Best Practices for Bite Problems Explained
If your orthodontist tells you that you have a bite problem, you might wonder what that really means. Bite problems are incredibly common—most people have something that isn't perfectly aligned. Understanding exactly what your orthodontist found helps you make informed decisions about whether to treat it and what approach to take.
Getting the Right Diagnosis
Good diagnosis starts with detailed records. Your orthodontist takes X-rays from multiple angles to see your entire jaw structure. A panoramic X-ray shows all your teeth, their roots, any missing or extra teeth, and your overall bone levels. A side view X-ray reveals how your upper and lower jaws line up compared to each other and to your skull.
Physical photos from several angles show what your bite looks like in your actual face. You'll probably see photos of your full face, your teeth close up, and views from the side. These images become your baseline for comparing how much your bite improves during treatment.
Your orthodontist also takes molds or scans of your teeth. These three-dimensional replicas let them measure exactly how much crowding or spacing exists, what shape your dental arches are, and how your teeth relate to each other.
Understanding Jaw Measurements
Your orthodontist analyzes your X-rays using specific measurements. One measurement (called the SNA angle) shows how far forward your upper jaw sits. Another (the SNB angle) shows where your lower jaw is positioned. The difference between these two (the ANB angle) tells whether you have a Class I (normal), Class II (upper jaw too far forward), or Class III (lower jaw too far forward) bite.
These aren't arbitrary numbers—they give your orthodontist concrete data about what's happening structurally. If your measurements show your upper jaw is in normal position but your lower jaw is way back, that's very different from having both jaws in abnormal positions. Different problems need different solutions.
The measurement from your mouth to your chin area (called vertical dimensions) reveals whether you have a high-angle or low-angle growth pattern. This influences everything about your bite and how it should be treated.
Knowing Your Specific Problem
Crowding means your teeth don't have enough space, so they overlap or rotate. Severe crowding (more than 4 to 5 millimeters of missing space) usually needs braces. Mild crowding (less than 2 to 3 millimeters) sometimes resolves naturally as you grow.
Spacing is the opposite—extra room between your teeth. Sometimes this closes naturally as your teeth shift. Other times it needs braces to close.
Crossbite means some of your upper teeth bite on the inside of your lower teeth (the wrong way around). This can involve your front teeth, your back teeth, or both. This usually needs treatment to prevent uneven wear and jaw stress.
Overbite is how much your upper teeth stick down over your lower teeth. A normal overbite is about 2 to 3 millimeters. Too much overbite (called a deep bite) can cause wear on your lower front teeth and jaw discomfort.
Open bite means your front teeth don't touch at all when you bite down. This often indicates a tongue-thrust habit or vertical growth pattern that needs addressing.
Timing Decisions: Early vs. Later Treatment
Your age and growth status matter enormously. Kids who are still growing have an advantage—their orthodontist can use growth to help fix the problem. A child with a Class III bite (lower jaw too far forward) benefits from early intervention because the orthodontist can redirect growth patterns using special appliances.
Growth modification works best between ages 8 and 10 for some problems. Waiting until age 14 or later means you've missed the optimal window, and braces alone might not achieve the same results without jaw surgery.
However, recent research shows that for crowding and spacing problems, waiting until all permanent teeth have come in and then doing comprehensive braces works just as well as doing early treatment. You might avoid one treatment phase and reduce total treatment time by waiting.
Your orthodontist balances these factors. Severe structural problems and crossbites often benefit from early treatment. Crowding and spacing frequently respond equally well to comprehensive later treatment.
The Two-Phase Debate
Some practices recommend two phases of treatment: early intervention for specific problems, then comprehensive braces later when permanent teeth finish erupting. The advantage is addressing structural problems early when growth can help. The disadvantage is extended total treatment time and potential relapse of early corrections before phase two begins.
Other practices recommend one-phase treatment starting once permanent teeth are in place. This approach is simpler, potentially faster overall, and avoids early relapse concerns. Research increasingly suggests similar outcomes between approaches.
Your orthodontist's recommendation depends on their training, your specific situation, and their experience with different approaches. A very severe structural bite problem usually benefits from early intervention. Mild crowding or spacing might not need early treatment.
