Common Problems

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Common Bite Problems | Missing Teeth | Impacted Cuspids | Tongue Thrusting Habit | Impacted Wisdom Teeth

Common Bite Problems

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When a person’s teeth or jaws do not fit together properly, orthodontic treatment may be necessary to correct the problem. If left untreated, these orthodontic problems, often referred to as malocclusions, can cause speech difficulty, premature wear of the teeth and protective enamel, and even increase the chance of injury to the teeth and jaw joints.

Underbite
An underbite is characterized by the lower jaw extending too far out, causing the lower front teeth to sit in front of the upper front teeth.

Crossbite
This malocclusion occurs when the upper teeth sit inside the lower teeth, which may cause tooth stratification and misaligned jaw growth. In order to close the mouth, patients usually move their lower jaw forward or to the side when closing. This incorrect bite results in an improper use of the lower jaws and sometimes brings about facial asymmetry.

Upper Front Teeth Protrusion
The appearance and function of your teeth are impacted by this type of bite. It is characterized by the upper teeth extending too far forward or the lower teeth not extending far enough forward.

Overbite
The upper front teeth extend too far out over the lower front teeth, sometimes causing the lower front teeth to bite into the roof of the mouth. Problems often associated with an overbite include a “gummy” smile, protruding lips and excessive incisor wear.

Crowding
Crowding occurs when teeth have insufficient room to erupt from the gums. It is the most common reason for braces. Not only is crowding unattractive, but it has also been linked to periodontal problems and dental decay because it is harder to clean overlapping teeth’s surfaces.

Spacing
Spacing problems may be caused by missing teeth, or they may only be a cosmetic or aesthetic issue. Spacing is another popular reason for braces. The opposite of crowding, spacing is most commonly caused by excessive jaw room for the size of the erupting teeth.

Openbite
Proper chewing is impacted by this type of bite, in which the upper and lower front teeth do not overlap. Openbite may cause a number of unwanted habits, such as tongue thrusting or thumb sucking. An early evaluation and intervention is essential in correcting an openbite.

Dental Midlines not Matched
Dental midlines that do not match are evident when the back bite does not fit and match appropriately. This may negatively impact jaw function and proper dental function.

Missing teeth and their Replacements

Teeth are missing due to two factors: they are either congenitally missing or have been extracted. During orthodontic treatment, if a front tooth is missing we will strive to provide a temporary replacement. Once enough space has been opened for the false tooth (called a pontic), the following occurs:

  1. An impression is taken and model is sent to the lab and a shade is chosen.
  2. The lab makes a special tooth for the area where the tooth is missing.
  3. We deliver the tooth, glue a brace on the tooth and tie it to the wire attached to the braces as well as the adjacent tooth.

The pontic is only for aesthetics. You cannot bite or chew with it. It has no root for stability.

The patient has to be careful with this tooth and not get in the habit of pushing it with the tongue. If this tooth is not stable, an appliance called a flipper may be suggested. This is a removable retainer-like appliance with a tooth on it.

As braces move the teeth, additional pontics or flippers may be needed. If so, additional lab costs are generated and there will be additional fees. Also, the bone in this area recontours and changes in shape. This change may necessitate a new pontic.

Do not expect the pontic to feel like a natural tooth. It is only a tooth for "looks" and must be cared for gently. After braces come off, a more permanent replacement for the missing tooth will be needed, like a bridge or implant. Your general dentist will do these.

Impacted Cuspids (Eye Teeth)

Cuspids (or eye teeth) sometimes do not come down out of the palate. These are considered impacted.

If the cuspid root is in a favorable position, we try to bring it in. Frequently, the oral surgeon has to surgically expose these teeth for us. The process is:

  1. Place your braces.
  2. Open a space for the impacted cuspid with braces.
  3. When in a strong wire, in your braces, we send you to the oral surgeon for exposure of the cuspid and the attachment of a button with a chain to the impacted eye tooth.
  4. An oral surgeon attaches the button and chain to braces with elastic thread.
  5. As we see you for subsequent braces adjustments, we re-tie the elastic thread to attempt to bring the cuspid down, into place.

