Can an Open Bite in Children Resolve Itself?

An open bite can be bothersome as it affects speaking, chewing, and even smiling. Parents or primary caregivers often wonder whether open bites in children will eventually resolve themselves. Here we address some commonly asked questions related to open bite.

What is an open bite?

Normally, a person's biting position is characterized by contact with the teeth in the upper and lower jaws. An open bite is a biting problem (also known as malocclusion) in which the upper and lower teeth do not contact properly when the mouth is closed. This condition leaves an open space even when the patient closes their mouth.

Open bites are further differentiated based on the unevenness of the bite, namely anterior open bite (front teeth open), posterior (back teeth do not touch each other), and incomplete (front teeth close together, but do not touch).

Is open bite a common problem?

Open bites, together with periodontal disease and dental caries, are reported as the most common abnormalities found in the jaw and mouth area. Furthermore, the World Health Organization considers open bite will be the most common oral health problem after periodontal disease and dental caries.

The prevalence rate of open bites is estimated to be between 40% and more than 90% in children and adolescents. Various factors such as age and ethnicity affect the incidence of open bites. Furthermore, the prevalence of open bites can be classified according to the class of occlusion.

ANB is the angle that describes the relative anteroposterior position of the upper jawbone to the lower jawbone. The prevalence of class I occlusion (ANB angle between 0° and 4°) ranged from 35% to 94%, class II occlusion (ANB angle more than 4°) ranged from 4% to 45%, and class III occlusion (ANB angle less than 0°) ranged from 1% to 19%. This data shows that open bite is one of the common problems.

What are its causes and risk factors?

In general, risk factors associated with open bites are:

• Poor oral habits.
• Airway obstruction.
• Genetics.
• A combination of the three.

Bone growth abnormalities can cause misaligned jaw bone growth that is conducive to an open bite and give an abnormal facial appearance. For example, vertical growth in the molar region that is not accompanied by the development of the lower jaw is thought to be responsible for the incidence of anterior open bite.

Poor oral habits such as thumb sucking, and excessive bottle use can also lead to an open bite. These habits need to be discontinued or changed early on, especially in children under three years of age. Tongue thrusting as an adaptive behavior is also considered to cause an open bite. The tongue resting on the front teeth will trigger the incisors to grow abnormally. This can also lead to difficulty in biting and speaking.

Airway obstruction has been reported to be associated with open bites. Airway obstruction is caused by disproportionate growth of the facial bones. Abnormal jaw and tooth skeleton pattern contributes to open bite.

What are the symptoms of an open bite?

The most noticeable symptom of an open bite is the absence of proper contact between the upper and lower teeth when the mouth is closed. This condition results in the opening of the vertical dimension between the upper and lower anterior teeth.

Additional symptoms, which can be quite uncomfortable, may result from an open bite. Front teeth that look crowded and crooked can result in an abnormal facial appearance. An open bite can also cause the patient to have difficulty biting and chewing. Discomfort and jaw fractures can be triggered by excessive tooth wear. Moreover, open bites can cause speech problems such as slurred speech.

What are the treatments and their effectiveness?

Dentists develop treatment plans for open bites based on the type of open bite and the age of the patient.

Jaw shape correction can often be done naturally in children with baby teeth. Stopping bad oral habits such as finger sucking or using a bottle of milk excessively is considered effective for improving the condition of open bites in children.

Braces or aligners can be used to mechanically correct the open bite. Braces will realign the front and bottom teeth gradually. This type of non-surgical treatment is effective for adult patients with moderate to severe open bites.

Chin-cup therapy can be performed to reduce the habit of sticking out the tongue, straightening the teeth, and minimizing the vertical growth of the lower jawbone. Extraoral force on chin cup therapy is effective for correcting crossbites and controlling mandibular vertical growth.

In addition, orthognathic surgery may be recommended when the jaw is misaligned due to bone problems. Surgery may be performed to remove part of the upper jaw. This straightens the jawbone again. Surgical-assisted rapid maxillary expansion (SARME) can also be performed to correct a narrow maxilla. These surgeries are performed to improve the functionality and aesthetics of the jaw with long-term effectiveness and stability.

Although open bites in children might resolve themselves, consulting a dentist early on is important. During preventative care visits, the dentist can monitor the progression of open bits and suggest treatment plans as and when needed.