your child hasn’t been evaluated by an orthodontist. We offer complimentary initial consultations and if treatment is needed, we will discuss your options and answer any questions you have. I look forward to seeing you in my office soon! Feel free to give us a call to discuss this along with any other type of treatments needed in your family. Remember, we are also one of the top Miami Invisalign orthodontic practices as well.

1 Comment

  1. Dear sir
    I am 25 years old but never noticed that i have an open bite untill i observed the diffrence between my smile and the smiles of my friends. i hope you understand my problem and could help me to have normal teeth. I have never consulted any dentist.

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