Orthodontics is a dental practice that deals with the diagnosis, prevention and correction of oral malocclusion. A malocclusion is the abnormal alignment of teeth, jaw and/or a bad bite. It can develop when and the upper and lower teeth do not fit together normally. This misalignment of teeth and jaw and can lead to oral health problems if not treated.

An orthodontist is a dental specialist who works to prevent or correct misaligned teeth and jaws, which are called malocclusions or faulty occlusions. A person may seek this specialist’s services for cosmetic reasons as well as health reasons. Beside the insecurity and low self esteem that dental irregularities may cause, they can also affect a person’s ability to chew and speak. Severely misaligned teeth and jaws can cause snoring, sleep apnea, and other breathing problems. An orthodontist is also instrumental in correcting the teeth and jaws in babies born with cleft lips or cleft palates.

Causes of Malocclusion

Most cases of malocclusion are hereditary. However, certain habits that alter the alignment between the teeth and jaw can also contribute to malocclusion. Some causes include:

  • frequent use of a pacifier past infancy
  • prolonged bottle feeding
  • early childhood thumb sucking
  • oral injuries
  • impacted / crowded teeth
  • poor dental hygiene
  • airway obstruction
  • mouth tumors
  • enlarged adenoids and tonsils
  • cleft lip / cleft palate


There are four classifications of malocclusion and depending on the class level; the symptoms can range from mild to severe and can include:

  • misalignment or crowding of the teeth
  • oral discomfort when eating
  • speech impediment
  • biting of the tongue or cheek
  • changes in facial appearance
  • mouth breathing

Diagnosing and Classifying Malocclusions 

Oral malocclusion can be diagnosed through a routine dental exam along with X-rays.  The dentist can determine if your teeth and jaw are aligned properly. If malocclusion is discovered, it will be classified by the type and severity.

Conditions We Treated

Upper Protrusion / Overjet


Spacing and Teeth Crowding



Open Bite

Misplaced Midline

Cross Bite

Cross Bite

A cross bite occurs when any or all of the upper teeth fit into the wrong side of the lower teeth.

Misplaced Midline

In people who have a misplaced midline, the front center line between the upper front teeth doesn’t match up with the center line of the lower front teeth.

Open Bite

Although the molars fit together in a person who has an open bite, the upper and lower front teeth don’t overlap. This creates an opening straight into the mouth. An open bite can also be present on one or both sides of the mouth.


In a person who has an excessive overbite, the upper front teeth reach too far down over the lower front teeth and, in severe cases, can cause the lower teeth to bite into the roof of the mouth.


Rotation is present when a tooth turns or tips out of its normal position.

Spacing and Teeth Crowding

Too much or too little room for the teeth can cause spacing or crowding problems. Crowding can prevent permanent teeth from coming in properly or at all (impaction).


Transposition occurs when teeth grow (erupt) in one another’s place.


An underbite is present when the lower front teeth are farther forward than the upper front teeth.

Upper Protrusion / Overjet

In an upper protrusion, the upper front teeth are pushed outward (buck teeth). A small lower jaw may be the cause. Pacifier use or thumb-sucking can also create this condition by pushing the teeth outward, sometimes causing the roof of the mouth to change shape (upper palate).

There are three classifications of malocclusion. They include:

Class 1

Class 1 malocclusion is diagnosed when the upper teeth overlap the lower teeth. In this type of malocclusion, the bite is normal and the overlap is slight. Class 1 malocclusion is the most common classification of malocclusion.

Class 1: Neutrocclusion

Malocclusion class 1 is the most common classification of malocclusion. It occurs when the upper teeth overlap the lower teeth. The bite is normal and the overlap is minimal.

Here the molar relationship of the occlusion is normal or as described for the maxillary first molar, but the other teeth have problems like spacing, crowding, over or under eruption, etc.

Class 2

Malocclusion class 2 is when the upper teeth and jaw significantly overlap the lower jaw and teeth. This presence of a sever overbite, also known as retrognathism detected when a severe overbite is present. This condition, known as  (or retrognathia), means

Distocclusion (retrognathismoverjet, overbite)

In this situation, the mesiobuccal cusp of the upper first molar is not aligned with the mesiobuccal groove of the lower first molar. Instead it is anterior to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars.

