Malocclusion is a problem in the way the upper and lower teeth fit together in biting or chewing. Malocclusion literally means "bad bite." The condition may also be referred to as an irregular bite, crossbite, or overbite.

Malocclusion may be seen as crooked, crowded, or protruding teeth. It may affect a person's appearance, speech, or ability to eat.

Malocclusions are most often inherited, but may be acquired. Inherited conditions include too many or too few teeth, too much or too little space betweenteeth, irregular mouth and jaw size and shape, and atypical formations of thejaws and face, such as a cleft palate. Malocclusions may be acquired from habits like finger or thumb sucking, tongue thrusting, premature loss of teethfrom an accident or dental disease, and medical conditions such as enlarged tonsils and adenoids that lead to mouth breathing.

Malocclusions may be symptomless or they may produce pain from increased stress on the oral structures. Abnormal signs of wear on the teeth's chewing surfaces or tooth decay may occur in areas of tight overlap. Chewing may be difficult.

Malocclusion is most often found during a routine dental examination. A dentist will check a patient's occlusion by watching how the teeth make contact when the patient bites down normally. The dentist may ask the patient to bite down with a piece of coated paper between the upper and lower teeth; this paper will leave colored marks at the points of contact. When malocclusion is suspected, photographs and x rays of the face and mouth may be taken for furtherstudy. To confirm the presence and extent of malocclusion, the dentist makesplaster, plastic, or artificial stone models of the patient's teeth from impressions. These models duplicate the fit of the teeth and are very useful intreatment planning.

Malocclusion may be remedied by orthodontic treatment; orthodontics is a specialty of dentistry that manages the growth and correction of dental and facial structures. Braces are the most commonly used orthodontic appliances in thetreatment of malocclusion. At any given time, approximately 4 million peoplein the United States are wearing braces, including 800,000 adults.

Braces apply constant gentle force to slowly change the position of the teeth, straightening them and properly aligning them with the opposing teeth. Braces consist of brackets cemented to the surface of each tooth and wires of stainless steel or nickel titanium alloy. When the wires are threaded through the brackets, they exert pressure against the teeth, causing them to graduallymove.

Braces are not removable for daily tooth brushing, so the patient must be especially diligent about keeping the mouth clean and removing food particles which become easily trapped, to prevent tooth decay. Foods that are crunchy should be avoided to minimize the risk of breaking the appliance. Hard fruits, vegetables, and breads must be cut into bite-sized pieces before eating. Foodsthat are sticky, including chewing gum, should be avoided because they may pull off the brackets or weaken the cement. Carbonated beverages may also weaken the cement, as well as contribute to tooth decay. Teeth should be brushedimmediately after eating sweet foods. Special floss threaders are available to make flossing easier.

If overcrowding is creating malocclusion, one or more teeth may be extracted(surgically removed), giving the others room to move. If a tooth has not yeterupted or is prematurely lost, the orthodontist may insert an appliance called a space maintainer to keep the other teeth from moving out of their natural position. In severe cases of malocclusion, surgery may be necessary and thepatient would be referred to yet another specialist, an oral or maxillofacial surgeon.

Once the teeth have been moved into their new position, the braces are removed and a retainer is worn until the teeth stabilize in that position. Retainers do not move teeth, they only hold them in place.

Orthodontic treatment is the only effective treatment for malocclusion not requiring surgery. However, depending on the cause and severity of the condition, an orthodontist may be able to suggest other appliances as alternatives tobraces.

There are some techniques of craniosacral therapy that can alter structure. This therapy may allow correction of some cases of malocclusion. If surgery isrequired, pre- and post-surgical care with homeopathic remedies, as well asvitamin and mineral dietary supplements, can enhance recovery. Night guards are sometimes recommended to ease the strain on the jaw and to limit teeth grinding.

Depending on the cause and severity of the malocclusion and the appliance used in treatment, a patient may expect correction of the condition to take twoor more years. Patients typically wear braces 18-24 months and a retainer foranother year. Treatment is faster and more successful in children and teenswhose teeth and bones are still developing. The length of treatment time is also affected by how well the patient follows orthodontic instructions.

In general, malocclusion is not preventable. It may be minimized by controlling habits such as finger or thumb sucking. An initial consultation with an orthodontist before a child is seven years old may lead to appropriate management of the growth and development of the child's dental and facial structures,circumventing many of the factors contributing to malocclusion.

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