You’ve noticed something about your child’s teeth. A gap at the front. A tooth coming in behind another one. A lower jaw that sits further forward than it used to. The question is always the same: does this matter, and when should someone look at it?
Table of Contents
Here are the eight bite problems seen most often in children, what’s genuinely done about each, and when the American Association of Orthodontists says a first check-up should happen.
What a Bad Bite Actually Is
Malocclusion is Latin for “bad bite,” and it covers teeth that don’t fit together properly. The point of straightening them isn’t really appearance. When teeth and jaws line up correctly, the AAO says, force is evenly distributed, which is what allows for proper chewing, biting and speaking.
Left alone, misaligned teeth may lead to tooth decay, gum disease, uneven wear on the enamel and difficulty chewing.
Bite problems rarely fix themselves. But that’s a statement about bites, not about everything in a child’s mouth, and the difference matters: molars that come in crooked, crowding in the lower front teeth and gaps between the upper front teeth all often settle on their own. Working out which is which is what an exam is for.
Noticed something about your child’s teeth? Call our Everett dental office and we’ll take a look.
The Eight Problems
1. Crowding
There isn’t enough room for the teeth, so they overlap, twist, or get pushed forward or back. Overlapping teeth are harder to clean, which raises the risk of decay and gum disease.
Crowding in the lower front teeth often eases as a child grows, though a review cited by the AAPD found wide variation, and some children got worse instead. Where space does need managing, one option is a holding arch, worn through the years when baby and adult teeth are both present, to keep the space that’s there. Teeth shouldn’t be pulled to relieve crowding without a full space analysis behind the decision.
A related appliance is the space maintainer, used when a baby tooth is lost early and the gap it leaves would otherwise close up. The AAPD says their use should be considered, while also saying the evidence that they reduce the severity of a bad bite is lacking.
2. Crossbite
Upper teeth bite inside the lower ones, either at the front, where an upper front tooth sits behind a lower one, or at the back, which is the more common of the two. Untreated, a crossbite can push the jaw to one side, and the AAO links that to lopsided jaw growth and worn enamel.
A 2021 Cochrane review of 31 studies found a palatal expander beats no treatment for a crossbite at the back of the mouth in children roughly 7 to 11, and rated that finding high certainty.
3. Underbite
The lower front teeth bite in front of the upper ones. Most of the time it comes down to the upper and lower jaws growing at different rates.
Underbite sits first on the AAO’s list of problems that may lend themselves to early treatment. The AAPD says early work can reduce the problem and may remove the need for jaw surgery later, but not always, because these children tend to keep growing for longer and less predictably. For some, surgery alongside orthodontics ends up being the better route, and nobody can promise otherwise at 7.
4. Overbite
The upper front teeth cover too much of the lower front teeth vertically. Also called a deep bite. In the AAO’s words, a small amount of overlap is natural, and it’s only a problem when there’s more of it than usual.
Untreated, a deep bite can wear the teeth down, leading to damage and sensitivity, and can contribute to gum disease and jaw pain. Correcting it is orthodontic work, usually braces; the AAO also lists overbite among the conditions clear aligners commonly treat, though it is clear that aligners are not right for everyone.
5. Increased Overjet
A different problem, and often confused with the one above. Here the upper front teeth stick out too far forward, past the lower teeth, which is what’s usually meant by buck teeth.
It gets attention because of injury, not appearance. The AAPD reports that an overjet beyond 3 mm is associated with an increased risk of injury to the front teeth, and that above 8 mm, more than 40% of children end up damaging them. Those are measurements taken at an exam, not at home. Treatment is orthodontic: braces, functional appliances or headgear, chosen case by case.
6. Open Bite
The front or back teeth don’t meet when the child bites down, leaving a gap. An open bite at the front can follow from thumb sucking, from the way the tongue sits, or from mouth breathing while the teeth are developing, and it can make swallowing, chewing and speech harder.
If a habit is driving it, that gets addressed first. The AAO also describes a tongue crib, an appliance that helps retrain the tongue during swallowing and can help close the bite.
7. Teeth Erupting Off Course
A tooth comes in somewhere it shouldn’t. The commonest version involves the first adult molars, which arrive at an angle and catch against the baby tooth in front of them. The AAPD reports 71% of these sort themselves out by age 9.
One that is only mildly caught can be eased back into position with small separators. The cases that matter most are canines stuck under the gum, where finding them early reduces the risk of damage to the front teeth beside them. Much of it is not visible from outside the mouth: it shows up on X-rays, which is much of why the age-7 check-up exists.
