Open bite in children its main causes and methods of correction

Open bite is one of the most common dental problems in early childhood, and parents often don’t notice it until it starts affecting their child’s speech or eating habits. Simply put, an open bite occurs when the upper and lower teeth do not meet properly when the child closes their mouth, leaving a visible gap between them.This issue not only affects the appearance of the smile but can also lead to difficulties in chewing, speech problems, and improper jaw development if not addressed early.In this Dalily Medical article, we will cover everything you need to know about open bite in children: its causes, symptoms, potential complications, and the best ways to treat and correct it before the problem worsens.

What is an Open Bite in Children?

An open bite is a type of malocclusion where the upper and lower teeth do not meet properly when the child closes their mouth, leaving a visible gap between them. This issue not only affects the appearance of the smile but can also lead to difficulties in chewing, speech problems, and sometimes breathing issues. The causes of an open bite may be structural, due to improper jaw development, or dental, often resulting from unhealthy habits such as thumb sucking or prolonged pacifier use.

How Can an Open Bite Be Corrected in Children?

In most cases, open bites appear due to frequent and prolonged pacifier use, especially beyond the age of one year. Therefore, the most important preventive step is to stop using the pacifier before the child turns one.

Thumb or finger sucking can cause the same problem, but children often stop this habit naturally before age four. If the habit persists beyond this age, professional intervention is needed to prevent worsening of the condition.

The good news is that if the harmful habit stops early, the open bite can improve on its own over several months without complex treatment. However, if the habit continues for a long time, treatment may become more complicated, and in severe cases, the child might need orthodontic treatment or even jaw surgery in the future.

How is an Open Bite Treated in Children?

Treatment depends on the child’s age, the cause of the problem, and its severity (mild, moderate, or severe). First, the doctor must accurately determine the cause and perform a thorough examination before choosing the most appropriate treatment plan.

Here are the most common treatment options:

Preventive Orthodontics
- Usually the first step, typically used between ages 6 and 12 while the jaw is still growing.
- Its goal is to guide jaw development correctly and prevent worsening of the problem over time.
Traditional Orthodontics
- If the open bite appears at an older age, braces or aligners may be used to move the teeth into the correct position and improve occlusion.
- Types include traditional metal braces or clear (invisible) aligners, depending on the child’s needs.
Jaw Surgery (Orthognathic Surgery)
- In very severe cases affecting eating, breathing, or sleep, jaw surgery may be required to realign the bones.
- Surgery is usually combined with orthodontics: surgery corrects the jaw bones, while orthodontics adjusts the teeth.

⏱️ How Long Does Open Bite Treatment Take?

Mild cases: Can improve within 12–18 months using orthodontics alone.
Severe cases: Treatment may last 30–36 months if jaw surgery and orthodontics are required together.

Stages of Open Bite Development in Children

Open bite usually develops gradually, often starting with simple childhood habits that can evolve into a larger problem if not addressed early:

Early Stage (Early Childhood)
- Typically starts around age 2 due to habits like thumb sucking or prolonged pacifier use.
- A small gap appears between the upper and lower teeth when the child closes their mouth.
- Often resolves naturally if the habit is stopped in time.
Moderate Stage (Mixed Dentition Stage)
- Occurs between ages 6–9 when permanent teeth begin to erupt.
- The open bite and gap become more noticeable.
- Children may experience:
  - Difficulty pronouncing certain sounds
  - Problems biting or chewing food
- Early intervention is crucial, including stopping harmful habits, performing oral exercises, or using simple orthodontic devices.
Advanced Stage (Permanent Dentition Stage)
- Begins after age 10 when all permanent teeth have erupted.
- The gap is clearly visible and may affect the shape of the face and jaw.
- Increased risk of:
  - Chewing and speech difficulties
  - Abnormal wear of teeth over time
- Treatment becomes more complex, often requiring advanced orthodontics and sometimes jaw surgery if the jaw bones are involved.

Causes of Open Bite in Children

Open bite does not appear without reason; several factors affect tooth and jaw development. The most common causes include:

Unhealthy Oral Habits
- Thumb sucking: Pressure on the front teeth after age 3–4 can prevent them from growing in their natural position.
- Prolonged pacifier use: Continuous use can prevent the teeth from meeting properly.
- Tongue thrusting: Pushing the tongue between the teeth while swallowing or speaking can widen the gap.
Jaw Growth Issues
- Some cases are congenital or hereditary, resulting in uneven growth between the upper and lower jaw.
Mouth Breathing
- Chronic mouth breathing due to nasal issues or enlarged tonsils/adenoids can affect tongue and jaw positioning, leading to an open bite.
Genetic Factors
- A family history of malocclusion can increase the likelihood of an open bite even without harmful habits.
Early Loss of Baby Teeth
- Losing front teeth prematurely can affect the eruption of permanent teeth, increasing the risk of an open bite.

