Smiling's never been so easy

Everybody knows how important your smile is. It is your window to the world, and according to research, it is the very first thing that people notice about you. In other words, your smile is your greeting card, and if your greeting card is flawed, you can kiss a lot of your opportunities goodbye.

Studies have shown that people with a nice smile have a lot more going for them than people who don’t. They have greater job opportunities, are easier to find their partner and get married, and are generally happier in their life.

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There are a number of reasons why your smile isn’t perfect, either due to stains or decay or even missing teeth, but it is malocclusion that takes the number one spot for the reasons of a less than perfect smile.

So what is a malocclusion?

Occlusion is defines as the way your teeth come in contact together, or to put it simply, the relation between the teeth in the upper jaw and those in the lower. Malocclusion is a problem that happens in that system, making the way that the teeth come in contact all messed up.

Malocclusion was first described by Angle, a dentist who lived last century, and concluded that the keys to perfect occlusion lies within 2 teeth, these are the canines (or cuspids) and the first molar teeth. These two are of great importance in the mouth, the canine being at the exact corner and responsible for the curvature of your mouth and smile, and the first molar being the most chewed on and force subjected tooth (which is why when you unfortunately lose this one, your chewing efficiency will decrease by more than 50%).

Angle named perfect occlusion “Class 1 Occlusion”. In this case, the lower canine is slightly in front of the upper canine, and the lower first molar is slightly in front of the upper one when the upper and lower teeth are in contact (meaning when your mouth is closed). He also defined 3 types of malocclusions:

· Class 1 Malocclusion:
Meaning that the relationship between the canines and first molars are as described above, but the problem is elsewhere in the mouth, such as crooked or spaced teeth.

·  Class 2 Malocclusion:
This is when the upper jaw is advanced forward (or vice versa the lower jaw is held back) so the upper canine becomes situated in front of the lower canine, and the same for the upper first molar as well.

· Class 3 Malocclusion:
Which is our main topic here.

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So what is Class 3 Malocclusion?

Class 3 malocclusion is the opposite of class 2, where the lower jaw is advanced forwards or the upper jaw is held back. The lower canine becomes situated so far in front of the upper canine, and the lower first molar becomes also so far ahead of the upper one.

The classic appearance of this type of malocclusion includes:

  • Enlarged lower jaw in comparison to the upper.
  • Cross-bite, which means the lower front teeth lie in front of the upper ones when the mouth is closed, which is the opposite of normal and hence the term “Cross-bite”
  • Scissors bite, which is the same as cross-bite but for the back teeth rather than the front.
  • Incompetent lips, which doesn’t happen in all cases, but quite often you find the lips unable to completely cover the teeth even when the mouth is closed, due to the sheer difference in size of the jaws.

Types of class III malocclusion

According to the nature and cause, we can identify 3 types of the condition:

1.  Skeletal malocclusion:
As the name suggests, the origin in this type lies in the bones of the jaws rather than the teeth. This happens when for some reason the bones of the upper and lower jaws have different rates of growth, meaning that the lower jaw grows very quickly as opposed to the upper jaw which grows slower, and the result being that the bones of the lower jaw are significantly larger than the upper.

2.  Dental malocclusion:
The opposite of the first type, where the bones are of normal size and their growth rates are even, but something happened to the teeth making them drift into these new positions. This most commonly happens with early loss of the baby teeth, giving the other teeth free reign to move and drift wherever they want, giving the class 3 relationship between the teeth, while the bones’ relationship is normal.

3.  Combined malocclusion:
This happens when the problem lies both within the jaw bones, and within the teeth themselves at the same time, but it is quite rare for this type of malocclusion.

Causes of malocclusion

Malocclusion – we’re talking about all types here- is usually genetic. If you have any type of the malocclusions listed above, then probably one of your parents or a close relative has the same problem, even if to a lesser extent.

That being said, there are a few risk factors that a person may develop malocclusion later on in life, even if his\her occlusion was originally perfect, such as:

