Tooth and jaw misalignments

Every person’s teeth are unique. When they have an obviously different shape than most other people’s, this is due to tooth or jaw misalignments. In some cases, only a single tooth is affected, and sometimes several teeth or the jawbones are misaligned.

If the misalignments are very distinctive, the result can be discomfort in chewing, talking and breathing, but also psychological strain. Tooth or jaw misalignments can also increase the risk of developing gum inflammation (gingivitis) and caries (tooth decay).

Removable or fixed braces are normally used to correct tooth and jaw misalignments. They are usually worn by adolescents because the teeth are still growing and their arrangement is still flexible at this age.

Tooth and jaw misalignments may cause discomfort, but this is not necessarily the case. Whether there is discomfort depends on the type and severity of the misalignment. Very distinctive misalignments, for instance, may cause difficulties with eating, drinking or talking, or impair breathing. In some cases, teeth press into the gums or lips due to their misalignment and cause pain. Misaligned teeth can also come loose. They can also make it more likely that tooth decay will occur because one or more teeth may be difficult to clean due to their positioning in the mouth. For some of those affected, the teeth can also be more easily damaged – for example during an accident. Over time, misalignments sometimes also cause pain in the mandibular joints and tension in the jaw muscles.

When they are easy to see, tooth and jaw misalignments often also cause psychological stress to those affected – especially if children and adolescents are teased because of them. Many people with misaligned teeth feel insecure, less attractive and avoid social contact, especially when the misalignment is associated with a speech impediment. The extent of psychological stress depends on how pronounced the misalignment is and how the individual copes with it.

You can find more detailed information, for instance about the appearance of tooth and jaw misalignments, at gesundheitsinformation.de.

Tooth and jaw misalignments can have various causes. For example, they may be the result of abnormal development of individual teeth or of the jawbones. However, misalignments may also occur due to abnormal development of the tongue, lips, cheeks or muscle tissue. Hereditary predispositions can play a role too. Other causes are tooth loss and premature loss of baby teeth. Furthermore, injuries or diseases of the bone may cause teeth to be displaced or dentition to develop abnormally.

An example of a risk factor is the habit of sucking a pacifier, thumb or finger. While this is normal for babies and small children, it increases the risk of tooth and jaw misalignments in children from about the age of three.

Children who only breathe through the mouth also have a higher risk of tooth and jaw misalignments. This occurs for instance when an enlarged pharyngeal tonsil inhibits nasal breathing.

Tooth and jaw misalignments are common. According to estimates, more than half of all children and adolescents in Germany are affected.

In older children, the baby teeth are gradually replaced by the permanent teeth. The jawbones can continue to grow until the end of puberty. Tooth and jaw misalignments may therefore improve, but also deteriorate, by the end of the growth period. 

However, the tooth alignment of adults can also change, for instance when teeth are lost or with bruxism (grinding of the teeth).

For smaller children, parents can try to wean them off bad habits. For example, many children will suck their thumb less often if a face is painted on it or an unpleasant-tasting tincture applied. 

After a dental examination and consultation, a pacifier can be replaced by what is known as a vestibular plate. Such a plate bears an outward resemblance to a pacifier. But on the inside, it lies between the teeth and lips like a shield. In many cases, a vestibular plate is paid for by the individual’s health insurance fund. 

It is also important to take good care of the baby teeth so that they remain as placeholders in the mouth for a sufficient period.

Parents themselves often notice that their child has a tooth or jaw misalignment. In other instances, the suspicion arises during a medical or dental examination. To establish whether a tooth or jaw misalignment requires treatment, the child is usually referred to an orthodontic practice. The specialist then appraises the teeth and mouth, but also examines the rest of the head. As part of the examination, questions are asked about possible causes and attention is paid to abnormalities when opening and closing the mouth.

For further examination, X-rays and dental impressions are normally taken. For the impressions, the child has to bite on two small trays that are filled with soft plastic compound. For many children, this can be unpleasant and also trigger a gagging reflex. A model of the teeth is made with the aid of the impressions. This model enables better treatment planning. Some practices also offer digital dental impressions. This involves scanning the teeth and then digitally creating a model of the position of the teeth in the mouth.

In some cases, other specialists have to be consulted. For example, if the airways are also constricted, an examination by a specialist in ear, nose and throat medicine is a good idea.

In most cases, misalignments are corrected with an orthodontic treatment – in particular one using fixed or removable braces. Sometimes, both types of braces are also combined. For example, those affected might initially wear removable braces and then fixed ones. The treatment should correct the position of the teeth and harmonize the proportions of the upper and lower jaws.

Fixed or removable braces are usually worn for about two years. This period is described as the “active treatment phase”.

Important: People with tooth or jaw misalignment usually undergo orthodontic treatment if the misalignments exceed a certain degree of severity. That is the case, for instance, if the upper incisors overlap the lower ones by more than 3 millimeters or if lateral teeth bite past each other. However, treatment for less severe misalignments may also be desired for cosmetic reasons.

It is unclear whether orthodontic treatments are in fact required as frequently as they are recommended nowadays. Up to now, there have been no studies to indicate with certainty the cases in which such treatments may prevent later tooth problems and other health ailments and when they merely improve the appearance.

It is true that braces can help to correct misalignments and thus relieve or eliminate associated discomfort. But the treatment can also be stressful. Wearing braces can hurt initially because they pull on the teeth. Anyone who wears fixed braces moreover has to take care when eating.

Treatment with braces requires the cooperation of the children and adolescents concerned, as it is essential for them to take care of their teeth and their braces. Removable braces must be worn consistently. Motivation can be provided by showing, during follow-up appointments, how much the positioning of the teeth has already improved.

If misalignments in children and adolescents aged under 18 reach a certain degree of severity, the treatment costs in Germany are covered by the health insurance funds. The patient is initially required to pay a co-payment (personal contribution) towards the cost. This is fully refunded if treatment is completed as scheduled.