Malocclusion (Misaligned Bite)

Types of Malocclusion

Orthodontists classify malocclusion using a system developed by Edward Angle in 1899 — still the standard in clinical practice today. It is based on how the upper and lower first molars (the large back teeth) align when biting down.

• Class I Malocclusion

  The molar relationship is normal — the upper and lower back teeth sit together correctly. However, individual teeth are crooked, crowded, rotated, or spaced apart. Class I is the most common type, accounting for around half of all malocclusion cases.

• Class II Malocclusion (Overbite)

  The upper jaw or upper teeth sit too far forward in relation to the lower jaw. This creates what most people call an overbite — where the upper front teeth noticeably protrude or heavily overlap the lower teeth. Class II is divided into two subtypes: Division 1 (protruding upper front teeth) and Division 2 (upper front teeth tilted inward, creating a deep bite). Around one in four people have a Class II pattern.

• Class III Malocclusion (Underbite)

  The lower jaw sits forward of the upper jaw, causing the lower front teeth to protrude in front of the upper ones. This is commonly called an underbite. Class III is less common than Class I and II but tends to be more complex to treat, particularly when the jaw itself is involved.

• Other Bite Problems

Several specific bite patterns fall under the malocclusion umbrella:

• Crossbite — one or more upper teeth sit inside the lower teeth instead of outside; can affect the front or back of the mouth
• Open bite — the upper and lower front teeth do not make contact when biting down, leaving a visible gap
• Deep bite — the upper front teeth excessively cover the lower front teeth
• Crowding — insufficient space in the jaw causes teeth to overlap, rotate, or push in front of each other
• Spacing — gaps between teeth, which can result from missing teeth or a jaw that is larger than the teeth it holds

What Causes Malocclusion

Malocclusion is almost always the result of a mismatch between the size of the jaws and the size, number, or position of the teeth. The causes are often a combination of inherited traits and environmental influences.

• Genetics

  Jaw size, tooth size, and overall facial structure are largely inherited. If one or both parents have a significant overbite, underbite, or crowded teeth, there is a meaningful chance their children will too. Genetic factors remain the most common underlying cause of malocclusion.

• Childhood habits

  Certain habits during early childhood can affect how the jaws develop. Prolonged thumb-sucking, extended pacifier use past the age of three, and persistent mouth breathing can gradually shift the position of teeth and alter jaw growth patterns over time.

• Tooth loss

  When a tooth is lost — whether through decay, injury, or early extraction — neighboring teeth tend to drift into the empty space. Over time, this shifting can disrupt the bite and cause misalignment in surrounding teeth.

• Extra, missing, or abnormally shaped teeth

  Supernumerary (extra) teeth, congenitally missing teeth, or teeth that are unusually large or small can prevent the remaining teeth from fitting together properly.

• Dental work

  Poorly fitted crowns, fillings, or other restorations that do not sit at the correct height can alter the bite and create an imbalance that affects surrounding teeth over time.

• Jaw injuries

  Trauma to the face or jaw — including fractures or dislocations — can shift jaw position and result in a misaligned bite, even after the injury has healed.

Symptoms and Signs to Watch For

Mild malocclusion often causes no symptoms at all, which is why many people do not realize they have it until a dentist or orthodontist points it out during a routine examination.

When symptoms are present, they may include:

• Teeth that visibly overlap, protrude, crowd each other, or do not meet when the mouth closes
• Difficulty biting, tearing, or chewing food properly
• Speech difficulties, including a lisp or trouble with certain sounds — particularly "s," "t," and "z"
• Jaw pain, jaw fatigue, or a clicking or popping sensation when opening and closing the mouth
• Frequent headaches, particularly on waking
• Breathing through the mouth habitually rather than the nose
• Uneven or accelerated wear on specific teeth

In children, signs worth noting include visible crowding of the baby teeth, protruding front teeth, a noticeably shifted jaw when biting down, or an early habit of mouth breathing.

Why Malocclusion Should Not Be Left Untreated

Mild malocclusion that causes no discomfort and poses no structural risk does not always require treatment. A Specialist Orthodontist can advise on whether intervention is needed after a full assessment.

However, moderate to severe malocclusion that goes untreated tends to cause compounding problems over time.

• Tooth decay and gum disease

  Crowded and overlapping teeth are harder to clean effectively with a toothbrush and floss. Plaque accumulates in the gaps that cannot be reached, raising the risk of cavities and gum disease. Left unaddressed, gum disease can progress to periodontitis — a condition that damages the bone supporting the teeth.