There are two subtypes:

Class II Division 1: The molar relationships are like that of Class II and the anterior teeth are protruded.

 Class II Division 2: The molar relationships are Class II but the central are retroclined and the lateral teeth are seen overlapping the centrals.

 Class 3

Class 3 malocclusion is also diagnosed when there’s a severe underbite. This condition, known as prognathism, means that the lower jaw protrudes forward. This causes the lower teeth to overlap the upper teeth and jaw.

Class 3 malocclusion is also diagnosed when there’s a severe underbite. This condition, known as prognathism, means that the lower jaw protrudes forward. This causes the lower teeth to overlap the upper teeth and jaw.

Mesiocclusion (prognathismnegative overjet, underbite) In this case the upper molars are placed not in the mesiobuccal groove but posteriorly to it. The mesiobuccal cusp of the maxillary first molar lies posteriorly to the mesiobuccal groove of the mandibular first molar. Usually seen as when the lower front teeth are more prominent than the upper front teeth. In this case the patient very often has a large mandible or a short maxillary bone.

How Can Malocclusion Be Prevented?

Preventing the disorder can be difficult because most cases of malocclusion are hereditary. Parents of young children should limit pacifier and bottle use to help reduce changes in the development of the jaw. Early detection of malocclusion may help cut down on the length (and severity) of the treatment needed to correct the problem.

The treatment of malocclusion of teeth in children and adults typically results in correction of the problem. Early treatment in childhood will reduce the duration of treatment, and also make it less expensive.

Adults can also get good results. However, treatment for adults will generally take longer and will be more expensive. The earlier you treat malocclusion, the better the outcome.


Orthodontic Treatments  

Orthodontics is recommended when there is a need to enhance the orofacial appearance. When it comes to orthodontic treatments, there are many non-surgical orthodontic options available including braces, retainers, removable appliances and orthodontic aligners. Treatment can be beneficial and prevent future problems such as premature tooth loss, plaque buildup and jaw problems. The kind of orthodontic treatment you need depends on the oral diagnostic to achieve a balanced, aesthetic result. Our dental experts will recommend a treatment based on the severity of your bite, the degree of dental misalignment and your desired results. Below are some of the orthodontic treatment options offered at Sedation and Implant Dentistry Irvine.

Fixed Orthodontic Correction

There are several permanent orthodontic treatments available to straighten and align the teeth and mouth including traditional, ceramic and lingual braces. A bad bite, called a malocclusion, is often treated with braces. Braces are also used to treat a crossbite, overjet and open bite issues.

  • Traditional Metal 
    The most common type of braces is the traditional braces which consist of standard metal brackets. Through the years they have become much smoother and more comfortable. With metal braces, you have the option of adding colored elastic bands to make the braces dazzling and colorful.
  • Ceramic Braces
    Ceramic braces are less visible than metallic braces and look good. These appear more natural than the traditional metal braces.
  • Lingual Braces
    These are much like traditional metal braces but the difference is that the wires and brackets are placed on the inside of the teeth.
  • Clear Braces
    Not all braces brackets have to be metal. If you want your braces to be less obvious, clear braces may be for you. Clear braces function in the same way as traditional braces, but the brackets are made with translucent materials.

Removable Orthodontic Correction
Detachable aligners are available and often the preferred orthodontic treatment to straighten teeth. These aligners include clear removable and retainers. These retainers and trays are comfortable and removable and look the most natural.

    • Invisible Aligners
      Clear aligners are a set of removable trays that are custom fitted to your teeth and appear invisible. Each new set of clear aligners applies a slight adjustment to your teeth. The aligners are very comfortable, because they’re made with a pliable material and fit snuggly to your teeth. These aligners are removable and look the most natural.
      • Healthy Start for Young Children
        To create a healthy smile, a child’s teeth need to be straight and their jaws need to be aligned properly. That’s why it’s a good idea to have a dentist examine your child while they still have their baby teeth. By age seven, enough permanent teeth have emerged to evaluate relationships developing between the teeth, the jaw, and bite patterns for your child’s dentist to make sure everything in the mouth will continue to develop as it should. If early preventative treatment is deemed necessary, it will occur in two phases. Early treatment will help prevent greater oral issues later, and thus more invasive orthodontic procedures when the child gets older. A little early prevention and intervention makes orthodontic work as a teenager much more comfortable and successful.

