Short answer: An open bite is when some upper and lower teeth do not touch and a vertical gap remains between them when the jaw is closed. It is most often seen in the front teeth. The cause may be a habit, jaw development or a combination of the two; treatment is planned according to the cause.
How can you recognise an open bite?
- When you close your teeth, there is enough of a gap between the front teeth for the tongue or lip to be seen.
- The front teeth have difficulty cutting food when biting.
- There may be a lisp on sounds such as “s” and “z”.
- The side teeth take on the heavy chewing load alone.
Why does it occur?
- Thumb or pacifier sucking: A long-lasting habit can prevent the vertical development of the front teeth.
- Tongue thrust: The tongue pressing on the front teeth while swallowing can maintain the gap. For details, see our article on the tongue thrust habit.
- Mouth breathing: An open-mouth posture and tongue position can affect jaw development in the vertical direction. We covered this topic in our article on airway and orthodontics.
- Jaw growth direction: In people whose lower jaw grows by rotating downward and backward, a skeletal open bite may be seen.
- Genetic predisposition and tooth eruption problems
Dental and skeletal open bite
Open bite is divided into two main groups. In the dental type, the problem lies mostly in the position of the teeth and is related to a habit. In the skeletal type, the growth direction of the jaws relative to each other also plays a role. To tell them apart, the clinical examination, intraoral images and the side-view cephalometric X-ray are assessed together.
Treatment options
In children
- Support and motivation to give up the habit
- Habit-breaking appliances such as a tongue crib
- Tongue and swallowing exercises
- If considered necessary, appliances that control the vertical development of the side teeth
In adults
- Adjusting the vertical position of the front teeth with braces or clear aligners
- Orthodontic elastics
- Controlling the side teeth with mini-screw support
- Orthognathic surgery in pronounced skeletal cases
For general information, you can also look at our page on open bite treatment.
Why is care needed after treatment?
Open bite is a problem that can relapse if the habit that caused it continues. For this reason, it is important to wear a retainer for the period the clinician recommends and, if needed, to continue the tongue exercises.
How can an open bite affect daily life?
- Speech: Because the tongue sits between the teeth, the production of some sounds may change.
- Chewing: Because the front teeth do not touch, cutting food can become difficult; the load falls on the back teeth.
- Swallowing: The tongue pressing on the front teeth can contribute to the gap persisting.
- Appearance: Difficulty closing the lips or an open-mouth posture may be seen.
Not all of these signs are seen in every person; their severity varies with the size and cause of the opening.
When should you take action in childhood?
If thumb or pacifier sucking continues beyond the age of three to four, it is useful to talk to a paediatric dentist or an orthodontist. If the habit is given up in time, in some children the position of the front teeth can recover by itself. If the habit continues, the teeth and the palate structure may be affected. For what can be done in the early period, see our page on early orthodontic treatment.
What does the clinician look at when planning treatment?
- Whether the opening is limited to the front teeth or the side teeth
- The growth direction of the lower jaw and the height of the face
- The pattern of the tongue, lips and swallowing
- Nasal breathing and the state of the airway
- The person’s age and treatment expectations
At the end of this assessment, a decision is made on whether correcting the teeth alone will be enough and whether supporting exercises or jaw surgery are needed. The duration of treatment varies from case to case.
Tongue exercises and habit therapy
In people with a tongue thrust habit, correcting the teeth alone may not be enough. Exercises aimed at regulating the resting position of the tongue, the swallowing pattern and the function of the lip muscles can support treatment. When these exercises should begin and how they should be done is decided together with the clinician or, if necessary, a speech and language therapist. The exercises are meaningful only when used together with orthodontic treatment; on their own they may not be sufficient in every case.
When helping children give up a habit, a reward-and-support approach often gives better results than punishment or pressure. The attitude of the family can be decisive in the treatment process.
Frequently asked questions
Does an open bite close by itself?
If thumb sucking is given up at an early age, improvement may be seen in some children during the baby-tooth and mixed dentition periods. Skeletal cases generally do not close by themselves.
Can an open bite be treated in adults?
Yes, there are treatment options, although the method is different. The choice is made by the clinician according to the state of the teeth and jaws and the person’s expectations.
Can clear aligners be used for an open bite?
They can be used in suitable cases. They are considered especially for dental and moderate cases; in skeletal cases, additional methods may be needed.
How can you find out what suits you?
The information here is general; the right plan for you is determined by examination and clinical assessment. At our clinic in Oran, Çankaya, Ankara, we go through your questions together during the first orthodontic examination.