• Accelerated tooth wear

  When teeth do not meet evenly, certain teeth bear a disproportionate load when chewing. Over time, this leads to uneven enamel wear, which can result in sensitivity, fractures, and the need for restorative work such as crowns.

• TMJ (jaw joint) problems

  An uneven bite places ongoing strain on the temporomandibular joint — the hinge joint connecting the lower jaw to the skull. This strain can develop into a temporomandibular joint disorder (TMD), with symptoms including jaw pain, clicking, locking of the jaw, headaches, and discomfort that extends into the neck and shoulders.

• Speech and function

  Significant misalignment between the upper and lower teeth can interfere with how sounds are formed, particularly in children during the years of speech development. Some adults with severe malocclusion also experience difficulty chewing certain foods or speak with a persistent lisp.

• Self-esteem and quality of life

  Visible misalignment of the teeth or jaw can affect confidence. Research consistently notes a link between untreated malocclusion and reduced self-esteem, particularly in adolescents.

How Malocclusion Is Treated

Treatment depends on the type and severity of the malocclusion, the patient's age, and whether the issue is primarily dental (the position of teeth), skeletal (the position of the jaws), or a combination of both. A Specialist Orthodontist will carry out a full clinical examination and take X-rays — and in complex cases, a CBCT scan — to assess the underlying structure before recommending a treatment plan.

Fixed Braces

Braces use metal or ceramic brackets bonded to the teeth and connected by a wire. The wire is adjusted periodically, applying gentle, sustained pressure that gradually moves teeth into alignment. Braces work in three dimensions, making them effective for moderate to severe crowding, significant bite corrections, and complex cases involving multiple teeth.

Metal and ceramic braces are available for both children and adults. Damon braces use a self-ligating slide mechanism instead of elastic ties, which reduces friction during tooth movement. For a completely hidden option, incognito lingual braces are fixed to the inner surfaces of the teeth and invisible from the front.

Clear Aligners

Clear aligners are a series of custom-made, removable trays worn over the teeth. Each tray moves teeth a small amount before the next tray in the series takes over. They are nearly invisible and can be removed for eating and brushing.

Invisalign and Eon Aligner are two of the most common clear aligner systems available at our centers.

Clear aligners suit mild to moderate cases well. For complex bite corrections, fixed braces are often the more effective choice — your Specialist Orthodontist will advise which is right for you.

Myobrace (for Children)

Myobrace is designed for younger children whose developing malocclusion is linked to mouth breathing or incorrect swallowing habits. It works by addressing the root causes of misalignment before they become established. It is a preventive and early intervention approach, not a full corrective treatment.

Functional Appliances and Headgear

In growing children and adolescents, the jaws are still developing. Functional appliances and orthodontic headgear can guide jaw growth as well as tooth position — particularly in significant Class II or Class III skeletal patterns.

These approaches are most effective during active growth phases, which is one reason early orthodontic assessment matters.

Orthognathic (Jaw) Surgery

When malocclusion is rooted in a skeletal discrepancy — where the jaws themselves are positioned incorrectly — orthodontic treatment alone cannot fully correct the bite. Orthognathic surgery repositions the upper jaw, lower jaw, or both to bring them into correct alignment.

Orthodontic treatment is carried out before and after surgery to ensure the teeth fit the corrected jaw position. This option is reserved for severe cases and is performed by a Specialist Oral and Maxillofacial Surgeon in close coordination with a Specialist Orthodontist.

Retainers

At the end of active treatment, retainers hold teeth in their new positions while the surrounding bone stabilizes. Without them, teeth gradually shift back toward their original positions over time. Retainers are a permanent part of maintaining orthodontic results — not an optional final step.

Can Malocclusion Be Prevented

Genetic malocclusion — where jaw and tooth size are inherited — cannot be prevented. However, certain contributing factors can be addressed in childhood to reduce severity or avoid making an existing tendency worse.

Discouraging prolonged thumb-sucking and pacifier use after the age of three is a practical first step. Prompt treatment of tooth decay in baby teeth matters too — early tooth loss can allow neighboring teeth to drift and disrupt the space needed for permanent teeth to come in correctly.

Mouth breathing is worth addressing early: in children who habitually breathe through the mouth, evaluation by a Specialist Pediatric Dentist or ear, nose, and throat specialist is advisable, as chronic mouth breathing can affect how the jaws develop.

The American Association of Orthodontists recommends that children receive their first orthodontic assessment by the age of seven. At this stage, a Specialist Orthodontist can identify developing problems while the jaws are still growing — and, where needed, begin early intervention that simplifies or shortens later treatment.