Bite Problems

Bite problems in children cover a range of tooth and jaw relationships that affect how upper and lower teeth come together. Common patterns include crowding, spacing, excessive overbite (including deep bite), underbite, anterior open bite, and posterior crossbite. Each pattern can involve only tooth positions or an underlying skeletal discrepancy that affects jaw growth.

Understanding the specific type of malocclusion helps guide treatment timing and approach, since some issues respond well to simple tooth movement while others require growth guidance. Early identification gives clinicians more options to intercept developing problems and to plan phased care as a child grows.

A comprehensive bite evaluation looks beyond the teeth to include jaw relationships, facial growth patterns, oral habits, and airway considerations. Clinicians use a combination of clinical exam, dental models or digital scans, intraoral photographs, and targeted imaging such as panoramic or low-radiation CBCT when indicated to document tooth position and skeletal relationships. Assessment also checks for uneven wear, shifting when the child closes, and signs of functional problems like difficulty chewing or speech changes.

Evaluators factor in the child’s growth stage because timing affects which interventions are likely to succeed. Regular monitoring with periodic rechecks is common when issues are mild, while clear signs of progressive change or functional impairment prompt earlier treatment planning.

Parents should note behaviors and visible changes such as prolonged thumb or pacifier sucking, tongue thrusting, mouth breathing, or an asymmetric chewing pattern. Other red flags include teeth that do not meet in the front or back, an obvious jaw shift when the child bites down, speech concerns related to front teeth, and premature or uneven tooth wear. Changes in facial profile or a jaw that appears too far forward or back compared with the rest of the face also warrant evaluation.

When parents observe these signs, scheduling an examination helps determine whether the issue needs monitoring, habit intervention, or orthodontic referral. Early conversations with the dental team make it easier to track development and start appropriate interceptive care if necessary.

Treatment for excessive overbite or a deep bite depends on whether the problem is dental (tooth position) or skeletal (jaw relationship) and on the child’s remaining growth. For dental overbite issues, braces or clear aligners combined with bite-opening mechanics can reposition teeth and improve incisor overlap. When a growth component exists, growth-modifying appliances and habit correction may be used to encourage a more balanced jaw relationship before comprehensive alignment.

Managing function is also part of therapy, so clinicians often address oral posture, breathing, and parafunctional habits that contribute to relapse. Long-term stability commonly requires retention and periodic follow-up through growth to ensure the correction endures as permanent teeth erupt and the jaws mature.

Underbites and anterior crossbites can stem from tooth positions or from disproportionate jaw growth, and treatment targets the underlying cause. For tooth-level anterior crossbites, simple orthodontic mechanics such as braces or aligners often reposition the offending teeth to a normal relationship. When the lower jaw is growing forward relative to the upper jaw, growth-guidance appliances used during active development can help redirect growth and reduce the severity of skeletal underbites.

Because relapse may occur with growth, close monitoring and staged treatment are common, and coordination between pediatric dentists and orthodontists ensures the right timing. In rare severe skeletal cases that persist after growth, surgical options may be considered once growth is complete, but early intervention frequently reduces or eliminates the need for more invasive procedures.

An anterior open bite appears when the front upper and lower teeth do not meet, and causes often include prolonged sucking habits, tongue thrusting, and altered breathing patterns that change tongue and jaw posture. Habit cessation and myofunctional therapy aimed at retraining tongue and lip posture are important early steps because appliances alone are less stable without addressing muscle patterns. For persistent or larger open bites, fixed appliances, removable devices, or braces can help close the vertical gap while behavioral strategies continue in parallel.

A multidisciplinary approach that may involve speech therapy or ENT evaluation often improves outcomes when airway or swallowing patterns contribute to the problem. Because open bites have a higher tendency to reopen if underlying habits persist, treatment plans emphasize durable habit change and retention strategies to support lasting correction.

Posterior crossbites, where top back teeth sit inside the lower teeth on one or both sides, often reflect a narrow upper jaw and can cause the bite to shift laterally as a child closes. This functional shift may lead to asymmetric wear, muscle strain, and progressive facial asymmetry if left untreated. Early correction is important because the midface and palate are more responsive to expansion during growth, making noninvasive widening options more effective in younger patients.

Palatal expanders and similar devices are commonly used to widen the upper arch, create space for erupting teeth, and improve occlusal relationships. Timely expansion can simplify later orthodontic alignment and reduce the risk of compensatory dental or skeletal changes that complicate treatment.

Interceptive orthodontic care is recommended when a developing problem is likely to worsen with growth or when early intervention can simplify later treatment and improve function. Examples include severe crowding that risks impaction, crossbites that cause jaw shifting, and habit-related open bites where appliance therapy combined with habit management can change growth direction. The decision to start early treatment balances the advantages of guiding growth against the potential need for a second phase of comprehensive care once more permanent teeth erupt.

Determining timing requires an individualized assessment of growth patterns, tooth eruption stages, and functional considerations. Regular monitoring by a pediatric dental team helps families choose whether to observe, intervene early, or wait for full orthodontic correction at a later stage.

Oral habits such as thumb or pacifier sucking, prolonged bottle use, and tongue thrusting can exert sustained forces that move teeth and influence jaw relationships over time. Likewise, mouth breathing related to nasal obstruction or enlarged tonsils and adenoids changes tongue posture and facial muscle balance, which in turn affects how the jaws develop. Because these contributors are functional rather than purely dental, addressing them is often essential to achieving and maintaining orthodontic correction.

When habit or airway problems are suspected, clinicians commonly recommend behavioral strategies, myofunctional therapy, or collaboration with ENT and speech specialists to treat underlying causes. Correcting the functional drivers alongside orthodontic care increases the likelihood of stable, long-lasting results as the child grows.

Stability after bite correction depends on appropriate timing, addressing functional contributors, and using retention strategies tailored to each child’s needs. Retainers and long-term monitoring help preserve tooth positions, while ongoing attention to oral posture, breathing, and habits reduces the forces that can lead to relapse. Regular dental and orthodontic checkups during growth spurts are important to detect and manage changes early.

For families seeking evaluation and individualized planning, the office of Myers Pediatric Dentistry & Orthodontics coordinates growth-aware assessments and follow-up care to help young patients achieve durable, functional outcomes. Clear communication between the dental team and the family about expectations, retention, and functional therapy supports long-term success.