Malocclusion (Misaligned Bite): Types & Treatment

Key Takeaways

• Malocclusion:

It refers to misalignment of teeth or jaws, which can be mild (cosmetic) or severe (functional).

• Types of malocclusion:

  Class I: Normal bite with crowding, spacing, or rotated teeth.

  Class II (Overbite): Upper jaw/teeth significantly overlap the lower.

  Class III (Underbite): Lower jaw protrudes beyond the upper.

  Variations: Includes crossbite, open bite, and deep bite.

• Common symptoms:

Difficulty chewing, speech problems, mouth breathing, crooked teeth, jaw pain, and visible bite irregularities.

• Causes:

Genetics, jaw-to-tooth size imbalance, childhood habits (thumb sucking, pacifier use), birth defects, trauma, and early tooth loss.

• Diagnosis:

Dentists/orthodontists use exams, X-rays, impressions, and 3D scans to classify severity.

• Treatment options:

Braces, clear aligners, extractions, dental restorations, jaw surgery for severe cases, and early intervention for children.

• Cost range:

From $2,000 (clear aligners) to $40,000 (jaw surgery), depending on complexity and treatment type.

• Benefits of treatment:

Improved function, reduced oral health risks, jaw pain relief, better facial symmetry, and increased confidence.

• Aftercare:

Wearing retainers, maintaining oral hygiene, regular check-ups, and managing jaw comfort with exercises or care routines.

• Early detection matters:

Children should be screened by age 7; adults should seek help if they notice bite or jaw issues.

Everyone wants a perfect, straight, and bright smile. A perfect alignment not only helps you maintain your looks, but it can also help maintain your oral health. As nice as it sounds to have a perfect smile, malocclusions or misaligned bites can hinder that dream. Malocclusions or misaligned bites are becoming increasingly common, and it's due to many factors - genetics, lifestyle, etc. Thankfully, throughout the ages, orthodontics has made it possible to treat a malocclusion easily. With products like braces, aligners, bonding, and veneers, treating your misalignment has never been an easier task. While some cases may be treated easily due to being less severe, severe cases may present other issues, and it's best to be treated sooner rather than later. Early treatment is ideal, and we want to prevent it from getting even worse. Left untreated, malocclusions may worsen, causing temporomandibular joint dysfunction symptoms (TMJ disorders), tooth wear, gum disease, and even change your facial structure.

In this blog, we will walk you through the types of malocclusion, their causes, symptoms, diagnosis, and different treatment options.

What Is Malocclusion?

Malocclusion simply means your upper and lower teeth don’t align the way they should. It is also referred to as Misaligned Teeth . Ideally, the top teeth slightly overlap the bottom ones, and the molars fit neatly into their corresponding grooves to facilitate chewing. Any variation from this natural alignment is considered malocclusion.

Types of Malocclusion

Malocclusion is grouped into categories depending on the positioning and severity of the teeth or jaws. The most common types include:

Class I Malocclusion

• The bite itself is normal, with the top teeth slightly overlapping the bottom.
• The main issues are crowding, spacing, or rotated teeth.
• This is the most common and usually the least serious type.

Class II Malocclusion (Overbite)

• The upper jaw or teeth extend significantly over the lower jaw.
• Also known as retrognathism.
• Depending on how severe it is, it can lead to problems with chewing, speaking, or jaw discomfort.

Class III Malocclusion (Underbite)

• The lower jaw juts forward, making the bottom teeth extend past the top teeth.
• Also called prognathism.
• This can affect appearance and sometimes cause jaw pain.

Other Bite Variations

Crossbite : The upper teeth fit inside the lower teeth when biting down. This can happen with just one tooth or several and may affect the front or back teeth.

Open Bite: If you’ve ever wondered, what is open bite ? It’s a condition where the front teeth fail to meet when the mouth is closed, sometimes linked to thumb sucking or tongue thrusting.

Deep bite vs. Overbite: A deep bite happens when the top front teeth cover too much of the bottom teeth. An overbite refers more generally to the forward overlap.

Signs and Symptoms of Malocclusion

Malocclusion does not always provide obvious symptoms immediately. Some may notice changes in their smile, while others have difficulties with chewing or speaking. The severity of the issues is often a factor of the type of misalignment, as well as the degree of misalignment.

