“I just want straight teeth, I don’t care about my bite.” But why you should.
I often hear patients, friends, and acquaintances say something like “I just want straight teeth—I don’t care about my bite.” This isn’t at all surprising. Frankly, without my specific education, I would very likely feel the same way (and I did for a time back when I was an adolescent orthodontic patient—remember, even your orthodontist has probably had treatment and can relate with you as a patient!). The reality is that the primary motivating desire of most patients who seek treatment is to have their teeth straightened and get a stellar smile—which is a perfectly good reason to seek treatment—and few patients have significant concerns about their bite. This actually makes a lot of sense, especially considering that these people have adapted to their improper bite relationships and have never known anything else—there is no other reference. “We must taste the bitter before we can appreciate the sweet,” as it has been said, and vice versa. Yes, we all want orthodontic treatment for a beautiful smile, and this is a valid reason to seek care, but your orthodontist also cares very much about your bite relationships. Straightening teeth is actually the second most important thing an orthodontist does; correcting your bite is the first. So, if you are one of those thinking—“I just want straight teeth—I don’t care about my bite,” let me tell you why your orthodontist cares, and why you should care, too.
How a Good Bite can Improve Your Quality of Life
Nobody is better at straightening teeth and providing your best smile than an orthodontist—that is an integral component of our very specific specialty—but it is the icing on the cake. Actually, the most important thing an orthodontist can do for you is provide healthy, stable bite relationships that can last a lifetime with beautiful, straight teeth, too. If having a functional a bite is most important, would an orthodontist correct your bite, but perhaps neglect the “straightening part”—the part you are probably most concerned about? Never. In fact, the teeth must be excellently aligned for an excellent bite relationship to exist; in other words, you can’t achieve a good bite without excellent tooth alignment (the “straightening part”). If they were not straightened, then the bite would be awkward. So, achieving a great bite also means you will have well-aligned teeth because ideal orthodontics requires straight teeth and proper bite relationships; but teeth can be straightened without addressing the bite, and that is not ideal orthodontics. Achieving an ideal bite may provide many benefits: better facial balance and attractiveness with more balanced jaw positions and/or lip positions, increasing size of the airway (by widening the upper jaw or stimulating growth of the lower jaw), protection of the teeth from damaging wear and tear, etc.
Understanding Bite Relationships and How this Matters to You
Dental occlusion, often commonly referred to as a person’s “bite,” refers to the relationships between the upper and lower teeth when the mouth is closed. In other words, occlusion describes how the teeth fit together. Malocclusion refers to incorrect bite relationships and/or irregular alignment of the teeth (spacing, crowding, etc.). Malocclusion occurs in at least 70% of the population.1 Although the majority of the population experience malocclusion, it is not “normal.” Studies have shown that today’s prevalence of malocclusion is significantly higher than it was only several hundred years ago, although the reasons for the increased prevalence are not entirely clear (scholars have suggested it may have to do with softer modern diets, requiring less jaw and muscle function to chew).1
There are four classifications of dental occlusion:
- Class I
- Class II
- Class III
To simplify, it helps to categorize these into two larger groups, each with two subcategories:
- Normal jaw relationships (skeletal harmony/proportionate jaws)
a. Normal: ideal alignment of the teeth and ideal bite/jaw relationships. No orthodontic treatment is required. However, based on epidemiological research,1 fewer than 30% of people have “Normal” occlusion; therefore, “Normal” occlusion may be better classified as “Ideal,” because it is relatively uncommon.
b. Class I malocclusion: Normal jaw relationships, but with irregular alignment of the teeth and other bite problems.
2. Abnormal jaw relationships (skeletal disharmony/disproportionate jaws)
a. Class II malocclusion: Abnormal jaw relationships with improper bite relationships; often due to a relatively small lower jaw/chin, the lower teeth are positioned too far back relative to the upper teeth, resulting in what is commonly called excess “overbite.” This type of malocclusion usually results in the appearance of protruding upper front teeth with excess “overjet” (when biting down, excess space between the upper and lower front teeth) and “deep overbite” (when biting down, the upper front teeth overlap the lower teeth too much vertically, hiding the lower front teeth).
b. Class III malocclusion: Abnormal jaw relationships with improper bite relationships; often due to a relatively large lower jaw/chin, the lower teeth are positioned too far forward relative to the upper teeth, sometimes (but not always) resulting in an “underbite” (when biting down, the lower front teeth are ahead of the upper front teeth).