8. A Gap Between the Front Teeth
A space between the two upper front teeth, and most of the time it’s a normal stage. The AAPD’s position is that most gaps at this age are normal and tend to close with maturity, usually by the time the permanent canines come through. The flared look while that’s happening even has a name: the ugly duckling stage.
Some don’t close. There’s a width past which a gap rarely closes on its own, and it’s a measurement an orthodontist takes at an exam. Treatment usually waits until the canines are in, and the AAO’s list of what closes a gap holds two: braces and clear aligners, with a retainer to hold the result. Retention matters more with gaps than with almost anything else, because they’re prone to reopening, and treatment of any kind finishes with one.
When to Have Your Child Looked At
The AAO’s recommendation, in full: a child’s first orthodontic check-up should happen when a problem is first recognized, and no later than age 7. Both halves count. It isn’t “at age 7.”
Why that age? Because a 7-year-old has a mix of baby and adult teeth, which is what lets an orthodontist catch problems in their earliest stages, with X-rays checking below the surface for what an exam can’t see.
It isn’t a deadline either. If your child is younger than 7 and something looks off, don’t wait. The signs the AAO tells parents to watch for are early or late loss of baby teeth, difficulty chewing or biting, mouth breathing, jaws shifting or clicking, cheek biting, and a face that looks unbalanced. On chewing it’s blunt: eating should never hurt.
Those are reasons to call. They aren’t a way to work out what’s wrong.
Everett, WA
Is your child due a first check-up?
An exam is how you tell which findings need treating and which can be watched.
What Early Treatment Can and Cannot Do
Early treatment, sometimes called interceptive treatment, starts while some baby teeth are still in place. The idea is to catch a developing problem, steer the growth of the jaws, and make room for the adult teeth coming through.
What it isn’t, in the AAO’s own words, is a rush to put every child in braces. An early check-up can just as easily end in no treatment at all, or in following a child for a few years to see what develops. Plenty of problems are better handled once all the adult teeth are in, which is why so much orthodontic work happens during the teenage years.
For front teeth that stick out, a Cochrane review of 27 trials found, on low to moderate quality evidence, that treating early cut new injuries to those teeth from 30% to 19%. It found no other advantage over treating later, and no difference in the final bite once both groups had finished. The AAPD adds that splitting treatment into two phases takes significantly longer overall. So going early buys fewer broken front teeth, not a better result, and it doesn’t rule out braces later.
Thumb Sucking, Pacifiers and Tongue Position
Habits get blamed for a lot, and the AAPD puts it carefully: the link between oral habits and the way a child’s teeth and face develop is an association, not a proven cause. A habit frequent enough, long enough and forceful enough may go along with an overjet, a shallower bite, an open bite or a crossbite at the back.
Thumb, finger and pacifier sucking is normal in babies and young children. It’s the long-running habits that the AAPD ties to an open bite and a crossbite, and its suggestion is that early dental visits give parents guidance to help a child stop by around age three. The ADA notes most children stop between two and four on their own.
On tongue thrust: if the tongue rests in a normal position, a tongue-thrust swallow has no clinical significance. It’s where the tongue sits at rest that counts. And if a habit does need managing, the options run from talking it through with the child to appliances, on what a Cochrane review found to be low quality evidence either way. Raise it at an exam.
Children’s Orthodontics at Icon Dental Center
All orthodontic treatment here is done by Dr. Keyvan Sohrabi, our orthodontist. We see children from 6 months old and every general dentist here is trained to treat them, so the check-up that first raises a question about a child’s bite and the children’s orthodontics that may follow both happen in the same office in Everett.
What treatment costs depends on what’s being corrected, whether it runs in one phase or two, and what your plan covers. CareCredit is available, which spreads the cost over monthly payments. We’re in network with Delta Dental/WDS, Regence, Premera, Aetna and Cigna, and out of network with MetLife, United and Concordia. Call and we’ll go through yours. You can also see the full range of orthodontic treatment offered here.
Common Questions
Does an untreated bad bite cause jaw joint problems?
No. The National Institute of Dental and Craniofacial Research is direct about it: research does not support the belief that a bad bite, or orthodontic treatment such as braces, causes TMDs, and current evidence doesn’t support a strong link between the two. What is supported is narrower. A deep bite can contribute to jaw pain, which isn’t the same thing as damage to the joint.
Do we need a referral from our dentist first?
No. You don’t have to wait for a referral to bring a child to an orthodontist. A general dentist and an orthodontist are looking at different things. Parents are often the first to notice that something looks off.