What Is an Open Bite?
An open bite occurs when the upper and lower teeth fail to make contact in one or more areas when the jaw is fully closed. The most recognizable form is an anterior open bite, where the front teeth leave a visible gap even when the back teeth are biting together. This makes it difficult to bite into foods like sandwiches or apples.
A posterior open bite is less common. In this type, the front teeth touch normally but the back teeth do not meet. This can affect chewing efficiency and place extra stress on the teeth that do make contact.
Anterior Open Bite vs. Posterior Open Bite
Anterior open bite affects the front teeth and is the type most patients and parents notice first. It can cause difficulty biting food, lisping or other speech changes, and mouth breathing. It is also the type most strongly linked to childhood habits like thumb sucking.
Posterior open bite affects the back teeth and is more often related to skeletal growth issues or abnormal eruption patterns. Because the back teeth bear most of the chewing force, a posterior open bite can cause uneven wear on the front teeth that are forced to do extra work.
What Causes an Open Bite?
Open bites develop from a combination of habits, skeletal growth patterns, and functional issues. Understanding the cause is critical because it determines which treatment will be most effective and most stable long term.
Thumb Sucking and Pacifier Use
Prolonged thumb sucking, finger sucking, or pacifier use past age 3 to 4 is the most common cause of anterior open bite in children. The constant pressure of the thumb or pacifier pushes the front teeth outward and prevents them from erupting into normal position. If the habit stops early enough, the bite may self-correct. If it continues past age 5 or 6, orthodontic treatment is usually needed.
Tongue Thrust
Tongue thrust is a swallowing pattern where the tongue pushes forward against or between the front teeth instead of pressing against the roof of the mouth. This repeated force can create or maintain an open bite even after thumb sucking has stopped. Tongue thrust is sometimes called an orofacial myofunctional disorder, and correcting it may require exercises (myofunctional therapy) in addition to orthodontic treatment.
Skeletal Growth Patterns
Some open bites are caused by the way the jaw bones grow rather than by habits. When the lower jaw grows in a downward and backward direction (a long face growth pattern), the back teeth may erupt more than normal while the front teeth cannot reach each other. These skeletal open bites tend to be more severe and harder to correct with braces alone. Adults with skeletal open bites may need orthognathic (jaw) surgery for a stable result.
TMJ Disorders and Other Factors
Temporomandibular joint (TMJ) conditions that cause the jaw joint to break down can lead to a progressive open bite in adults. Conditions like rheumatoid arthritis or idiopathic condylar resorption gradually change the shape of the joint, causing the bite to open over time. Airway issues, chronic mouth breathing, and certain genetic conditions can also contribute to open bite development.
Open Bite Treatment Options
The right treatment for an open bite depends on the patient's age, the underlying cause, and how severe the bite discrepancy is. Treatment plans often combine more than one approach.
Habit-Breaking Appliances (Children)
For children whose open bite is caused by thumb sucking or tongue thrust, a habit appliance can be effective. A tongue crib or palatal rake is a small wire device bonded behind the upper front teeth. It physically blocks the tongue or thumb from pressing against the teeth. These appliances are typically worn for 6 to 12 months and are most effective in children under age 10.
Braces for Open Bite Correction
Traditional braces are the most common treatment for moderate to severe open bites. The orthodontist uses brackets and wires to intrude (push down) the back teeth and allow the front teeth to come together. Temporary anchorage devices (TADs), which are small screws placed in the jawbone, give the orthodontist extra control for moving teeth in directions that braces alone cannot achieve. Treatment with braces typically takes 18 to 30 months for an open bite.
Clear Aligners for Mild Open Bites
Clear aligners can treat mild anterior open bites in compliant patients. They work best when the open bite is caused by a dental issue (tooth position) rather than a skeletal problem. Aligners are less predictable for open bite correction than braces because they have limited ability to intrude back teeth. Your orthodontist can evaluate whether aligners are a realistic option for your specific case.