Difficulty biting or chewing

It's difficult to bite into or chew food when your teeth do not align properly. Some people may even experience discomfort and uneven wear on their teeth.

Speech issues

Misalignment can inhibit the movement of the tongue and, therefore, sometimes cause lisps, slurs, or difficulty pronouncing certain words.

Mouth breathing

Many people with malocclusion breathe through their mouths instead of their noses, which can lead to dry mouth and long-term oral health concerns.

Crowded, crooked, or rotated teeth

Misaligned teeth can overlap, twist, or leave gaps, making cleaning more difficult and affecting the appearance of a smile.

Visible bite issues

Overbites, underbites, crossbites, or open bites are often noticeable in how the top and bottom teeth meet.

Jaw pain or discomfort

Chewing may cause jaw soreness, clicking, or tightness, sometimes connected to temporomandibular joint (TMJ) problems.

Changes in facial appearance

In more severe cases, malocclusion can shift jaw position, leading to facial asymmetry or a visibly uneven profile.

If left untreated, these symptoms can get worse over time. Malocclusion that goes unmanaged may result in chronic TMJ pain, frequent headaches, difficulty keeping teeth clean, and premature tooth wear, turning what begins as a manageable issue into a lasting dental and health concern.

Causes of Malocclusion

Malocclusion can develop from a mix of genetic, developmental, and environmental factors, including:

• Genetics: Inherited traits such as jaw size or tooth spacing issues.
• Jaw-tooth size mismatch: When teeth are too large for the jaw, crowding often occurs.
• Childhood habits: Long-term thumb sucking, pacifier use, or tongue thrusting can affect alignment.
• Birth defects: Conditions like a cleft lip or a cleft palate may contribute.
• Injury or trauma: Jaw fractures or dislocations that interfere with normal growth.
• Dental problems: Poor oral hygiene, early loss of baby teeth, or impacted teeth.

Diagnosis of Malocclusion

Dentists or orthodontists diagnose malocclusion using a few key steps:

• Visual examination: Checking the bite, jaw alignment, and any visible tooth irregularities.
• Dental X-rays: Providing a closer look at tooth roots, jawbone structure, and possible impacted teeth.
• Impressions or 3D scans: Creating detailed models of the teeth to plan treatment.

Treatment Options for Malocclusion

The best treatment for malocclusion depends on several factors, such as the type and severity of misalignment, the patient’s age, overall oral health, and whether the goal is mainly cosmetic or functional. While some cases can be corrected with orthodontic appliances, more severe conditions may require surgery. Below are the most common treatment approaches:

• Orthodontic appliances (braces, aligners, etc.)
• Dental restorations
• Surgical options

Orthodontic Appliances

Orthodontics forms the foundation of malocclusion treatment. These appliances gently and consistently move teeth and jaws to fix misaligned teeth .

Braces

• Traditional braces use metal brackets and wires to gradually shift teeth
• Ceramic braces blend with the natural tooth color for a more aesthetic look.
• Effective for moderate to severe misalignment and complex bite issues.
• Treatment usually lasts 18–36 months.

Aligners for Teeth Straightening

• Ideal for mild to moderate cases such as crowding, spacing, or minor bite problems.
• Must be worn 20–22 hours a day and switched every 1–2 weeks.
• Average treatment takes 12–18 months.
• Benefits include comfort, easy cleaning, and no food restrictions.

Tooth Extraction

• Recommended when overcrowded or overlapping teeth prevent proper alignment.
• Often involves removing premolars to create space.
• Helps braces or aligners work more effectively.
• While modern orthodontics tries to avoid extractions, they are still useful in some cases.

Dental Restorations

When the issue comes from the shape or condition of teeth rather than jaw position, restorations may help:

Tooth Reshaping/Contouring

Tooth reshaping is a minimally invasive procedure that helps remove tiny amounts of enamel to even out rough edges, adjust tooth length, or fix slight overlaps. It’s effective for minor bite corrections and cosmetic improvements.

