Misalignment of the jaw, like misalignment of the teeth, is now a widespread problem. It is estimated that approximately 60 percent of children and adolescents suffer from such malocclusion. However, in addition to general problems with chewing and speaking, misaligned jaws and teeth can lead to serious problems.
What is malocclusion (misaligned teeth)?
Doctors speak of a malocclusion when the teeth are in the wrong relationship to each other. If the shape and position of the upper and lower jaws do not fit exactly, the patient has a malocclusion. Contrary to the position in a healthy set of teeth, which is also called neutral bite, a malocclusion of teeth or jaws results in the teeth not being arranged symmetrically. Therefore, the incisors cannot interlock, similar to scissors, or the molars do not fit on top of and into each other like gears. This not only disturbs the overall appearance of the face, but also prevents the teeth from chewing optimally. It is also possible that the misalignment of the jaws or teeth can cause a speech impediment.
Causes
Jaw misalignment or tooth misalignment can have very different causes. In most cases, however, the cause is congenital. Particularly problematic in this context is that the hereditary dispositions for teeth and jaws are inherited separately. This can lead to the fact that the size of the teeth and the size of the jaw do not fit together. This can lead to crowding of the teeth or, in the opposite case, to a gap bite. However, certain hereditary diseases or congenital malformations, such as cleft lip and palate or Down syndrome, also lead to malformation of teeth and jaws. However, the malformation of the jaw and teeth is not always present from birth. Certain behaviors, especially at a young age, can lead to jaw misalignment or even tooth misalignment. For example, frequent and long-term use of pacifiers or feeding bottles, thumb sucking, premature loss of baby teeth due to tooth decay or accidents, predominant mouth breathing due to health problems, or bad habits such as pressing the tongue against the teeth or chewing on the lips can trigger a malocclusion or misalignment of the jaws.
Symptoms, complaints and signs
A malocclusion or misalignment of the teeth can affect and cause symptoms locally in the jaw area as well as in other organ structures. In the mouth, misaligned teeth can often be seen by abrasion on the surfaces of the teeth. This is caused by an inaccurate bite and grinding of the teeth at night, which can also be a consequence and thus symptoms of jaw or tooth misalignment. In addition, uneven teeth are also often a factor in the development of caries or periodontal disease, which are also possible signs of malocclusion. Swallowing disorders or problems with breathing can also indicate a malocclusion of the jaw and resulting dysfunctions of the musculature or constrictions. The term craniomandibular dysfunction (CMD) is often used in connection with malocclusion of the jaw and teeth. This symptom complex shows that a malocclusion can affect many other parts of the body. It starts with tension and pain in the muscles of the jaw and neck, which can spread further. It is not uncommon for headaches and back pain to be a symptom based on jaw misalignment. Stomach and intestinal complaints can also be a secondary symptom of jaw misalignment. The saying “digestion begins in the mouth” should be remembered here. If teeth are crooked or the upper and lower jaws are not in proper contact with each other, chewing function is impeded, which can manifest itself in digestive problems.
Diagnosis and progression
Brackets may look unsightly at first glance. In the long term, straight teeth pay off visually, as well as dental health. The diagnosis of a misaligned tooth or jaw is first made by a thorough examination. Important signs of a misalignment of the jaw and teeth can be a visible misalignment, problems with lip closure or chewing, speech impediments, pain and cracking when opening the mouth in the temporomandibular joint. But also permanent headaches or snoring can be an indication of jaw misalignment.For trained professionals, even a first look at the oral cavity can be enough to justify the suspicion of a malocclusion of the jaw or teeth. However, it is important to make an accurate orthodontic diagnosis by taking impressions of the jaws and various X-rays. If a jaw misalignment or teeth misalignment is not permanently corrected, it can not only worsen, but it can also lead to inflammation of the mucous membrane, periodontitis, tooth decay, gastrointestinal problems, spinal misalignment and headaches.
Complications
Due to untreated jaw misalignment or even tooth misalignment, uneven stress occurs on the individual teeth and jaw joints. The result is unilateral wear of occlusal surfaces, emergence of sharp edges on tooth margins, up to breaking off of tooth edges. If the enamel is then missing, caries has an easy game. Furthermore, the one-sided pressure on the tooth bed causes the surrounding gums to shrink, so that tooth necks are exposed over time. The unprotected necks of the teeth cause pulling pain when eating hot, cold and spicy foods or even just a cold draught. This is called sensitive teeth. If the condition continues to progress, inflammatory periodontitis and eventually chronic periodontosis develop. With decreasing support from the gums, teeth can tilt, rotate and loosen, which in the worst case leads to tooth loss. Gradual arthritic changes of the temporomandibular joints with sometimes considerable pain when opening the mouth and chewing become an unpleasant permanent condition. Treatment by means of a bite block makes several visits to the dentist necessary and requires a lot of time and patience over months. Nevertheless, the reduction of the expected consequences justifies the lengthy treatment and the continuous cooperation of the patient. Last but not least, treatment of jaw malocclusion saves considerable costs of later prosthetic restoration of the dentition.
When should you go to the doctor?