Why Should I Be Concerned About Malocclusion?
Malocclusions can cause three types of problems for the individual: (1) Esthetic/psychosocial, (2) functional, and (3) injury/pathology.1
(1) Esthetic/Psychosocial problems:
At all social levels and in all age groups, well-aligned teeth and an attractive smile confer a positive status, whereas teeth that are irregularly aligned or protruding are associated with a negative status.1 Obviously, appearance plays an important role in the formation of romantic relationships. However, scientific studies have also shown that appearance significantly affects multiple elements that contribute to quality of life, including:
- How schoolteachers think about and treat students (and consequently, how well students progress in school).1,2
- Evidence strongly supports that teachers have higher expectations for students whom they judge as attractive, and they may be more likely to offer support to these students (more interaction, praise, encouragement, presentation of special material, more eye contact and smiling,s etc.).2 And, decades of research have demonstrated the powerful effect of high teacher expectations on individual student performance.2
- People with “ideal dental esthetics were, on average, evaluated as superior with respect to intelligence and likelihood of being hired than were the photographs of the same subjects with non–ideal dental esthetics.”3
- “Attractive individuals fare better than their less attractive counterparts with regard to perceived job qualifications, hiring decisions, predicted job success, and compensation. Both men and women are subject to these biases, and the magnitude of effects is sizeable.”2 (pp. 97)
- Dental attractiveness is associated with greater self-esteem and social status. For prospective patients, orthodontic treatment is associated with an expectation for improved social and psychological well-being.1
(2) Functional problems:
Malocclusion has the potential to cause problems with chewing, swallowing, and speech.1 Additionally, some malocclusions have been associated with pain and dysfunction in and around the temporomandibular joints (the TMJs), although this is rare.4,5 Furthermore, malocclusion has the potential to damage the periodontal tissues (the gums and bone surrounding the teeth) and the teeth themselves (awkward or traumatic fit of the teeth can lead to destructive wear and deterioration of the teeth).
Protruding upper incisors (sometimes called “buck teeth,” in lay terms) are at risk for injury; 6 in fact, the risk of trauma to the upper incisors is as high as one in three in children with untreated incisor protrusion.1 Teeth that are crowded and poorly aligned can complicate hygiene, potentially increasing the risk for some individuals to develop dental disease (i.e., cavities and gum disease); however, regardless of tooth position and bite relationships, an individual’s oral hygiene habits are a much better determinant of the development of oral disease.1
The Bottom Line
Malocclusion, or improper tooth/bite relationships, can significantly affect your quality of life. Investing in orthodontic treatment to achieve a better bite and a more pleasing smile can pay dividends for a lifetime!
1. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. 4th ed. St. Louis, Mo.: Mosby Elsevier; 2007:751.
2. Nevin JB, Keim R (2005). Social Psychology of Facial Appearance. In Nanda, Biomechanics and Esthetic Strategies in Clinical Orthodontics (pp. 94-109). 1st ed. St. Louis, Mo.: Mosby Elsevier.
3. Pithon, Matheus Melo et al. “Do dental esthetics have any influence on finding a job?”
American Journal of Orthodontics and Dentofacial Orthopedics , Volume 146 , Issue 4 , 423 – 429.
4. Poveda Roda R, Bagan J, Díaz-Fernández J, Hernández-Bazán S, Jiménez-Soriano Y. Review of temporomandibular joint pathology. part I: Classification, epidemiology and risk factors. Medicina oral, patología oral y cirugía bucal. 2007;12(4):E292-E298.
5. McNamara JA, Seligman DA, Okeson JP. Occlusion, orthodontic treatment, and temporomandibular disorders: A review. J Orofac Pain. 1995;9(1):73-90.
6. Bastone, E B, T J JFreer, and J R RMcNamara. “Epidemiology of dental trauma: a review of the literature.” Australian Dental Journal 45.1 (2000):2-9.