Types of Normal and Healthy Bite in Children

Understanding normal occlusion helps parents and doctors detect problems early:

Normal Bite (Class I / Ideal Occlusion)
- Upper front teeth slightly overlap the lower front teeth (1–2 mm).
- Upper back teeth fit neatly with the lower back teeth.
- Indicates healthy jaw development without chewing or speech problems.

2. Edge-to-Edge Bite
The upper and lower front teeth meet directly at the same level without overlapping.

This bite can be acceptable if the difference is minimal, but it is not considered ideal.
Regular check-ups with a dentist are important to ensure it doesn’t cause tooth wear or jaw joint problems over time.

3. Deep Bite
The upper front teeth cover more than one-third of the lower teeth when the mouth is closed.

A slight overlap is normal, but if excessive, a dentist should evaluate it.
Excessive coverage can lead to jaw issues or tooth wear.

4. End-on Molar Relationship (Posterior Bite)
The upper and lower back teeth sit directly on top of each other.

Not ideal, but sometimes doesn’t require treatment if mild.
Monitoring is important to prevent it from developing into a crossbite or other occlusion problems.

Types of Malocclusion and Bite Problems in Children

Malocclusion occurs when the upper and lower teeth don’t align properly, affecting facial appearance, speech, chewing, and oral health. It is common during the mixed dentition stage, and early detection makes treatment easier.

Common Types of Malocclusion:

Open Bite
- Front teeth do not meet, leaving a visible gap.
- Children may have difficulty biting food or pronouncing certain sounds.
- Causes: thumb sucking, prolonged pacifier use, or jaw growth issues.
Underbite (Anterior Crossbite)
- Lower front teeth are in front of the upper front teeth.
- Affects facial appearance and causes a prominent lower jaw.
- Causes: overgrowth of the lower jaw or delayed growth of the upper jaw.
Crossbite (Posterior or Anterior)
- Upper teeth sit inside the lower teeth instead of outside.
- Can occur on one or both sides.
- Untreated crossbite may cause jaw asymmetry or facial growth issues.
Deep Bite (Excessive Overbite)
- Upper front teeth cover more than half of the lower teeth or touch the gums.
- May cause tooth wear or jaw pain.
- Causes: jaw growth problems or crowded teeth.
Overjet (Protrusion of Upper Teeth)
- Upper front teeth stick out noticeably.
- Increases the risk of broken teeth and may affect speech.
- Causes: thumb sucking, prolonged pacifier use, or jaw growth imbalance.
Crowding
- Teeth are too close together or misaligned.
- Makes cleaning difficult and increases the risk of cavities and gum disease.
- Causes: small jaw size or early loss of primary teeth.
Spacing
- Wide gaps between teeth.
- Not always a problem, but persistent gaps after permanent teeth erupt should be evaluated.
- Causes: mismatch between tooth and jaw size or delayed eruption of teeth.

Tips for Parents

Observe your child’s chewing, speech, and teeth from ages 5–7.
Regular dental visits every six months help detect issues early.
Most bite problems, if treated early, can be corrected easily with simple orthodontics or minor interventions.

Consequences of Open Bite in Children

Open bite is not only a cosmetic issue but, if untreated, can affect chewing, speech, and facial appearance. Key problems include:

Difficulty Chewing and Eating
- Front teeth do not meet, making it hard to bite foods like apples or sandwiches.
- Poor chewing can affect digestion over time.
Speech Problems
- Tongue may protrude slightly when speaking, causing difficulty with sounds like “s” and “z.”
- Some children may need speech therapy.
Impact on Appearance
- Visible gap between teeth even when the mouth is closed.
- In severe cases, facial shape may be affected due to abnormal jaw growth.
Jaw Development Issues
- Untreated open bite can cause abnormal growth of the upper or lower jaw.
- Treatment becomes more difficult and longer, sometimes requiring surgery.
Jaw Joint Pain (TMJ Issues)
- Persistent malocclusion can strain the jaw joint.
- May cause pain, clicking, or difficulty opening and closing the mouth.
Increased Risk of Tooth Decay
- Gaps allow food to get stuck easily, leading to cavities and gum inflammation.

