Open Bite

An open bite is usually described as vertical gap between the biting edges of the front teeth or the chewing surfaces of the back teeth. Open bites are often associated with jaw growth problems, but they are always associated with forward tongue position. Sometimes they are associated with thumb and finger habits.

It is normal for babies and very young children to suck fingers and pacifiers. It provides comfort and security. Most children stop sucking on fingers or pacifiers between two and four years of age and no harm is done to their teeth or jaws. If a child continues sucking beyond this age it may cause the upper front teeth to tip forward, the lower front teeth to tip back and the upper jaw to narrow. These changes in the teeth and jaws will cause abnormal tongue and lip function and development.

If sucking persists beyond four years of age, the child should be encouraged to stop the habit. A visit to the dentist or orthodontist can be a helpful way to explain why sucking is bad for the teeth and jaws. Once the child is interested in stopping, a stepwise approach is used until the habit is stopped. For very persistent habits, a special appliance may be needed. Soon after the sucking stops, the problems caused by it may begin to correct themselves. Depending on the child’s age and other conditions present, additional orthodontic treatment may be needed.

Forward tongue posture or “tongue thrust” is seen in open bite patients with or without thumb/finger habits. This too is normal in infants and is usually outgrown. Beyond this time, it can cause undesirable changes in the bite similar to those seen in thumbsuckers. In young children (8-10), forward tongue posture can be predictably corrected with appliance therapy. Myofunctional therapy, a behavioral approach to retraining the tongue, can be an extremely valuable adjunct to appliance therapy.

Posterior open bites are less common. When they do occur, they are often associated with baby molars that are ankylosed or fused to the bone. This becomes an even bigger issue when the permanent second premolars are missing. Posterior open bites are also associated with lateral tongue thrusts.

In patients with severe anterior “skeletal” open bite, orthodontics combined with jaw surgery may be the best treatment. A complete four dimensional evaluation is critical, since growth changes must be considered.

For patients with an open bite, early evaluation is critical in order to achieve the best results with the most conservative treatment.

Dr. Frank R. Egan

www.TeethOnTheMove.com