Orthodontics (Braces)

Braces can correct crooked or misaligned teeth, and can improve the health and appearance of anyone’s smile — adult or child. Braces work by applying steady pressure over time to slowly move teeth into alignment. As the teeth move, the bony tooth socket changes shape as pressure is applied.

Types of Braces

While metal braces are still used, braces can be as inconspicuous as you like. Brackets — the part that attach to each tooth — can be clear, tooth-colored, or multi-colored. There are even “invisible” braces which use a series of clear, plastic molds to gradually move the teeth into alignment.

Treatment plans will vary depending on the type of malocclusion. Various treatments are available and can include:

      • braces to correct the position of the teeth
      • removal of teeth to correct overcrowding
      • reshaping, bonding, or capping of teeth
      • surgery to reshape or shorten the jaw
      • wires or plates to stabilize the jaw bone

Treatment for the disorder may also result in some complications. These include:

      • tooth decay
      • pain or discomfort
      • irritation of the mouth from the use of appliances, such as braces
      • difficulty chewing or speaking during treatment


In their entirety, braces work by applying continuous pressure over a period of time to slowly move teeth in a specific direction. As the teeth move, the bone changes shape as pressure is applied.

Braces are made up of the following components:

      • Brackets are the small squares that are bonded directly to the front of each tooth with a special dental bonding agent or are attached to orthodontic bands. Brackets act like handles, holding the arch wires that move the teeth. There are several types of brackets, including stainless steel and tooth-colored ceramic or plastic, which are often selected because they’re less obvious. Occasionally, brackets are cemented to the back of teeth, in order to hide them from view.
      • Orthodontic bands are stainless steel, clear, or tooth-colored materials that are cemented to the teeth with dental bonding agents. They wrap around each tooth to provide an anchor for the brackets. The clear or tooth-colored bands are more cosmetically appealing options but are more expensive than stainless steel. They are not used in all patients. Some people have only brackets and no bands.
      • Spacers are separators that fit between teeth to create a small space prior to placement of orthodontic bands.
      • Arch wires attach to the brackets and act as tracks to guide the movement of the teeth. Arch wires can be made of metal or be clear or tooth-colored.
      • Ties are small rubber rings or fine wires that fasten the arch wire to the brackets. They can be clear, metal, or colored.
      • A buccal tube on the band of the last tooth holds the end of the arch wire securely in place.
      • Tiny elastic rubber bands, called ligatures, hold the arch wires to the brackets.
      • Springs may be placed on the arch wires between brackets to push, pull, open, or close the spaces between teeth.
      • Two bands on the upper teeth may have headgear tubes on them to hold the facebow of the headgear in place. (A headgear is another tool used by orthodontists to aid in correcting irregularities of the teeth; see below)
      • Elastics or rubber bands attach to hooks on brackets and are worn between the upper and lower teeth in various ways. They apply pressure to move the upper teeth against the lower teeth to achieve a perfect fit of individual teeth.
      • Facebow headgear is the wire gadget that is used to move the upper molars back in the mouth to correct bite discrepancies and also to create room for crowded teeth. The facebow consists of an inner metal part shaped like a horseshoe that goes in the mouth, attaching to buccal tubes, and an outer part that goes around the outside of the face and is connected to a headgear strap.

Newer “mini-braces,” which are much smaller than traditional braces, may be an option for some. There is another method of straightening teeth that uses removable plastic retainers that may also work when crowding of the teeth is not too severe. Your orthodontist will discuss the various types of braces with you and determine which might be the best option for your situation.

Questions and Answers

What causes orthodontic problems?

Most orthodontic problems (malocclusions) are inherited. Examples of these genetic problems are crowding, spacing, protrusion, extra or missing teeth, and some jaw growth problems. Other malocclusions are acquired as a result of thumb- or finger sucking, dental disease, accidents, the early or late loss of baby (primary) teeth, or other causes.

Why is treatment so important?

Orthodontic treatment creates a better bite, making teeth fit better, and decreases the risk of future, and potentially costly dental problems. Crooked and crowded teeth are hard to clean and maintain. A malocclusion can cause tooth enamel to wear abnormally, difficulty in chewing and/or speaking, and excess stress on supporting bone and gum tissue. Without treatment, many problems simply become worse.

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