Diagnosis of Open Bite in Children

Diagnosis involves simple but essential steps by a dentist or orthodontist:

Direct Examination
- Check how teeth meet when the child closes their mouth.
- Identify gaps and determine if the issue is dental or skeletal.
Oral Habit Assessment
- Ask about thumb/pacifier sucking, tongue thrusting, or mouth breathing.
X-rays and Imaging
- Panoramic or lateral cephalometric X-rays to study jaw and teeth structure.
- Determines if simple orthodontics is enough or if a larger intervention is needed.
Speech Evaluation
- If speech issues exist, refer to a speech therapist.
Assessing Severity
- Mild: small gap
- Moderate: noticeable impact on chewing and speech
- Severe: facial deformity or jaw problems

Tip: Early detection (before ages 7–8) makes treatment easier and usually avoids surgery.

Common Bite Problems in Children and Their Causes

Overjet (Protruding Upper Teeth)
- Causes: thumb sucking, prolonged pacifier use, jaw imbalance
- Problems: difficulty closing mouth, speech issues, increased risk of broken teeth
Open Bite
- Causes: thumb/pacifier habits, tongue thrust, jaw growth issues
- Problems: difficulty biting, speech issues
Crossbite
- Causes: jaw growth imbalance, early tooth loss
- Problems: affects jaw and facial growth
Underbite
- Causes: overgrowth of lower jaw or delayed upper jaw growth
- Problems: prominent lower jaw, chewing and speech difficulties
Deep Bite
- Causes: jaw growth issues or crowded teeth
- Problems: tooth wear, jaw pain
Crowding
- Causes: small jaw, early loss of primary teeth
- Problems: cleaning difficulty, cavities, gum disease
Spacing
- Causes: mismatch in jaw and teeth size, delayed eruption
- Problems: persistent gaps need evaluation

Surgical Treatment for Open Bite in Children: When Is It Needed?

Most open bites in children do not require surgery because jaw bones are still growing and can be corrected with orthodontics or habit modification.

Surgery is considered only in rare, severe cases, usually after jaw growth is complete (teenage years).

When is surgery needed?

Skeletal jaw deformity rather than just tooth misalignment.
Severe difficulty in chewing or speaking.
Lack of response to orthodontics or habit correction after growth.
Certain genetic conditions causing abnormal jaw growth.

Note: Surgery is usually delayed until jaw growth is complete to avoid repeat procedures.

Steps of Surgical Treatment (after growth completion):

Examination and Planning
- 3D imaging to determine cause and location (upper jaw, lower jaw, or both).
- Pre-surgical orthodontics to align teeth.
Orthognathic Surgery
- Surgeon repositions jaw bones for proper bite alignment.
- Procedure under general anesthesia, lasting 2–4 hours depending on the case.

Open Bite Treatment in Children

Open bite is one of the most common dental issues in children, appearing when upper and lower teeth don’t meet properly, leaving a visible gap even when the mouth is closed.

This affects chewing, speech, and long-term dental health.
Early detection (before puberty) allows simple and quick treatment since jaw growth is still adjustable.

Common causes of open bite in children:

Prolonged thumb sucking
Tongue thrusting
Pacifier use after age 3

Treatment Methods:

Removable Orthodontic Appliances
- Thumb-sucking appliance: prevents continued habit.
- Tongue crib: prevents tongue thrusting.
- Chin cup: controls lower jaw growth if skeletal.
- Headgear: helps guide jaw growth and tooth alignment.
Behavioral Exercises
- Correct swallowing, tongue posture, and strengthen oral muscles.
- Very effective if started early.
Surgery (only in advanced cases)
- Rarely needed in children unless major skeletal problem exists.
- Followed by orthodontics to stabilize results.

Important tip: Regular dental check-ups from ages 5–7 can prevent open bite progression and avoid complex treatments later.

Exercises for Correcting Open Bite in Children

If the open bite is mild or in early stages, exercises can significantly improve it without braces or surgery. The goal is to correct swallowing, tongue position, and strengthen oral muscles.

Key Exercises:

Correct Tongue Position Exercise
- Sit upright.
- Touch the tip of the tongue to the roof of the mouth behind upper front teeth.
- Press gently and swallow while maintaining position.
- Repeat 10 times, morning and evening.
Proper Swallowing Exercise
- Place a small amount of water in the mouth.
- Close teeth and lips, swallow without tongue pressing on front teeth.
Speech and Tongue Strengthening Exercise
- Practice words with “s” and “z” slowly, keeping the tongue from moving forward.
- Blow into a balloon or whistle to strengthen tongue and oral muscles.
Lip Exercise
- Hold a light spoon or pencil between lips (without teeth) for 10 seconds.
- Press lips together firmly for 5 seconds, repeat 10 times.
Blowing Exercise
- Play blowing games: balloons, soap bubbles, or blowing on a paper to improve coordination and oral strength.