Jaw misalignment

introduction

A healthy, aesthetic set of teeth is characterized by the fact that the teeth are symmetrical to each other.
The incisors interlock like scissors and the molars are arranged like gears to one another.
Such a tooth position ensures optimal conditions for chewing and speaking.

In addition, the teeth without much distance, stand straight next to each other and don't overlap, they should be with the whole jaw and shape the face into a harmonious overall picture.

Such a jaw is the ideal of today's society, but actually only about one in twenty has such a set of teeth. Something 60% of children and adolescents exhibit more or less severe forms of dental and / or Jaw misalignments on. While some of these misalignments are congenital, most are caused by external factors, such as thumb sucking.

What types of jaw misalignment are there?

Not every jaw misalignment is the same, there are different types of malformation of the dentition or jaw.

The most common reasons for which orthodontic treatment is necessary include the cross bite, the open bite, the overbite, the undershot, various crowding, the gap bite, the overbite and the deep bite.

Crossbite

The crossbite is by far the most common jaw misalignment, it can affect individual teeth or the entire jaw. The crossbite is characterized by the fact that the teeth of the lower jaw lie in front of the teeth of the upper jaw when they clench.

A common reason why the lower jaw teeth bite before the upper jaw teeth is too small a palate due to inhibited upper jaw growth.

In order to correct the cross bite, the upper jaw growth must first be stimulated. This happens in the context of the palatal expansion.

Open bite

An open bite is mainly triggered in toddler age by frequent thumb sucking or using pacifiers for too long. An incorrect development of the jaw creates gaps between the front teeth of the upper and lower jaw.

Furthermore, two types of open bite can be distinguished from one another.

• In one case, the lower jaw closes in front of the upper jaw (so-called mesial bite)
• in the other case, the upper jaw closes in front of the lower jaw (so-called distal bite).

Overbite

In patients who suffer from an overbite (prognathy) as a jaw malposition, the size of the lower jaw does not match the size of the upper jaw. In most cases, the upper jaw is relatively too large, so that the front teeth are far ahead of those of the lower jaw when the jaw closes.

Overshot

The undershot as a jaw misalignment is often referred to as progeny and is the opposite of the overbite. In patients with an undershot bite, the lower jaw is too pronounced in relation to the upper jaw, the front teeth are in front of those of the upper jaw.

Cover dentition

The overbite is better known as the "deep bite" and is characterized by the fact that the upper front teeth are positioned too steeply. For this reason, the teeth of the lower jaw are completely covered by the front teeth of the upper jaw when clenching.

Causes of jaw misalignments

There are congenital jaw misalignments that are not caused by external factors. In particular, the size of the jaw halves and their position in the jaw joint are determined from birth and can lead to various jaw misalignments.

Much more often, however, such malfunctions of the dentition occur due to incorrect behavior in childhood. In the meantime, some risk factors are known which contribute decisively to the development of a malalignment of the jaw.

• Experts assume that feeding a baby with bottle feed is a major risk factor, because the shape of most bottle teats bears no relation to the child's jaw. Regular and / or long sucking on these children's bottles promotes the development of jaw deformations.
  
• The use of pacifiers can also be harmful to the child's teeth. Children should refrain from using a pacifier before the age of 3, otherwise there is a risk of developing an open bite in the anterior region. In addition, the non-physiological shape of the pacifier often leads to misaligned teeth.
  
• Teeth and / or jaw misalignments are more likely to occur in children who suffer an accident at a young age that leads to tooth loss or who have severe caries.
  
• Furthermore, mouth breathing, as it often occurs in asthmatics, for example, should promote deformation of the teeth. This fact is based on the fact that when breathing through the mouth, the tongue is pressed more against the front teeth. In the course of this, the upper incisors are shifted forwards, while the lower front teeth are pushed backwards at the same time. A too deep bite is often the result.

There are also a number of other factors that favor the development of a misaligned tooth and / or jaw.

Can pacifiers lead to jaw misalignments?