  • Parafunctional habits:
    If you have ever been to the dentist and he\she advised you to keep a close eye on your baby’s thumb sucking, then you would know what we mean. Habits that our babies develop have a detrimental effect not only on their oral and general health, but on their occlusion as well. Of course the main habit for babies is the thumb sucking habit, which could lead to class 2 malocclusion and what dentists call an “open bite” where the front teeth are not in contact even if the mouth is closed.
    The same principle applies when using the pacifier for far too long than needed by your child.
  • Trauma:
    When you suffer a knock to your jaws, you disrupt the growth centers within the jaw. It is these centers that are responsible for balancing out the growth rates of both your jaws and making them even, so if you suffered a blow to the upper jaw, it will stop growing while the lower jaw continues on, and the final result is class III malocclusion. The opposite applies for class II.
  • Early loss of baby teeth:
    We touched on this earlier. Our baby teeth are of the utmost importance, not only for appearance or chewing, but to maintain the relationship between the teeth that will follow them as well as the relationship of the jaws. When you lose one or more of your baby teeth at an earlier age than they should, you disrupt the balance inside the mouth, and the remaining teeth – as well as the permanent teeth that will follow later – end up where they shouldn’t.
  • Early extraction of Permanent teeth without replacement:
    Our mouths are very delicate environments. The teeth inside this environment touch each other ever so lightly in what we call contact points or contact areas, which keep the teeth from moving sideways and tilting. When a tooth is extracted for whatever reason, and you don’t attempt to replace that missing tooth at once (either with implants, bridges or dentures), this contact point disappears, and there is nothing stopping the tooth from moving around, the same way as with baby teeth, with the only difference being that with baby teeth, the jaw is still in its growing phase, meaning the problem can be solved with only minor interventions, but with permanent teeth, you would probably need braces and in some severe cases even surgery.
  • Impacted or Missing teeth:
    In some rare cases, some of our teeth fail to form completely, while in others, they are normally formed but fail to appear inside the mouth. In these cases, again the balance and contact points are not there, and you could expect the teeth to move around and drift creating some form of malocclusion.
  • Poor Fillings or dental work:
    If your teeth are extensively restored either with fillings, bridges, dentures or any other form of dental work, and they were not properly done or you haven’t been to a check-up in some time to see if they are still well and good, then these restorations may be the reason why your teeth are not occluding normally as they once did. Again the same principle of contact points, so if the restoration creates a space between the teeth (in other words, the contact points are lost) then again the teeth will drift apart and you will probably end up with crooked teeth.
  • Tumors:
    If you were unfortunate enough to get a tumor (or any other form of pathology in your jaw bones), then you would know how these tumors affect the shape and size – not to mention the growth – of the jaws.
    Tumors cause the bone to either expand, or to be resorbed and eaten away according to its aggressiveness. In both cases, the result is a change in the normal size of the jaw bones, as well as stopping the growth centers from forming new bones and keeping up with the other jaw, so that one jaw keeps growing normally while the other stops growing. Not only that, but the surgery to remove the tumor removes a large chunk of the jaw bones, and when the surgeon seeks to repair that defect, it is very difficult – if not impossible – to maintain proper occlusion.
  • Airway Obstruction:
    When your nose is constantly congested, so much so that you are unable to breathe normally through the nose (as in cases of sinusitis or adenoids), you end up breathing through your mouth. The results of prolonged mouth breathing are catastrophic to the teeth as well as the jaws. Your mouth will constantly be dry, meaning that you lose the washing and buffering effect of saliva, and the rate of decay and gum disease sky rockets. Not only that, but the mouth gets bent into the new shape for proper breathing, where the palate (that is the roof of your mouth) moves upwards, and your front teeth move outwards to create more space for breathing, and so you end up with some form of malocclusion and crooked teeth.
  • Cleft lip or Palate:
    In some rare cases, a child is born with a cleft in his\her lip or palate or both. These clefts are unfortunately quite a burden to the child and the parent as well. The child will have trouble feeding, not to mention breathing, and the jaw bones will not grow as well or as completely as they should. Cleft lip and palate patients more often than not end up with class III malocclusion because their lower jaw is normal and fats growing, while their upper jaw is halted due to the presence of that cleft.

Diagnosis and treatment planning of class III malocclusion

To properly diagnose the presence of malocclusion, as well as determine its type and therefore the way it would be treated, the orthodontist requires 4 things:

1. Clinical Examination:
First and foremost, the orthodontist has to see first-hand what the condition is like. He\she can determine, at least on a primary basis, the type of malocclusion that you have and probable causes of the condition. The classic appearance of class 3 malocclusion (as we mentioned earlier) is a dead give-away, but it is not the only determinant since in some cases, the patient presents with what is known as “Pseudo Class III”, in simpler terms, the patient could have some of the classical signs, but the relationship between the first molars and the canines are normal, and in these cases the treatment differs completely.

