Malocclusion in children: what are the different types and how can it be treated?

Malocclusion is the medical term for crooked teeth with or without misaligned jaws. It typically begins in childhood and if not treated, can result in complications such as tooth wear, speech problems and self-confidence issues later on in life.

In this article, Dr Moira Wong, one of our top orthodontists based in London, explains the causes of malocclusion, the various types and how long it typically takes to fix.

What causes malocclusion?

Malocclusion is usually caused by a combination of genetic and environmental factors. It can be an inherited condition but also be associated with the way we speak, eat, or the habits we develop such as nail-biting and thumb-sucking when we are children. In addition, many believe that it can be caused by prolonged use of a bottle or dummy in early childhood.

There are many other environmental causes such as jaw injuries, and it has even been seen to develop in some people who have had a habit of chewing the end of their pen in the same position for many years.

Can malocclusion be prevented?

The genetic components of malocclusion can’t be prevented however, we can use genetics to predict how a child is going to develop by looking at the parents. This helps guide us on how the child’s jaw and teeth are going to grow and then we can apply the appropriate treatment.

The environmental aspect can be prevented though. For example, if the child’s habit is contributing to malocclusion, and they are below 9 years old, then stopping these habits can result in a spontaneous improvement. Generally with these habits, the earlier they stop the less they contribute to the malocclusion.

How long does it take to fix a malocclusion?

The main goal is to straighten and improve the look of the child’s teeth. This may include the use of mouth appliances, such as retainers or braces and sometimes surgery. Very rarely tooth removal is used. The treatment is typically done in two phases:

  • Phase 1 orthodontic treatment – at around eight years old, if their malocclusion is affecting the front teeth, then phase 1 orthodontic treatment can be carried out to reduce the complexity of treatment needed later on in life. For example, if crowding is identified in adulthood, it’s possible to carry out a procedure to create space, but without having to remove any teeth. Normally, phase 1 orthodontic treatment takes around 9-12 months.
  • Phase 2 orthodontic treatment – phase two is carried out when all adult teeth have come through, usually at the age of 12-13 years. The goal of phase two treatment is to ensure the teeth are in the right places for a healthy bite, good function and an overall pleasing appearance. This usually takes between 18-24 months.

What are the different types of malocclusion?

Cases of misaligned teeth are not all the same and we categorise them into three distinct types:

  • Class 1 malocclusion – This is when there is no deformity in jaws but the teeth are overcrowded
  • Class 2 malocclusion – When the lower jaw hasn’t grown as well as the upper jaw resulting in a larger distance between the upper and lower teeth
  • Class 3 malocclusion – There has been increased growth in the lower jaw relative to the upper jaw, resulting in a prominent lower jaw and the upper teeth fitting behind the lower teeth. This is known commonly as an underbite.

It’s important to note that asymmetries of the jaw can occur in any three classes of malocclusion.

Can malocclusion cause speech problems?

Yes, it can. I work together with a speech therapist to offer the best treatment and results for my patients. Each case of malocclusion is so distinct that the treatment has to be very personalised – there is no one-size-fits-all treatment for this condition. Therefore, it’s important to approach the problem as a team.

Can I get my child’s malocclusion fixed during the COVID-19 pandemic?

At the moment, routine appointments have been cancelled and children who are currently in treatment have been wearing their braces without having any adjustments done. This means their treatment has now been prolonged for three months.

As we can now reopen, we are starting to be able to see our patients more frequently. We are equipped with the highest level of PPE in order to protect both our patients and staff. Social distancing is practiced and a new system is in place to screen all staff and patients upon arrival to the clinic.

However, we are still offering video consultations which we can use to start the process of treating your child’s malocclusion if you are abroad at present or would prefer to be seen remotely.

If you believe your child has a form of malocclusion, don’t hesitate to book an appointment with Dr Moira Wong by going to her Top Doctors profile and checking her availability.