The most common orthodontics issues and how they’re fixed

Good oral health doesn’t just involve keeping your teeth clean and cavity-free. Making sure that they are properly aligned throughout your life is crucial. Misaligned teeth, if left untreated, can lead to a variety of mouth and jaw problems, including pain, difficulty chewing and speaking, and even increased risks of disease and infection.

That’s why it’s important to visit an orthodontist and get a professional opinion on the alignment of your teeth. Catching an alignment issue early can save you time and money on more invasive treatment later. A trained orthodontist, such as those at Fredericksburg Orthodontics, will be able to diagnose your issue and prescribe the ideal treatment for your teeth, whether that be retainers, braces or surgery.

Malocclusion: What are the different classes?

Before you can go to the orthodontist for misaligned teeth, you need to know what aligned teeth look and feel like. Ideally, your teeth should fit comfortably in your mouth without crowding, excessive spacing, or severe rotation. Your upper jaw should overlap your lower just enough for your upper molars to fit into the grooves of your lower ones. Your teeth shouldn’t inhibit you from closing your mouth fully.

Misalignment from the usual occlusion — the alignment of one’s teeth — is referred to as malocclusion. Depending on the class and severity of the malocclusion, symptoms can include difficulty chewing, constantly biting the inner cheek or tongue, speech changes, and even changes in the facial structure. There are three separate classes of malocclusion:

  • Class I: In Class I malocclusion, the teeth are overcrowded or unevenly spaced, but the upper and lower teeth overlap properly throughout the jaw. The most common and least severe type of malocclusion.
  • Class II: Class II malocclusion is classified as a severe overbite — the upper jaw and teeth significantly overlap the lower. If the lower jaw is also smaller than average, class II malocclusion can also be known as retrognathism.
    Class III: Class III malocclusion happens when the lower jaw and teeth significantly overlap the upper. This is classified as a severe underbite. If the lower jaw is larger than usual, class III malocclusion is also referred to as prognathism.

Basic malocclusion can result from a variety of things — genetics, childhood behavior, mouth or jaw injuries, tumors, and even improper dental work. It varies in severity and treatment method, if treatment is required at all.

Common orthodontic problems

Even with the three classifications, there are still several subdivisions of malocclusion. They can involve an overlapping upper jaw, an overlapping under jaw, or be related to the spacing and placement of the teeth themselves. Here are a few of the most common orthodontic problems:


An underbite is when the lower jaw overlaps the upper jaw, causing the lower teeth to protrude. Some underbites are caused by genetics, but they can also come from prolonged bottle-feeding or thumb-sucking — specifically beyond infancy — as well as jaw injuries. In rare cases, it can even come from a tumor on the jaw or in the mouth.

Not all underbites require treatment, as slight ones only affect a person’s appearance by causing the chin to jut out more. However, more pronounced underbites can have negative consequences. Depending on the severity, those with underbites may have difficulty chewing, slurred speech, lisping, crooked teeth, gum disease, jaw pain and even trouble breathing. Underbites can also make it more difficult to clean certain teeth, which can lead to increased tooth decay.

Severe underbites can be treated with braces to pull the teeth back, or by removing several teeth to allow the others more space. In some cases, the orthodontist may shave down teeth that are jutting out too much. The most severe underbites require corrective surgery to reshape the jawbone.


An overbite, also referred to as buck teeth, is the inverse of an underbite — the upper jaw overlaps the lower, causing the upper teeth to protrude. It shares many root causes with underbites, such as genetics and excessive bottle-feeding or thumb-sucking past infancy. It can also be caused by constant grinding of the teeth, excessive nail-biting, or tongue-thrusting,  which refers to the tongue being continuously pressed forward against the teeth.

Slight overbites don’t require treatment, as their only effect is to make the chin look smaller in comparison to the upper jaw. However, just like severe underbites, severe overbites can cause difficulty chewing, slurred speech or lisping, crooked teeth, jaw pain and trouble breathing. They can also make it harder to clean certain teeth, which leads to increased tooth decay.

Overbites can be treated with braces or by removing select teeth to allow the rest more space. Palate expanders can be used to influence the shape of the jaw, but only on children who are still growing. In severe cases, surgery may be required to reshape the jawbone.


A crossbite refers to when lower teeth protrude in front of the top teeth when the mouth is fully closed. This condition is similar to an underbite, but while underbites affect the whole jaw, crossbites only apply to a group of teeth. There are two classifications of crossbites:

  • Posterior crossbite: With a posterior crossbite, the lower teeth in the back of the mouth fit over the upper teeth. For example, the lower molars may protrude over the upper molars.
  • Anterior crossbite: With an anterior crossbite, the lower teeth at the front of the mouth fit over the upper teeth. For example, the lower incisors may protrude over the upper ones.

Just like overbites and underbites, crossbites can be the result of genetics or thumb-sucking. They can also occur when baby teeth take too long to fall out, or when adult teeth take too long to grow in. Depending on the severity, they can result in difficulty speaking, jaw pain, temporomandibular (TMJ) disorders and increased rates of tooth decay due to the increased cleaning difficulty.

A crossbite can be treated with braces, retainers, palate expanders or elastic bands used to pull the teeth into position over time. In severe cases, surgery may be requires to reshape the jawbone.


Similarly to an overbite, an overjet is when the upper teeth protrude over the lower ones. The difference between the two is that with an overbite, the upper teeth are shifted entirely forward in relation to the lower. With an overjet, only groups of teeth are affected, and the teeth protrude out at an angle.

Overjets can be caused by genetics, but they can also come from prolonged thumb-sucking or tongue-thrusting. Overjets can lead to difficulty chewing, jaw pain, difficulty closing the lips fully, frequent tongue or inner cheek biting, and speaking problems.

