Tooth and jaw misalignments

In tooth or jaw misalignments, the teeth are clearly shaped differently than they are normally. To correct these misalignments, fixed or removable braces can be inserted – especially in adolescents since the dentition can still be formed at this age.

At a glance

  • Everyone’s teeth look a little different.
  • If the teeth obviously have a different shape than for most people, then this is called tooth or jaw misalignments.
  • Sometimes only a single tooth shows a misalignment, sometimes several teeth are affected. The jawbones can also have a misalignment.
  • Severe misalignments may cause discomfort in chewing, talking and breathing, but also psychological stress.
  • Misalignments can moreover favor gingivitis and caries.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Tooth or jaw misalignments: boy smiling and showing his teeth. Many of his teeth are crooked and have a malformation.

What are 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 in addition encourage gingivitis and caries.

To correct tooth and jaw misalignments, removable or fixed braces are often used. They are usually worn by adolescents, because the teeth are still growing and can be formed at this age.

What are the symptoms of tooth and jaw misalignments?

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. Misalignments can moreover favor caries. 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 involves a speech impediment. But the extent of psychological stress depends on how pronounced the misalignment is. The way the affected person handles it also plays a role.

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

What are the causes of tooth and jaw misalignments?

There are a number of different causes of tooth or jaw misalignments: abnormal development of teeth, oral bone or tongue, lips or cheeks, sucking pacifier or thumb for too long, falling out of teeth, genetic predisposition, bone trauma or bone disease.

Tooth and jaw misalignments can have various causes. For example, they may be the result of abnormal development and positioning of individual teeth or the jawbone. But also if the tongue, lips, cheeks or muscle tissue develop unusually, this can cause misalignments. 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 the dentition to not develop normally.

What are the risk factors for tooth and jaw misalignments?

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 can increase 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.

How common are tooth and jaw misalignments?

Schätzungsweise mehr als die Hälfte aller Kinder und Jugendlichen werden wegen Zahn- und Kieferfehlstellungen behandelt.

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

In older children, the baby teeth are gradually replaced by the permanent teeth. The jawbones can still grow until the end of puberty. Tooth and jaw misalignments can therefore improve until the end of the growing period, but also get worse. However, the tooth alignment of adults can also change, for instance when teeth are lost or with bruxism (grinding teeth together).

How can tooth and jaw misalignments be prevented?

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 screen. In many cases, a vestibular plate is paid for by a health insurance fund. It is also important to take good care of the baby teeth so that they remain in the dentition for long enough as a placeholder.

How are tooth and jaw misalignments diagnosed?

Parents themselves often notice that their child could have 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 should be treated, 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 makes better treatment planning possible.

In some cases, other specialists have to be consulted. For example, if the airways are additionally constricted, an examination at a doctor's office for ear, nose and throat medicine is a good idea.

How are tooth and jaw misalignments treated?

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 both correct the position of the teeth, and also harmonize the proportions of the upper and lower jaw.

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

Important: People with a tooth or jaw misalignment usually undergo orthodontic treatment if the misalignments exceed a certain extent. 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. But a treatment may also be desired for less severe misalignments for cosmetic reasons. It is unclear whether orthodontic treatments are in fact required as frequently as they are recommended nowadays. Up to now, there are no studies that prove exactly in which cases such treatments may prevent later tooth problems and other health ailments and when they merely improve the appearance.

What more should you know about tooth and jaw misalignments?

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.

Important: Some children and adolescents may consider braces “cool” nowadays. But others find them awkward, especially when eating. Some of those affected also worry that they might damage the braces in the process.

Treatment with braces also requires the cooperation of the children and adolescents concerned. They must take care of their teeth and braces. Removable braces must be worn consistently. It can be motivating if it can be shown during a follow-up appointment how much the dentition has already improved.

If misalignments in children and adolescents aged under 18 reach a certain extent, the treatment costs in Germany are borne by the health insurance providers. But an excess must initially be paid at the same time. This is fully refunded if the therapy is completed as scheduled.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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