Front teeth can protrude for various reasons including: crowding, narrow arch form, loss of bone support, bite dynamics, and others. The example below shows how reshaping and slenderizing the front teeth for an adult patient allowed them to be drawn back into a better functional and cosmetic position.

There are several types of crossbites. They can be caused by teeth erupting (growing) into the wrong position, by the bone structure being improperly shaped or sized, or a combination of these factors. Upper posterior (back) teeth are in crossbite if they erupt and function inside or outside of the arch of the lower posterior teeth. Lower anterior (front) teeth are in crossbite if they erupt and function in front of the upper anterior teeth (also called an underbite). A crossbite can be individual teeth or groups of teeth. Crossbites in young persons can cause the jaw bones to grow in a lopsided manner, and in all ages can lead to uneven and accelerated tooth wear. It can even cause damage to the teeth’s gum and bone support. Examples of single tooth crossbite correction with a removable appliance and correction of a posterior crossbite with a fixed (glued in place) appliance are show below.

Straightening crowded teeth requires creating enough room to be able to align them. The two basic methods for achieving this goal are expansion (broadening the bone that houses the teeth) and extraction (having fewer teeth in the existing bone structure). Before and after examples of these two approaches are shown below:

Some children as early as 5 or 6 years of age may benefit from an orthodontic evaluation. Although treatment is unusual at this early age, some preventative treatment may be indicated. By age 7, most children have a mix of baby (primary) and adult (permanent) teeth. Some common orthodontic problems seen in children can be traced to genetics, that is they may be inherited from their parents. Children may experience dental crowding, too much space between teeth, protruding teeth, extra or missing teeth, and sometimes jaw growth problems. Other malocclusions (literally, “bad bite”) are acquired. In other words, they develop over time. They can be caused by thumb or finger-sucking, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, the early or late loss of baby teeth, accidents or poor nutrition. Trauma and other medical conditions such as birth defects may contribute to orthodontic problems as well. Sometimes an inherited malocclusion is complicated by an acquired problem. Whatever the cause, the orthodontist is usually able to treat most conditions successfully.

Orthodontists are trained to spot subtle problems with jaw growth and emerging teeth while some baby teeth are still present. The advantage for patients of early detection of orthodontic problems is that some problems may be easier to correct if they are found and treated early. Waiting until all the permanent teeth have come in, or until facial growth is nearly complete, may make correction of some problems more difficult. For these reasons, the AAO recommends that all children get a check-up with an orthodontist no later than age 7. While your child’s teeth may appear straight to you, there could be a problem that only an orthodontist can detect. Of course, the check-up may reveal that your child’s bite is fine, and that is comforting news. Even if a problem is detected, chances are your orthodontist will take a “wait-and-see” approach, checking your child from time to time as the permanent teeth come in and the jaws and face continue to grow. For each patient who needs treatment, there is an ideal time for it to begin in order to achieve the best results. The orthodontist has the expertise to determine when the treatment time is right. The orthodontist’s goal is to provide each patient with the most appropriate treatment at the most appropriate time. In some cases, your orthodontist might find a problem that can benefit from early treatment. Early treatment may prevent more serious problems from developing and may make treatment at a later age shorter and less complicated. For those patients who have clear indications for early orthodontic intervention, early treatment gives your orthodontist the chance to: Guide jaw growth Lower the risk of trauma to protruded front teeth Correct harmful oral habits Improve appearance and self-esteem Guide permanent teeth into a more favorable position Improve the way lips meet It’s not always easy for parents to tell if their child has an orthodontic problem. Here are some signs or habits that may indicate the need for an orthodontic examination: Early or late loss of baby teeth Difficulty in chewing or biting Mouth breathing Thumb sucking Finger sucking Crowding, misplaced or blocked out teeth Jaws that shift or make sounds Biting the cheek or roof of the mouth Teeth that meet abnormally or not at all Jaws and teeth that are out of proportion to the rest of the face If any of these problems are noted by parents, regardless of age, it is advisable to consult an orthodontist. It is not necessary to wait until age 7 for an orthodontic check-up.

Congenitally Missing Teeth: A genetic occurrence in which the expected number of permanent teeth do not develop. Orthodontic treatment can be helpful in arranging the existing teeth to either close the space left behind by a missing tooth or to arrange the neighboring teeth into a position where replacement teeth can be placed with implants or bridges by your family dentist. The example below shows the teeth before orthodontics, after orthodontics with implants in place, and the final cosmetic result.

When the upper dental arch is narrow, the teeth can be crowded and meet the lower teeth in a crossbite relationship. Since the upper jawbone is made of two bones, a right side and a left side maxillary bone, it can be widened with an expansion appliance called a rapid palatal expander (RPE). The RPE is temporarily cemented in place, and activated over a four to six week period. During the next several months the bone is allowed to firm up in it’s new position before the expander is removed. Braces can be added while the RPE is in place.

An open bite is a malocclusion (bad bite) in which teeth do not make contact with each other. With an anterior open bite, the front teeth do not touch when the back teeth are closed together. With a posterior open bite, the back teeth do not touch when the front teeth are closed together.

A deep overbite describes a condition where the lower front teeth bite in high above the upper incisors, sometimes into the gum on the roof of the mouth. This type of bite can cause accelerated tooth wear, receding gums, and jaw joint problems. For many people with this kind of bite, the upper incisor teeth tip down and backwards.

A large overjet (or horizontal overbite) describes a condition where the upper and lower front teeth have a large separation in the front to back direction. This can come from upper front teeth protruding forward (see the first example below), from the lower front teeth being set back or a combination of both (see the second example below).

Space Maintainer: A fixed appliance used to hold space for an unerupted permanent tooth after a primary (baby) tooth has been lost prematurely, due to accident or decay, or to hold room for permanent teeth to drift into a better position.

When large spaces between anterior (front) teeth are a cosmetic concern for people, orthodontic treatment to move the teeth together is the best treatment option. Occasionally, the frenum or cord of tissue that runs from the lip to the gum near the front teeth needs to be clipped to help keep the space from opening after treatment.