Overjets can be treated with braces that push the teeth back into place, but they can also be hidden with veneers, dental bonding or crowns. These mimic the appearance of straight, natural teeth through various methods:

  • Veneers: Flat pieces of porcelain that are attached to the front of the tooth.
  • Dental bonding: A composite resin molded around the tooth.
  • Crown: A custom prosthetic that covers the entire tooth.

All three have different costs and durabilities, so if you’re considering one, be sure to discuss it with your orthodontist to decide which one works best for you.

Open bite

An open bite occurs when the upper and lower teeth slant outwards and don’t touch when the mouth is closed. They can be caused by genetics, TMJ disorders, thumb-sucking or tongue-thrusting. Open bites can cause speech problems, difficulty chewing, jaw pain and tooth wear that can lead to fractures in severe cases.

When open bites occur in the child stage, they can be treated through behavior modification. This involves discouraging excessive thumb-sucking or other behaviors that lead to open bites. If the issue persists once the adult teeth grow in, however, then it must be treated with braces, headgear or even surgery.

Hypodontia (missing tooth)

On average, a child’s primary teeth have grown in by age three, and all adult teeth have grown in between the ages of twelve and fourteen. Hypodontia is the term used when a child fails to develop one or more of their teeth. It can come from genetics, trauma, infection or other environmental circumstances.There are four different forms of hypodontia:

  • Congenitally missing teeth: This stage of hypodontia occurs when tooth buds — the buds located beneath the gums that allow teeth to grow — are missing in unborn children.
  • Tooth agnesis: This is the term used when teeth fail to develop. It is the standard form of hypodontia.
  • Oligodontia: Oligodontia occurs when six or more teeth fail to develop.
  • Anodontia: The most severe form of hypodontia. Those affected with anodontia fail to develop any teeth.

If hypodontia only affects one’s baby teeth, then the issue is resolved once the adult teeth grow in. However, if the issue persists to the permanent teeth, it can affect the ability to chew and speak. It can also lead to gum damage, insufficient bone growth and further malocclusion, as other teeth may shift out of alignment to fill the gaps and become crooked.

Treatment for hypodontia follows one of two paths — either orthodontic treatments such as braces are used to pull the remaining teeth in to fill the gaps, or replacement teeth are made in the form of removable dentures, bridges or dental implants.

Impacted teeth

Impacted teeth are teeth that have either entirely failed to grow in through the gums or have only partially grown through. Impacted teeth are the result of a lack of space in the mouth. The new tooth has no room to grow, so it becomes impacted under the gums. The wisdom teeth are the most commonly impacted, but it can affect any kind of tooth.

Not all impacted teeth lead to symptoms — in fact, some are only discovered during x-rays. However, other cases can cause mouth pain, bad breath, a constant bad taste in the mouth, and red, swollen or bleeding gums. Partially impacted teeth are more difficult to clean, which can lead to cavities, infections, gum disease and cysts.

There are several forms of treatment for impacted teeth. If there are no symptoms, dentists will often monitor the tooth to see if any symptoms occur. If there are symptoms, then eruption aids such as braces may be used to force the impacted tooth to grow. If the tooth is damaging the jaw and surrounding teeth, then it must be removed surgically.

Excessive spacing

Excessive spacing, as the name implies, is when teeth grow with an excessive amount of space between them. These gaps between the teeth are referred to as diastema. Diastema can come from a number of genetic factors, such as tooth size, the size of the jawbone, and the growth rate of the gums. Diastema can also come from tongue-thrusting, thumb-sucking or as a result of gum disease.

Symptoms of diastema are often just cosmetic, meaning it doesn’t necessarily need to be treated. However, if it comes from gum disease, it can be accompanied by loose teeth, bone loss, and red, swollen or bleeding gums. Gum disease is often treated by deep cleaning to remove any accumulated tartar, but diastema must be treated with braces in order to pull the teeth back into position.

What happens during an initial orthodontist consultation?

Ideally, a child should have their first orthodontic consultation by no later than age seven. This provides enough time for the baby teeth to develop, but not enough time for them to be replaced by the adult teeth. At this stage, orthodontists can identify problems with emerging teeth or jaw structure and prescribe corrective treatment early. However, orthodontists can be consulted at any age.

Your typical consultation is fairly simple — and depending on the practice, fairly low-cost, if not free. Once you meet your orthodontist, you explain any concerns you might have. It’s advised to come prepared with several questions to ask. Once you’ve finished, the orthodontist will examine your teeth, jaw and oral tissues. They will also occasionally take photos and panoramic x-rays to examine what lies beneath your gums.

Once the orthodontist has finished their examination, they will address any issues they might have found. If they believe you require further treatment, they will discuss your options, what treatment will cost you and payment plans. Any discoveries they make will also be shared with your dentist.

Scheduling a consultation with Fredericksburg Orthodontics

There’s a lot more to good oral health than brushing your teeth. It’s important to make sure your teeth are aligned and properly spaced. Correcting malocclusion when it occurs can prevent pain, difficulty chewing, speaking and breathing, and even major issues like cysts and gum disease.

If you’re suffering from malocclusion, consider Fredericksburg Orthodontics. After over sixteen years of service, we’re ABO certified and have been voted the best practice in the area. We offer both in-person and virtual consultations, as well as a variety of products, such as metal or clear braces, Invisalign®, and more. Our team will diagnose your brand of malocclusion and work with you to plan the best treatment. If you’re in need of reliable orthodontic care, contact Frederickburg Orthodontics for a complimentary consultation.