2. Xrays:
The most important aspect for diagnosing malocclusion is xrays. Two of these are needed:

a. Panoramic X-ray: Which is an xray of the whole mouth and teeth from a frontal view. It is needed to view the shape and condition of the bone, as well as rule out the presence of impacted teeth, missing teeth, retained baby teeth, or any other pathology that could be the main cause of the problem.

b. Lateral Cephalometric X-Ray: Which is an xray of the whole skull from a side view. It is this type of xray that shows the relationship between the upper and lower jaws to the skull bones as well as to each other. Using certain measurements with the aid of the computer, the orthodontist can determine exactly the type of malocclusion as well as its severity, and also the type and strength of bone, all of which would affect the treatment plan.

3. Photographs:
Photographs are not just for documentation, they are key diagnostic aids. Not only current photographs of the patient, but any old photographs he\she might have to determine if the condition is new or has been there for a while, in addition to any photos of his\her relatives that have a similar situation (because as you remember, the cause for malocclusion is more often than not genetic).
The orthodontist would take photographs of the face, smile, teeth, a side view and a top view as well, all of which determine the type and the way that he\she would proceed with the treatment.

4. Diagnostic Casts:
Orthodontics is not just about the looks, it also has to do with how your teeth integrate together. Diagnostic casts can aid the orthodontist in this endeavor. These are replicas of your mouth, where the orthodontist takes replicas (known as impressions) and poured out in stone, creating another version of your teeth.
On these casts, we can determine roughly where the braces will be set, how long will the treatment period be and what form of elastics or other methods of treatment will be needed.

How is class 3 malocclusion treated?

The choice of treatment for jaw size discrepancy cases (meaning either class II or Class III where one jaw is bigger than the other) depends on a few factors:

1. Nature of the condition:
Meaning what type of malocclusion you have. If you have a skeletal type of malocclusion, then most probably surgery will be needed along with braces, but if you have the dental type, then braces alone could be the answer.

2. Amount of discrepancy:
If the difference in jaw sizes is large, the surgery could be the only answer, even if the problem is of dental origin, so don’t make the mistake of thinking that braces is the answer to everything.

3. Age of the patient:
This is probably the most important factor of all. If the patient is under 16 years of age, then he\she are still in the growing phase, where the jaws haven’t yet reached their full potential size.
In that case, we make use of what we call functional appliance, which act on the muscles of the face and jaws, holding back a certain jaw from growing (in our case the lower jaw) while allowing the other one to grow, or vice versa by increasing the rate of growth of the upper jaw by pulling it forward. The most obvious example (and you have probably seen one of these before) is the head gear, used to pull the upper jaw forwards, or the chin cup used to hold back the lower jaw.
For this reason, it is of the utmost importance that you head to the orthodontist as soon as you begin to notice any of the classical signs of the condition, because when it is caught early, 90 % of the time surgery could be avoided, and who wouldn’t want that?!

It is also important to note that treatment of class III cases in particular takes quite a bit of time, since it is not easy to move the teeth such a large space, so expect to wear the braces for as long as 3 or 4 years.

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How can we help?

Easysmile is an aligner manufacturing company. Aligners are the future of orthodontics, where instead of the good ole brackets, wires and elastics, a plastic, clear mold of your teeth is worn, which can be removed at need (such as during eating or if you have an important meeting). These aligners exert pressure on the teeth in a certain way to help move them to the desired placed.

These were designed to be worn by adults, who will probably refuse to wear traditional braces because of how they look: However, they can be used by anyone, provided that all the permanent teeth have erupted in the mouth (meaning after 12 years of age). These aligners are an excellent way to treat all sorts of dental malocclusions, and can also be used in combination with surgeries to fix skeletal or severe cases of dental malocclusion. They are also made with the aid of a computer, so you can expect them to be incredibly accurate, with very little chance of human error, and the treatment outcome will be exactly like you imagined and even more so.

What is great about Easysmile, and what sets us apart from our rivals, is that we are a direct to consumer sort of company, meaning that you deal with us directly to get your aligners, with no need for an orthodontists intervention. Our team of experts includes a top orthodontist who can formulate your treatment plan and send you the aligners directly. Of course in some cases, We need the intervention of a clinical orthodontist, and we got you covered there, since we can send you to one of our partner clinics to do the minor adjustments needed to effectively complete your treatment, examples being IPR (which means interproximal stripping, or in simpler terms, creating space for the movement of teeth by grinding them) as well as attachment of buttons and engagers (also needed to move the teeth effectively) .

So if you noticed any of the classical signs of class 3 malocclusion on you or any of your children, head to your dentist immediately, and if he\she confirms the diagnosis, and that you would need braces, Ask yourself this "Are Easysmile aligners the answer to my problems?".