If the child wears the pacifier for too long, i.e. beyond the prescribed maximum age, jaw misalignments can occur, such as the open bite. The treating dentist recommends the best time to wean the pacifier.
Not only the jaw but also the position of the teeth is massively influenced. It has an effect similar to children's thumb sucking.

In most cases, the misaligned teeth and jaws have to be treated with orthodontic treatment to compensate for the defects. Care should therefore be taken to wean the child off the pacifier in good time.

Possible symptoms of a misaligned jaw

In many cases, the misaligned jaws show no physical symptoms.
Those affected tend to suffer on the psychological level, feel shame, do not dare to smile and feel severely restricted in their daily life.
Symptoms of a jawbone that is too small are usually nesting of the teeth; the lack of space is particularly noticeable in the form of misalignments in the front teeth area.
A jaw that is too large, on the other hand, is indicated by the presence of tooth gaps.
In addition, due to the difficult cleaning conditions, crooked teeth increase due to a greatly increased risk of tooth decay.

Many patients with a malaligned jaw complain of frequent headaches and pain in the temporomandibular joint, which are caused by an unfavorable stress on the joint. Pronunciation can also be impaired; s and z sounds in particular become increasingly indistinct.
You can find more about this under: Speech disorder

Cost of jaw misalignment

Up to the age of eighteen, orthodontic treatment for jaw misalignment is covered by the statutory and / or private health insurance companies, but in certain cases it is also possible that the health insurance companies bear at least part of the costs after the age of eighteen.

This is possible if additional surgical therapy has to be carried out in addition to the actual treatment of the jaw deformity.

Diagnosis of jaw misalignment

An existing misalignment of the jaw can be easily and quickly determined by an orthodontic specialist.

The dentist first assesses the situation within the oral cavity, checks the number of teeth, their position in the jaw, their size and shape and the size ratio of the jaw in relation to the skull.

Imprints of the teeth are then made and a plaster model is made from them.

The creation of an X-ray image of the entire jaw (orthopantomogram; OPG for short) is also standard in orthodontic diagnostics.

With the orthodontic indications, the orthodontist classifies the malpositions according to their severity.

Therapy of jaw misalignment

It is not necessary to correct a misaligned tooth or jaw in all cases.

Treatment of the jaw misalignment is only necessary if the misalignment has a negative effect on the temporomandibular joint and / or the patient's attitude to life. Orthodontic treatment is possible at any age and older patients in particular are increasingly choosing to have their teeth straightened.

There is the possibility to choose between loose braces and fixed braces, whereby it is necessary to use fixed braces from the beginning with some jaw misalignments.
Loose braces are dental appliances that are used to straighten the jaw and teeth.

In contrast to the fixed braces, the loose braces can be removed from the oral cavity and reinserted by the patient.
For this reason, loose braces are often referred to as removable braces. With the help of these removable braces, sufficient space in the jaw can be created before the teeth erupt and gaps in the teeth that are too narrow can be expanded.
Fixed braces are dental devices that are used to correct jaw and tooth misalignments, but cannot be removed from the oral cavity by the patient himself. It remains in the mouth for the entire duration of the treatment.

Basically, a distinction is made between appliances that lie entirely within the mouth (intraoral appliances), of those that are partially outside the oral cavity (extraoral appliances) must be attached.

Functional orthodontic devices (FKO devices), on the other hand, are used to influence the growth of the jaw in such a way that a normal bite position arises (Neutral occlusion).

Splint therapy for jaw misalignments

If the jaw or the temporomandibular joint is incorrectly positioned, a hard splint made of plastic can help. The misalignment can be caused by severe stress-related grinding of the teeth, as the grinding results in strong tension in the muscles. These can ultimately position the temporomandibular joint in an incorrect position.
A splint can, on the one hand, absorb the forces generated by the crunch and, on the other hand, promote the right bite.

Read more about this at: Grinding splint

OP for a malaligned jaw

Correcting jaw misalignment with surgery is one option that is usually considered in adults and with severe misalignments.