Impacted cuspids are very unpredictable. The amount of time it takes to bring them in is very difficult to determine. Some possible pitfalls of impacted cuspids include:

  • slow to come in
  • may be ankylosed (fused to the bone) and not be movable
  • may be discolored
  • gum tissue may be high over impacted cuspid
  • bone loss may occur around tooth
  • may be mobile (loose)
  • may devitalize (nerve may die) and need root canal
  • may tend to spring up back toward the gum due to strong ligament pull
  • may not be salvageable and we have to extract

Luckily, most of the time the issues listed above do not arise. However, they are more likely with an impacted cuspid than a non-impacted tooth.

Treatment time in braces with an impacted cuspid is very hard to predict, because we cannot tell exactly when the cuspid will erupt and grow in. In extremely rare cases, a second exposure surgery is needed to remove scar tissue around the crown.

Tongue Thrusting Habit

About 30% of the population retains a tongue thrust habit past infancy. Virtually all infants swallow with a tongue thrust (meaning to place the tongue forward in the mouth to swallow). We feel this is due to the fact that there are no teeth and to eat or drink without losing the food out of the mouth, the tongue must come forward to keep it in. As growth and development occurs, most children re-accommodate and the tongue is positioned higher in the palate (behind the teeth) and does not push against the front of the mouth.

For those whose tongue thrust remains, long-term dental and skeletal discrepancies (such as an open bite) can occur that are increasingly difficult to correct. Therefore, we attempt to assist our patients to re-learn where to place the tongue. If the open bite and attendant tongue thrust is due to mouth breathing, a referral to the otolaryngologist (ENT) may be necessary to check for nasal blockage or enlarged tonsils or adenoids.

We also may recommend placement of a fixed appliance (called a "Tongue Thrust Appliance" or TTA) in the patient's mouth to remind the tongue of its desired position.

A referral to a speech pathologist may be needed to re-train the swallowing pattern. Some simple exercises may assist in this process, too:

  • No liquid should be taken when eating solid foods. (Don't "wash your food down”) This forces the tongue to push the food down the throat rather than the liquid washing it down.
  • "Click": Place tip of tongue in top of palate, press and then bring it forcefully down to make a click sound. Repeat as often in the day as possible.
  • "Slurp": After practicing the "click," place your tongue in the same high palatal position as if to "click," but instead, suck in air. This pulls the tongue back. Now while pressing the tongue against the palate, swallow without allowing your tongue to thrust forward. After you can easily "click," repeat "slurping" as often in the day as possible.
  • "Squeeze": While swallowing, tighten your jaw muscles and force teeth together as strongly as possible.

Impacted Wisdom Teeth

In a large percentage of cases, wisdom teeth remain impacted, trapped beneath the gum and bone and against the teeth in front of them. They may partially erupt because the jaw can be crowded by other permanent teeth. The partially erupted teeth may tilt sideways and may cause damage to adjacent teeth.

Because they are so far back in the mouth, wisdom teeth often are not needed for chewing and they are difficult to keep clean. Your dentist may recommend the early removal of impacted wisdom teeth to prevent against the potential complications of the following:

  • The wisdom tooth partially erupts through the gum. This creates an opening where bacteria may enter and cause infection. Pain, swelling and jaw stiffness may result.
  • The impacted wisdom tooth may continue growing without having enough room, which may damage adjacent teeth.
  • A fluid-filled sac (cyst) or tumor may form on or near the impacted tooth, destroying surrounding bone or tooth roots.

As your orthodontist, we will have a final set of X-rays taken after your braces are removed to check the status of your wisdom teeth. Dr. Long will advise you as to when they should be evaluated for removal.