Jaw Surgery for Severe Skeletal Open Bites
When the open bite is caused by a skeletal discrepancy, orthodontics alone may not produce a stable correction. Orthognathic surgery repositions one or both jaws to establish proper contact between the upper and lower teeth. Surgery is typically performed after growth is complete, around age 16 to 18 for females and 18 to 20 for males. Braces are usually worn before and after surgery, with the total treatment spanning 2 to 3 years.
Jaw surgery is performed by an oral and maxillofacial surgeon in a hospital setting under general anesthesia. The orthodontist and surgeon work together to plan the case. While surgery adds cost and recovery time, it provides the most predictable and stable results for skeletal open bites.
Open Bite Correction by Age
Age plays a significant role in treatment planning for open bite correction. The American Association of Orthodontists recommends that every child have an orthodontic screening by age 7, which is early enough to detect developing open bites.
Children (Ages 7 to 12)
Early treatment in children focuses on stopping the habit causing the open bite and guiding jaw growth. Habit appliances, palatal expanders, and limited braces (Phase 1 treatment) can correct or reduce an open bite while the child is still growing. Early intervention does not always prevent the need for full braces later, but it can reduce the severity and length of future treatment.
Teens (Ages 13 to 17)
Teenagers with remaining growth potential are good candidates for full braces with TADs. The orthodontist can take advantage of ongoing growth to help correct the bite. Most teen open bite cases are treated in 18 to 24 months. Retainer wear after treatment is especially important because open bites have a higher relapse rate than other types of malocclusion.
Adults
Adult open bite correction is more challenging because jaw growth is complete. Mild dental open bites can often be treated with braces and TADs. Moderate to severe skeletal open bites typically require jaw surgery for a stable result. Adults should also be evaluated for tongue thrust, since an untreated tongue habit will push the teeth back apart after orthodontic treatment.
Treatment Timeline and What to Expect
Open bite correction generally takes longer than treatment for simpler orthodontic issues like mild crowding. The timeline depends on the treatment approach and severity of the bite.
Braces for open bite correction typically require 18 to 30 months of active treatment. Clear aligner cases for mild open bites may take 12 to 18 months. Surgical cases involve 6 to 12 months of braces before surgery, the surgical procedure itself (with 2 to 6 weeks of recovery), and another 6 to 12 months of braces after surgery.
After active treatment, retainer wear is critical. Open bites are among the most relapse-prone orthodontic conditions. Most orthodontists prescribe a fixed (bonded) retainer behind the front teeth plus a removable retainer to be worn nightly. Patients who had tongue thrust may also need ongoing myofunctional therapy to retrain their swallowing pattern.
Open Bite Correction Cost
The cost of open bite correction varies based on the treatment approach, your location, and the complexity of your case.
Braces for open bite correction typically range from $3,000 to $7,000. Clear aligner treatment, when appropriate, falls in a similar range. If temporary anchorage devices (TADs) are needed, they may add $300 to $600 per screw to the total. Jaw surgery costs $20,000 to $40,000 or more, though medical insurance often covers a portion when the surgery is deemed medically necessary.
Many orthodontic offices offer monthly payment plans that spread the cost over the length of treatment. Dental insurance typically covers a portion of orthodontic treatment for children under 18, with lifetime maximums commonly ranging from $1,000 to $2,000. Coverage for adult orthodontics and jaw surgery varies by plan. Costs vary by location, provider, and case complexity.
When to See an Orthodontist for an Open Bite
A general dentist can identify an open bite during a routine exam, but treatment planning and correction should involve an orthodontist. An orthodontist has 2 to 3 years of specialty residency training beyond dental school, focused on diagnosing and correcting bite problems and tooth alignment.
You should schedule an orthodontic evaluation if you or your child has a visible gap between the upper and lower front teeth when biting down, difficulty biting into foods with the front teeth, speech changes such as a lisp, a thumb sucking or tongue thrust habit that has continued past age 4, or a previously corrected bite that has reopened. For severe skeletal cases, the orthodontist will coordinate with an oral and maxillofacial surgeon to plan the surgical component of treatment.
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