What Is an Open Bite?
An open bite is a malocclusion where the upper and lower front teeth do not contact each other when the back teeth are closed. The gap is vertical, not side-to-side. You may notice a visible space between your top and bottom front teeth even when you bite down hard.
Most open bites are anterior, meaning they affect the front teeth. A smaller number are posterior, affecting the back teeth on one or both sides. The condition can be dental (the teeth tilt the wrong way) or skeletal (the upper and lower jaws grew apart). Skeletal cases tend to be harder to correct.[8]
Open bite is one of the less common malocclusions. A 2018 systematic review found anterior open bite affects roughly 3-5% of the global population, with rates varying by region, age, and oral habits.[10] Children with active thumb-sucking or tongue-thrusting habits show higher rates than adults.
What Causes an Open Bite?
Open bites form when something blocks the front teeth from meeting as they erupt, or when the jaws grow at angles that push the teeth apart. Causes fall into three main groups: oral habits, jaw and airway issues, and genetics.
Childhood Oral Habits
Prolonged thumb-sucking, pacifier use past age 3-4, and tongue thrusting during swallowing are leading causes in children. The constant pressure prevents the front teeth from coming together as the jaw grows.
Tongue thrust is particularly important. A 2021 case-control study found that children with anterior open bite often rest the tongue between the front teeth during swallowing and speech, which both causes and worsens the gap.[5] Some children need speech therapy in addition to orthodontics to break the pattern.[7]
Mouth Breathing and Sleep-Disordered Breathing
Chronic mouth breathing changes how the jaws grow. The lower jaw drops, the tongue rests low, and the upper arch narrows. Over years, this can produce an open bite.
A 2023 study of children in Shanghai found a clear association between sleep-disordered breathing, including snoring and mouth breathing, and several malocclusions including open bite.[4] Enlarged tonsils, adenoids, and chronic allergies are common underlying causes.
Genetics and Jaw Growth Patterns
Some open bites are skeletal. The upper jaw grows longer in the back than the front, or the lower jaw rotates open as it develops. These patterns tend to run in families.
Research suggests that many features of how the face and jaws develop have a heritable component. A 2015 review of the genetics of dentofacial variation in human malocclusion concluded that bite traits, including vertical jaw relationships seen in open bite, are influenced by both genes and environment, with family and twin studies showing meaningful heritability for craniofacial form.[2] A specialist can usually tell whether the cause is dental, skeletal, or both during the initial exam.
Dental Trauma in Childhood
Injury to baby teeth, especially avulsion (a tooth knocked completely out), is common in young children and can affect how the permanent teeth come in. A 2024 case-control study identified risk factors that increase the chance of a baby front tooth being knocked out, including protrusion of the upper incisors and lip incompetence (lips that do not fully close at rest).[1] Children with these features, or who have already lost or damaged baby teeth in falls or sports, should be monitored as their permanent teeth come in, since trauma to a baby tooth can disturb the eruption of the adult tooth above it.
Symptoms and Diagnosis
Open bite shows up as a visible gap between the front teeth and difficulty biting into food. Speech changes and jaw fatigue are also common. An orthodontist diagnoses it with a visual exam, X-rays, and bite records.
What Patients Notice
The most obvious sign is the gap itself. You can see a space between your top and bottom front teeth in the mirror, even when biting down. Other symptoms include:
- Trouble biting into foods like sandwiches, apples, or pizza
- A lisp or unclear pronunciation of "s," "z," "t," and "d" sounds
- Tongue resting between the teeth at rest or during swallowing
- Excessive wear on the back teeth from over-use
- Jaw muscle fatigue or soreness
- Self-consciousness about how the smile looks
How It Is Diagnosed
An orthodontist measures the vertical gap at the front teeth and looks at how the back teeth meet. Cephalometric X-rays show the angles of the jaws and roots, which helps separate dental from skeletal cases.[8] Photos, digital scans, and sometimes a cone-beam CT round out the records.
A speech and swallowing assessment may be added when tongue thrust is suspected.[5][7] For children with snoring or restless sleep, an evaluation for sleep-disordered breathing can be important before starting treatment.[4]
When to Seek Care
The American Association of Orthodontists recommends a first orthodontic check by age 7.[11] This is when bite problems including open bite are first easy to spot. Early evaluation does not always mean early treatment, but it lets the specialist plan the right time to start. Adults with open bite can still pursue treatment at any age, though options may differ.
Treatment Options for Open Bite
Treatment depends on the patient's age, whether the cause is dental or skeletal, and how big the gap is. Options range from breaking childhood habits to braces, clear aligners, small bone screws, and jaw surgery in severe cases.
Habit Correction and Myofunctional Therapy
In young children, stopping the habit is sometimes enough. A tongue crib or thumb-guard appliance physically blocks thumb-sucking and tongue thrusting. Once the habit ends, the bite can close on its own as the jaw grows.