Once the growth is complete, fixed braces can only cause the teeth to tilt and move. The remodeling of the bony structures is only possible to a very limited extent.

A so-called hand x-ray can be used to provide information about the growth status. Congenital or acquired malalignments, an abnormal position of one or both jaws (Dysgnathia). However, it must be remembered that orthodontic pretreatment is absolutely necessary even before such an operation.
The dental arches are aligned as perfectly as possible to each other (mostly through fixed braces), the overall aesthetic picture at this point tends to worsen.

Only then can the upper and lower jaw be aligned with one another in a so-called adjustment osteotomy and correct interlocking guaranteed. Among other things, a lower jaw that protrudes too far can be corrected (Progeny). If the upper jaw is too far forward, this is called “maxillary prognathy”. A lower jaw that is too far back (mandibular retrognathia) can be corrected as well as an upper jaw that is too far back (Maxillary Retrognathia).
This changes the profile picture, noses appear visually smaller and the lip posture harmonious. The basic prerequisite is the diagnosis, the explanatory discussion and the planning phase. Various x-rays (almost always a CT), Analyzes and the creation of models are necessary.
Often teeth have to be removed before such a jaw malpositioning operation, possibly also displaced wisdom teeth. Oral hygiene has to be optimized, teeth cleaning, caries-free and healthy periodontal teeth are the prerequisites. This is followed by the often lengthy orthodontic pretreatment in which the teeth are corrected. During the operation, bone parts are usually severed under anesthesia (Osteotomy) and completely removed or relocated as required.

It can be found almost exclusively in the oral cavity (intraoral) surgery, scars on the skin around the face are avoided.
The new jaw position is fixed using plates and screws (Osteosynthesis procedure, mostly titanium). In many cases, chin surgeries are added to improve aesthetics.

Nowadays the two jaws are only rarely wired after a conversion operation, which means that the mouth can be opened easily, oral hygiene is careful and it is possible to eat soft food. In most cases, however, removable elastic bands are still used. Risks in the operation of a jaw deformity are particularly nerve injuries, bleeding, fractures and tooth damage.
Recurrences are rare, but orthodontic follow-up and physiotherapy are necessary. Hospitalization, pain medication, and antibiotics are required.

Consequences of jaw misalignments

Misalignments in the jaw and thus in the jaw joint can have serious consequences. The first signs of a misalignment are clicking and rubbing noises in the jaw joint. Misalignments often manifest themselves in severe headache, neck or back pain. Furthermore, they can influence or limit functions of the mouth opening such as speaking or chewing. The pain often spreads to the temples or ears. In the worst case, TMJ arthrosis can occur.

Headache from a misaligned jaw

The International Headache Society (IHS) differentiates between primary and secondary headaches. In the primary form, the headache cannot be assigned to any other clinical picture. A total of 46% of the population experience recurrent headaches.
A headache (secondary form) are also associated with jaw misalignments.

A “wrong bite” can lead to muscular tension or poor posture and incorrect strain. Not infrequently, headaches or neck pain are the result. These aspects are triggered by stress and the associated grinding of teeth (Bruxism). So-called splints can help, and in the case of worse misalignments, grinding measures, prosthetics, orthodontic therapy or surgery can help.

Often the jaw misalignments can be traced back to stress-induced grinding of the teeth at night. The tension and pain caused by the incorrect strain on the muscles in the mouth and jaw area very often radiate to the temples and head area.

Can tinnitus be a result of misaligned jaws?

One possible consequence of a jaw misalignment is the development of unpleasant noises in the ear, a tinnitus. Tensions are increased by a misaligned jaw. The misalignment can therefore affect the inner part of the ear. In the inner ear there are small so-called hair cells that can be damaged by the pressure. This can lead to a whistling noise or even sudden hearing loss.

In order to avoid the possible consequences of a misaligned jaw, it is important to consult a doctor immediately if symptoms arise. He can find out the causes and create a suitable therapy plan.

You might also be interested in: Ringing in the ears - causes, symptoms & treatment