Understanding Growth Patterns
Everyone's jaw grows differently. Some people's jaws grow mostly downward and backward (high-angle growth), which worsens open bites and deep bites. Other people's jaws grow forward and downward (normal growth), which naturally helps some bite problems. Still others have low-angle growth, growing more horizontal than vertical.
Your growth pattern influences what you can expect from treatment. Someone with high-angle growth might not achieve a perfect deep bite correction with braces alone—surgery could be necessary for ideal results. Someone with low-angle growth might see correction happen quite naturally with growth.
Understanding your specific growth pattern helps you make realistic expectations. Your orthodontist will discuss this with you—if your growth pattern is fighting against the result you want, that's important information.
When Surgery Might Be Needed
Very severe jaw discrepancies often respond best to surgery combined with braces. If your lower jaw is extremely far back or extremely far forward, or if your upper and lower jaws don't match well, braces alone have limitations.
Orthognathic surgery (jaw surgery) repositions your jaw surgically to achieve proper relationships. Braces before surgery align your individual teeth, then braces after surgery fine-tune everything after healing. This combination creates results that braces alone can't achieve.
Surgery is considered only when the problem is severe enough to justify surgical risk, when growth is complete (since surgery is done at skeletal maturity), and when the patient understands the commitment. It's not a quick fix, but for severe cases, it transforms results.
Making Your Treatment Decision
Your orthodontist will present a treatment plan with specific goals and a timeline. They should explain what your problem is, why you have it, what treatment approach they recommend, how long treatment typically takes, and what you'll need to do (like wearing elastics or a night retainer after treatment).
Ask questions about anything you don't understand. What happens if you don't treat it? What are the treatment options? How much will improvement realistically be? This conversation helps you make an informed decision.
Remember that perfect teeth aren't the only goal. Good bite function (teeth meeting properly, chewing working correctly), healthy teeth and gums, and a smile you feel confident about are the real objectives. Your orthodontist should focus on these practical goals, not pursuing perfection that might require unnecessary time and expense.
Once you understand your bite problem, the proposed treatment, and what results you can realistically expect, you're ready to proceed with confidence.
References
1. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 6th ed. Elsevier; 2019. 2. Baccetti T, et al. The timing of vertical maxillary growth completion. Angle Orthod. 1997;67(4):271-278. 3. De Clerck HJ, et al. Class III malocclusion: guidelines for early diagnosis and treatment. Am J Orthod Dentofacial Orthop. 2006;129(4 Suppl):S89-S95. 4. Fleming PS, et al. Effectiveness of removable functional appliances for Class II malocclusion. Am J Orthod Dentofacial Orthop. 2015;148(3):445-453. 5. Littlewood SJ, et al. Orthodontic retention: a systematic review.
J Orthod. 2017;44(1):24-34. 6. Onyeaso CO, Aderinokun GA. The relationship between occlusal trauma and periodontal status in a Nigerian population. Int J Dent Hyg. 2003;1(4):237-242. 7. McNamara JA Jr. Maxillary transverse skeletal discrepancy in Class II and Class III malocclusions. Angle Orthod. 2000;70(5):319-320. 8. Tulloch JFC, et al. Effectiveness of conventional orthodontic treatment of Class II Division 1 malocclusion. Angle Orthod. 1997;67(6):429-434. 9. Franchi L, et al. Predictability of skeletal changes induced by functional appliances in Class II malocclusion. Am J Orthod Dentofacial Orthop. 2003;123(2):114-123. 10. Baccetti T, Franchi L, McNamara JA Jr. Cephalometric variables related to the timing of different stages of the dentition. Angle Orthod. 1997;67(2):231-242.
Related reading: Foods to Avoid With Braces: Complete Guide and Rectangular Wires Final Detailing.
Conclusion
J Orthod. 2017;44(1):24-34. 6. Onyeaso CO, Aderinokun GA. Talk to your dentist about how this applies to your situation. Talk to your dentist about what options work best for your situation.
> Key Takeaway: If your orthodontist tells you that you have a bite problem, you might wonder what that really means.