Bonding

A tooth-colored composite resin is applied to teeth to close spaces, repair small chips, or build up undersized or uneven areas. Dental bonding is an affordable and fast option that improves the appearance and functionality.

Crowns

Crowns, often called “caps,” fully cover a tooth that’s damaged or irregular in shape. They restore durability, shield worn enamel, and improve bite alignment. This treatment works best for teeth needing more support than bonding.

Veneers

Veneers are thin, porcelain shell-like coverings bonded to the front of teeth. They enhance appearance by concealing flaws such as stains, chips, or slight misalignments. While mainly cosmetic, veneers can also promote a more balanced bite.

Jaw Surgery

• Required for severe cases caused by skeletal misalignment.
• Surgery repositions the upper jaw, lower jaw, or both.
• Common for significant overbites (Class II) or underbites (Class III).
• Typically combined with braces or aligners before and after surgery.
• Benefits include improved facial balance, better chewing and speech, and relief from TMJ issues.
• Recovery takes several weeks, but results are permanent.

Early Intervention in Children

• Addressing malocclusion in children can prevent more serious problems later.
• Growth modification appliances (expanders, functional appliances, headgear) guide proper jaw development.
• Effective for correcting bite problems like crossbites or overjets before bones fully mature.
• The American Association of Orthodontists recommends screening children as young as 7.
• Early treatment often reduces the need for surgery in adults

Cost of Treating Malocclusion

The cost of malocclusion treatment varies widely depending on complexity, type of treatment, and region:

• Clear aligners: $2,000 – $6,000
• Traditional braces: $3,000 – $7,500
• Lingual braces (behind the teeth): $8,000 – $10,000
• Jaw surgery: $20,000 – $40,000 (may be partially covered by insurance if medically necessary)

Investing in treatment not only improves aesthetics but also prevents costly oral health problems in the future.

Pros and Cons of Treating Malocclusion

Like most dental treatments, correcting a misaligned bite comes with benefits as well as challenges. Knowing both helps patients make informed choices.

Pros

• Better bite and chewing function: Proper alignment allows teeth to fit together naturally, making eating easier and more comfortable.
• Clearer speech: Fixing bite issues can resolve lisps or pronunciation problems linked to tongue placement.
• Lower oral health risks: Straight teeth are easier to clean, which helps prevent cavities, gum disease, and premature wear.
• Relief from TMJ symptoms: Treatment can reduce jaw strain, easing TMJ pain, headaches, or clicking joints.
• Improved confidence and appearance: A well-aligned smile not only supports oral health but also boosts self-esteem and facial balance.

Cons

• High costs: Depending on whether braces, aligners, or surgery are needed, treatment can range from a few thousand to tens of thousands of dollars.
• Time and commitment: Braces or aligners typically require 12–24 months of consistent wear and regular check-ups.
• Surgical risks: For severe cases needing jaw surgery, recovery can take longer and carries potential complications.
• Cosmetic vs. functional concerns: In mild cases, treatment may be more about appearance than necessity, which can make some patients hesitant.

Aftercare for Malocclusion Treatment

Finishing orthodontic or surgical treatment is only part of the journey; aftercare is essential for protecting results and maintaining long-term oral health.

Retainers

Retainers help to keep teeth from shifting back. Worn full-time at first, then typically just at night.

Oral hygiene

Careful brushing and flossing are crucial since appliances can trap food and plaque.

Regular check-ups

Allow your orthodontist to track progress, adjust retainers, and address any new issues.

Dietary care

Avoid hard, sticky, or chewy foods that can damage braces, aligners, or restorations. Softer, tooth-friendly options help maintain results.

Jaw pain relief

Applying warm compresses and gentle exercises can help alleviate pain. However, if the pain gets worse, you can always seek professional guidance to reduce soreness and stiffness.

Malocclusion of Teeth

Malocclusion is not only the misalignment of teeth. It also affects smile aesthetics, affecting your overall image to others. Malocclusion can affect your image as well as cause issues when biting, with speech, and maintaining your overall health and welfare. Orthodontics has come a long way over time and has made it easier to obtain the smile you have been hoping for. Your dentist can guide you on the best option for your dental misalignment, whether it is braces or clear aligners; orthodontics is available for everyone.