Sometimes a misaligned jaw causes visible signs, such as a lopsided smile or a noticeably recessed chin, but that’s not always the case. Many people don’t realize there is a mismatch between their upper and lower jaw until problems like difficulty chewing, jaw shifting, and uneven enamel wear set in.
Now you might be wondering, “Well, how do I know if my jaw is misaligned? And if it is, how do I fix it?”
That’s where a certified specialist in orthodontics like Dr. Ankush Khanna comes in. After dental school, orthodontists complete two to three additional years of specialty training focused exclusively on diagnosing, preventing, and treating misalignment of the teeth and jaws.
In this guide, we’re breaking down the causes, signs, and complications of jaw misalignment, how orthodontists diagnose the problem, and the treatment options available for kids, teens, and adults.
What is Jaw Misalignment?
The jaw consists of two parts: the maxilla (upper jaw) and the mandible (lower jaw). Jaw misalignment occurs when the maxilla and mandible don’t line up properly or grow at different rates. This affects how your top and bottom teeth come together (known as your bite, or occlusion).
Jaw discrepancies can lead to several types of malocclusion, or a bad bite, including:
- Overbite or Deep Bite: The upper teeth cover too much of the lower teeth when you bite down.
- Underbite: Your bottom teeth sit outside of your top teeth.
- Open Bite: Some of the upper and lower teeth don’t meet at all when you close your mouth.
- Crossbite: One or more top teeth are positioned behind the bottom teeth when the jaw is closed.
- Overjet: The top front teeth stick out too far in front of the bottom teeth.
It’s important to note that malocclusion isn’t always caused by a misaligned jaw. It can be dental (caused by tooth positioning), skeletal (caused by the size or position of the jawbones), or both. That’s why getting an accurate diagnosis is the key to finding the right treatment plan. To learn more about the difference, check out: “Why Two People With Crooked Teeth Might Need Totally Different Orthodontic Treatment Plans.”
Both skeletal and dental misalignment can lead to oral health challenges. For one, they make it harder to keep teeth clean. In more severe cases, misalignment can impact your ability to chew, speak, or breathe properly and increase the risk of damage to your gums, teeth, and/or jaw joints.¹
What Causes a Misaligned Jaw?
There isn’t one single cause of jaw misalignment. Genetics and facial growth are major factors, but developmental issues, trauma, and oral habits can contribute too.
Common causes include:
- Genetics: Jaw size, shape, and growth patterns often run in families, and you can even inherit characteristics from both parents. For example, you might inherit a small lower jaw from your dad and a larger upper jaw from your mom, creating a mismatch that affects how your bite comes together.
- Differences in Jaw Growth: The upper and lower jaw don’t always grow at the same rate. If one jaw grows more or less than the other, a skeletal discrepancy can occur.
- Childhood Oral Habits: Habits like thumb sucking, pacifier use, and tongue thrust can influence how the teeth and jaws develop, especially when they continue beyond the toddler years. The persistent pressure from the thumb, pacifier, or tongue may shift the front teeth outward, contribute to a high or narrow palate, and potentially lead to a crossbite or open bite.¹
- Congenital or Developmental Conditions: A cleft lip or cleft palate, as well as certain conditions that impact facial symmetry and growth, can cause the jawbones to develop irregularly.¹
- Trauma: A traumatic injury to the face or jaw can alter jaw position or, in a growing child, interfere with normal jaw development.²
Are Jaw Misalignment and TMJ the Same Thing?
No, jaw misalignment and TMJ are not the same thing. While people often use the term TMJ, it actually refers to your jaw joints, not a condition.
The temporomandibular joints (TMJs) are the joints on either side of your face that connect your jaw to your skull. Temporomandibular disorders (TMDs), also called temporomandibular joint disorders (TMJDs), are a group of conditions that involve the TMJ, the chewing muscles, and/or the surrounding structures.
