Malocclusion in kids

When Teeth Don’t Align

Only movie stars have perfect teeth. But even teeth that don’t align, or fit perfectly together, usually require no treatment. Alignment is what keeps us from biting our cheeks and lips. Properly aligned teeth also let us chew and speak properly and allow for proper cleaning to prevent decay.

Another name for badly aligned teeth is malocclusion. This simply means that the teeth of the upper and lower jaws don’t connect properly with the teeth of the lower jaw. Different types of malocclusion include overbites, underbites, and uneven bites.

Malocclusion causes many problems. These include trouble biting or chewing, speech difficulties such as lisping, mouth breathing, jaw pain, unhealthy gums, and an unattractive appearance.

Who Gets Malocclusion?

Children may inherit a family trait of malocclusion because of the size and shape of their face, jaws, and teeth. Or they can develop it from using a bottle or pacifier too long, thumb sucking, losing baby teeth too early or late, or from an accident.

Sometimes both inherited and later problems are to blame. Signs your child might have a malocclusion include crowded, misplaced, or oversized teeth; or jaws that shift or make sounds.

How Is It Diagnosed?

Your child’s dentist may notice your child’s malocclusion and refer you to an orthodontist. An orthodontist is a dentist with extra training. Orthodontists know how to diagnose, prevent, and treat dental and facial problems, such as malocclusion.

Don’t wait to see an orthodontist until all your child’s permanent teeth have come in. In fact, it’s easier, faster, and less expensive to treat a malocclusion during early childhood.

To diagnose your child’s malocclusion, the orthodontist may suggest several procedures:

  • Impressions of the teeth to make plaster models. These models, taken at various times during treatment, also show progress.

  • Photographs of the face and teeth to make a record of treatment.

  • Several types of X-rays. A panoramic X-ray shows the teeth in biting position, while a special head X-ray indicates the relationship of the teeth and jaws to the face and skull.


An orthodontist may try to prevent your young child’s malocclusion from developing. Preventive treatment means leaving enough space for permanent teeth to come in. This may require a space maintainer to take the place of a baby tooth lost too early. Or the orthodontist might remove primary teeth that don’t come out on their own.

A second type of treatment, called interceptive treatment, aims to keep a developing malocclusion from getting worse. The orthodontist may guide emerging permanent teeth into alignment by:

  • Removing teeth

  • Reducing the size of teeth

  • Holding space for permanent teeth

Comprehensive orthodontic treatment means correcting a malocclusion and making sure that the jaw works well. This treatment may take place in several phases.

Two types of appliances can correct malocclusion. Removable appliances made of wires and plastic are easy to keep clean. But to do their job, they must be worn exactly as instructed. Fixed appliances, called braces, control tooth movement better than removable appliances. But food collects around braces. So children wearing braces must be especially careful about cleaning their teeth.


“Malocclusion of Teeth.” Medline Plus, U.S. National Library of Medicine, National Institutes of Health, February 22, 2012. Accessed 2013.

“Braces.” Mouth Healthy, American Dental Association. 2013.

“Guideline on Management of the Developing Dentition and Occlusion in Pediatric Dentistry” American Academy of Pediatric Dentistry. Accessed 2013.

“Malocclusion and orthodontics: Treatment Overview.” WebMD Medical Reference from Healthwise. January 11, 2011. Accessed 2013.

“Why an Orthodontist” American Association of Orthodontics. Accessed 2013.

Back to Articles