Myofunctional therapy retrains how the tongue rests and moves during swallowing. A 2021 literature review found that combining orthodontic treatment with speech and swallowing therapy generally produces more stable results in patients with tongue thrust than orthodontics alone.[7]
Braces and Clear Aligners
Traditional braces and clear aligner systems can move the front teeth together by extruding (pulling down) the upper and lower incisors or by intruding (pushing up) the back teeth so the jaw closes. Many mild to moderate dental open bites are treated this way.
A 2023 systematic review and meta-analysis on long-term outcomes of non-surgical open-bite treatment found that most cases stayed closed for years after treatment, though a portion did show partial relapse over time.[3] Wearing retainers as directed is critical to keep the bite closed.
Skeletal Anchorage (TADs)
Temporary anchorage devices, or TADs, are small titanium screws placed in the jawbone. The orthodontist anchors elastics or wires to them to push the back teeth up. This rotates the lower jaw forward and closes the open bite.
Research demonstrates that molar intrusion with skeletal anchorage is effective and reasonably stable in adults. A 2020 systematic review and meta-analysis reported that on average, the back teeth stayed in their new position with limited relapse after treatment.[9] A 2021 review compared skeletal anchorage to jaw surgery in adults and found similar bite-closure outcomes for many cases, with TADs being far less invasive.[6]
Orthognathic (Jaw) Surgery
Severe skeletal open bites in adults often need a combination of braces and jaw surgery. The surgeon repositions the upper jaw, lower jaw, or both to bring the front teeth together. Surgery is typically done after growth is complete.
According to one comparative review, surgery and skeletal anchorage produce similar bite-closure results for many adult cases, though surgery can address larger skeletal discrepancies and facial proportions that braces alone cannot.[6] A specialist can help you weigh which approach fits your case.
Addressing Airway Issues
When mouth breathing or sleep-disordered breathing is part of the cause, treating the airway matters as much as treating the teeth. This may involve an ENT consult, allergy treatment, or removal of enlarged tonsils and adenoids in children. Studies have shown a clear link between airway problems and malocclusion in children, so addressing the root cause can support a stable orthodontic result.[4]
Recovery and Aftercare
Recovery depends on the treatment used. Braces and aligner treatment last 18-30 months on average, with retainers worn for years afterward. Surgical recovery takes 6-8 weeks before returning to normal activity.
After braces or aligners come off, retainers hold the teeth in place while the bone and gums settle. Open bites have a higher relapse risk than some other malocclusions, especially when tongue thrust or mouth breathing was part of the cause.[3][7] Wearing retainers as directed, often nightly for life, is the single most important step.
After jaw surgery, patients typically follow a soft or liquid diet for several weeks, attend regular post-op visits, and finish with a short phase of orthodontic adjustment. Numbness in the lower lip or chin is common in the early weeks and usually improves over months. Results vary by case and surgical approach.
Cost and Insurance
Treatment costs vary by location, provider, and case complexity. Comprehensive orthodontic care for open bite generally falls into the same range as other complex cases, with surgical cases costing more.
Typical ranges in the United States:
- Habit appliances or tongue cribs: $300-$1,000
- Comprehensive braces or clear aligners: $3,000-$8,000
- Treatment with TADs (skeletal anchorage): $4,500-$9,500
- Orthognathic surgery (in addition to orthodontics): $20,000-$60,000 or more before insurance
Insurance Coverage
Many dental insurance plans cover a portion of orthodontic treatment for children, often with a lifetime maximum benefit between $1,000 and $3,000. Adult orthodontic coverage varies widely. Medical insurance sometimes covers jaw surgery when there is a documented functional problem, but pre-authorization is usually required.
Most orthodontic offices offer in-house payment plans, and many accept third-party financing. The American Dental Association recommends asking for a written treatment plan and cost estimate before starting.[12] Costs vary by location, provider, and case complexity.
When to See a Specialist vs. a General Dentist
Open bite is best evaluated by an orthodontist. General dentists screen for malocclusion and refer when needed, but orthodontists are the specialists trained to plan and deliver bite correction.
Orthodontists complete 2-3 years of additional residency after dental school, focused on tooth movement, jaw growth, and bite correction. For skeletal cases, an orthodontist often works with an oral and maxillofacial surgeon. Children should have a first orthodontic check by age 7 even if the family dentist has not raised concerns.[11]
You can learn more about the specialty and what to expect at the orthodontics page. A general dentist remains essential for cleanings, cavities, and overall dental health throughout treatment.
Find an Orthodontist Near You
An orthodontist can examine your bite, explain whether the cause is dental or skeletal, and lay out the realistic options for closing the gap. Use our directory to find a board-certified orthodontist in your area, compare credentials and experience, and book a consultation.
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