If the growing child or adult suffers from problems during the chewing process, a dental examination is advisable. If there are disturbances in the grinding of food or if food can only be further ground in the mouth with great effort, a doctor is needed. If the jaw is misaligned, those affected often avoid eating foods that need to be chewed thoroughly in the mouth before they are transported down the esophagus. A doctor should assess the irregularities so that there is no worsening of the health condition. If pain develops in the area of the teeth, gums or jaw, a doctor should be consulted. Often, the discomfort spreads to the ear as well as neck region or the head. Therefore, a visit to the doctor is necessary as soon as repeated severe headaches, sleep disturbances, tension or concentration problems occur. If the shape of the face is visually conspicuous, discrepancies are already apparent and should be discussed with a doctor. If the lower jaw is very much in front of or behind the upper jaw, the grinding process of the food cannot take place sufficiently. If the malocclusion is noticed during the growth process, an oral surgery check-up is advisable. If the jaw position changes in the course of life or if there are problems with existing dentures, a visit to the doctor is necessary.
Treatment and therapy
A malpositioned tooth or jaw does not have to be corrected in every case. Only when it comes to the problems mentioned or the development of these problems seems likely, the malposition should be corrected. It is true that correction is possible at any age, but children and adolescents show better and faster results. In addition, most health insurance companies only pay for orthodontic treatment up to the age of 18. However, if children are younger than 9 years old, mild measures such as mouth inserts are usually used. These inserts promote muscle development at important points, so that small jaw and tooth misalignments can be corrected under their own power. For larger misalignments, however, it is usually necessary to exert force on the misaligned tooth from the outside. This can be done with braces. In the case of malocclusion of the incisors, removable braces are often sufficient. However, these should be worn for at least 14 hours a day.If the root position of the teeth must be massively interfered with, the patient receives fixed braces. Brackets are glued to the teeth and connected with a thin wire. This causes a permanent force to be applied to the teeth. In adulthood, due to the low flexibility of the jaw, it may be necessary to extract some teeth beforehand. In the case of particularly massive malocclusions of the jaw, surgical intervention may be necessary. In this case, parts of the jaw can be relocated or removed to correct the jaw misalignment.
Outlook and prognosis
The prognosis of a malocclusion depends on the extent of the existing symptoms. In most patients, the misalignment can be modified through the use of braces. These are worn daily for several months or years as the patient grows, leading to a gradual change and optimization of the jaw position. The corrective aids are checked at regular intervals and adjusted to the changes. After completion of the treatment, the patient experiences freedom from discomfort for the rest of his or her life. In case of severe jaw malposition, surgical procedures are used. Complete recovery cannot always be achieved. Often in these cases there are other diseases that prevent this. However, an optimization of the optical change as well as the functioning of the jaw is usually achieved. If the jaw position is triggered in adult life due to a violent impact, an accident or a fall, surgical procedures are also used. The prognosis here depends on the patient’s individual initial situation. In many patients, it is possible to correct the deformity completely. After a few months, the patient is then discharged from treatment as cured. In the case of severe injuries, some patients report long-term limitations in the range of motion of the jaw or other irregularities in masticatory processes or speech formation.
Prevention
To prevent malocclusion or jaw misalignment, the aforementioned behaviors that promote such misalignment should be avoided. These include, in particular, the long-term use of feeding bottles, pacifiers, thumb sucking and the like.
Aftercare
The treatment of jaw misalignment or tooth misalignment by the orthodontist can be supplemented in some cases with the help of special aftercare. This is discussed with the treating orthodontist, and in the case of CMD (craniomandibular dysfunction) accompanying the jaw malocclusion, possibly also with the orthopedist or physicians from other specialties. This must be decided individually in each case. The cause of the jaw and teeth malocclusion is closely related to the type of follow-up care. If it is simply a matter of teeth that have grown out of alignment, it may be helpful to continue wearing a stabilizer for a certain period of time after the traditional treatment with braces. This is adjusted by the orthodontist and secures the result of the treatment in the long term. If the cause of an orthodontic problem lies in teeth grinding or in the orthopedic area, the aftercare is also adjusted accordingly. This can be a psychological therapy with regard to teeth grinding as well as the stretching and strengthening of certain muscle parts in the fitness area. Sometimes relaxation methods such as progressive muscle relation and autogenic training are also helpful. Yoga can also restore physical or psychological balance. A special bite splint can also be prescribed for teeth grinding at night, which should be worn regularly as part of follow-up care. Regular check-ups by the dentist or orthodontist complete the aftercare.
What you can do yourself
A malocclusion or misalignment of the jaw cannot be treated on your own, but requires orthodontic care. In general, thorough oral hygiene is significant to support oral flora and keep all teeth healthy, especially the permanent ones. The dentist often indicates jaw malocclusion in children and refers the patient to an orthodontist. Children and adolescents with malocclusion of the jaw or teeth are initially given removable mouth orthoses or splints that deform the jaw. The cooperation of the patient is decisive for the success of the treatment.As a rule, the inserts should be worn daily, especially overnight and also during the day with the exception of meals. Regular cleaning of the insoles reduces irritation or inflammation of the gums. By wearing the insoles regularly and as prescribed, patients positively influence the success of the therapy. If the malocclusion is particularly severe, fixed brackets are used on the individual teeth. In adolescents, treatment usually takes several years and is often associated with complications such as pain, difficulty eating, and irritation of the gums and oral mucosa. Adequate oral and dental hygiene improves irritation, and soft foods and homeopathic pain relievers prescribed by a doctor are also recommended.
