Fixing an Open Bite: Are Braces the Only Answer?

An open bite is a type of malocclusion (teeth misalignment). With an open bite, there is a gap between the upper and lower teeth when the mouth is closed. This may be caused by genetics, oral habits (like tongue thrusting or pacifier use as a child), or injury. 

An open bite can cause problems that include decay, speech problems, difficulty chewing, and weakened tooth enamel. 

Serious cases of open bite that are caused by a skeletal problem or jaw positioning may require jaw surgery. Other treatment options may include braces, orthodontic appliances (such as palatal expanders), and clear aligners.

What is an Open Bite?

When teeth are properly aligned, the upper teeth will fit comfortably just over the lower teeth when the mouth is closed. The grooves and tops of opposing molars will line up to fit together. 

With an open bite, some of the upper and lower teeth do not connect when the mouth is closed. There is still a gap and in places, the upper and lower teeth are not touching. 

An open bite is a form of a malocclusion, or tooth misalignment. Malocclusion is common and open bites are particularly difficult to live with, as they can have a serious impact on important daily activities like chewing, talking, and taking care of your gums and teeth.

What are the Types of Open Bite?

While open bites vary in severity and some are more visible than others, there are two main types:

• Anterior open bite: Front teeth slant outward and don't connect at all, even when the back molars do. Most people with an open bite have this version.

• Posterior open bite: Front teeth fit together as they should, but back teeth never do.

What Causes an Open Bite?

Many types of malocclusion, including open bite, are often caused by genetics or hereditary issues that affect the jaw, mouth, or bite. 

These are other possible causes of an open bite:

• Childhood oral habits: Prolonged use of a pacifier or thumb sucking may cause an open bite, especially if these activities continue after permanent teeth replace baby teeth. 

• Certain types of sippy cups: Continuous use of sippy cups can affect a child’s mouth and jaw development. If you’re concerned about your child’s use of a sippy cup, talk to your pediatrician or pediatric dentist.

• Tooth eruption problems: If there are problems with tooth erupting, like delayed permanent teeth, the risk for malocclusion issues like open bite may be higher.

• Injury: Injury or trauma to the mouth and/or jaw may result in orthodontic issues like open bite.

• Missing teeth: If a tooth is lost and not treated, teeth may shift and cause misalignment problems.

Diagnosing an Open Bite

Most cases of open bite are diagnosed by dentists, pediatric dentists, or orthodontists during a simple oral evaluation. Doctors examine your teeth when your mouth is open and closed, and they use a measurement tool to determine how far your teeth should move to protect your smile.

X-rays are also an important part of diagnosing an open bite. These images help dental professionals determine the position of your teeth from the root to the tip, so doctors can accurately diagnose why the open bite is happening and how it should be treated.

How is an Open Bite Treated?

If you have an open bite, your treatment options will depend on how severe and complex your malocclusion is. For severe cases or those involving a skeletal issue causing the “bad bite,” surgery may be required. In these extreme cases, a combination of treatments may be needed — for example, surgery followed by the use of aligners or braces.

Treatments for open bite malocclusion include the following:

How Much Does Treatment Cost?

Your treatment costs can vary dramatically by the type of care you need and how long it might last. This table can help you understand the differences and what to expect:

People who opt for surgery will see the biggest bills. Experts say orthognathic surgery (which involves amending an open bite) can cost up to $40,000 for people without insurance. With coverage, you can knock that bill down to $5,000 or so. Choose braces, and you will pay less. Experts say braces cost, on average, about $5,000.

But difficult open bites come with higher prices. Expect to pay more for interventions like these:

• Headgear

• Jaw screws

• Rubber bands

You'll also pay more if you modify your braces. Choose tooth-colored ceramic brackets, for example, and your bill can jump to about $8,500. Dental insurance can offset some of the costs of braces, but this is usually only the case when braces are medically necessary rather than purely for aesthetic reasons.

Clear aligners offer both efficacy and value. You don’t have to visit an orthodontist regularly since the aligners are mailed right to your home. For mild cases, doctor-supervised, at-home aligners can be yours for about $2,000. These tools aren't right for all open bite problems. Severe cases may need more help than aligners can deliver. But for some, they offer the perfect way to straighten a smile while saving money and time.

Will Insurance Help?

It's common for insurance companies to chip in and pay for part of your care. However, exceptions exist.

Insurance companies use the term medical necessity to describe services provided to diagnose, treat, or cure a health condition, illness, injury, or disease. Your doctor might need to provide a Letter of Medical Necessity to your insurance plan to help you pay for very expensive issues like surgery.

Some insurance plans will cover costs associated with cosmetic orthodontic care, but limits might apply. You may have to pay some of the costs out of pocket, and your insurance plan might require you to work with specific doctors or clinics.

Talk with your insurance company and your doctor about the treatment you need, and find out what is and isn’t covered in your plan.

Are there Health Risks Associated with not Treating Open Bite?

Many people with an open bite may feel self-conscious about the condition, aware that their teeth are not lining up properly, and worrying about the appearance of their teeth. This alone can pose a number of problems and affect an individual’s mental health. 

But the problems associated with an overbite and malocclusion go beyond appearance. 

Misalignments may be associated with jaw problems, and they can cause teeth problems like spacing and crowding. Teeth may not line up correctly, and this may create friction between teeth or between a tooth and the gums or inner cheek. 

Health risks of open bites include the following:

Open Bite Frequently Asked Questions