TMD symptoms include jaw and facial pain, painful clicking or popping, stiffness, limited jaw movement, and the jaw locking in an open or closed position.
As we noted above, jaw misalignment refers to the relationship between the upper and lower jaw. Someone can have a misaligned jaw without having a TMJ disorder, and someone can have a TMJ disorder without having a misaligned jaw.
You might have come across claims online that a bad bite causes TMD or that orthodontic treatment can cause or cure TMJ disorders. The relationship isn’t that straightforward. Current research does not support the idea that a bad bite or orthodontic treatment causes TMD.³
That said, your jaw joints are part of the bigger picture. An aligned jaw and healthy bite support the entire chewing system, including the teeth, jaw, joints, and muscles.
If you’re experiencing TMD symptoms, let Dr. Khanna know at your consultation. He can assess your bite and jaw relationship, determine whether orthodontic treatment is the best solution, or recommend seeing another provider for a multidisciplinary approach.
How Do I Know if My Jaw is Misaligned?
Possible jaw misalignment symptoms include:
- An overbite, underbite, open bite, overjet teeth, or crossbite
- Upper and lower teeth that don’t seem to fit together correctly
- Trouble biting or chewing
- A jaw that shifts to one side
- Facial asymmetry¹
- A noticeably prominent or recessed chin
- Difficulty comfortably closing your lips
- Uneven enamel wear
- Speech difficulties
- Mouth breathing²
- Snoring and sleep apnea²
- Jaw pain, headaches, and neckaches
- Teeth grinding and clenching (bruxism)
Unfortunately, you can’t always tell if you have a misaligned jaw just by looking in the mirror. Your teeth might be fairly straight, but you could still have an underlying problem with your jaw or bite.
And symptoms alone aren’t a definitive way to determine whether the issue is skeletal or dental. An orthodontic evaluation is the best way to pinpoint the source, which brings us to our next point.
Who Do I See About a Misaligned Jaw?
If you’re asking, “Who do I see about a misaligned jaw?” an orthodontist is a great place to start. Orthodontists complete rigorous specialty training in an orthodontic residency program focused on diagnosing and treating irregularities of the teeth, jaw, and bite. They’re also experts in jaw and facial development.
At your initial consultation, an orthodontist like Dr. Khanna will develop a diagnosis and offer personalized treatment recommendations. Depending on the cause and severity of the problem, treatment could be a collaborative effort between your orthodontist and other specialists, such as an oral and maxillofacial surgeon.
How to Fix a Misaligned Jaw
When it comes to how to fix jaw misalignment, there isn’t a one-size-fits-all treatment that works for everyone. Again, it depends on a number of factors, such as the type of misalignment; the cause; whether it’s skeletal, dental, or both; your age; and the severity.
Potential treatments for a misaligned jaw include:
Braces
Braces can correct a bad bite, especially if it’s mainly related to tooth position. The system of brackets and wires straightens the upper and lower teeth independently, which is why we may also use auxiliaries like rubber bands or other bite-correcting appliances with braces. These tools provide the connective force needed to improve the relationship between your jaws.
Braces are sometimes used as part of a broader treatment plan for skeletal discrepancies in patients of all ages.
Spark™ Clear Aligners
Spark Aligners can fix a host of bite problems. At Fresh Orthodontics, Dr. Khanna digitally plans the movement of each individual tooth to not only ensure the teeth will be straight but also to correct how the upper and lower teeth work together. A series of removable clear aligners are then fabricated based on his prescription.
Like braces, the aligners straighten the teeth in each arch. For a jaw discrepancy, they’ll also be paired with auxiliaries such as attachments and/or rubber bands to create a healthy, functional bite.
Phase 1 Orthodontic Treatment
The American Association of Orthodontists recommends every child have their first orthodontic evaluation by age 7. Most kids won’t need treatment right away. But for certain bite issues, if Dr. Khanna spots red flags, he may recommend Phase 1 orthodontic treatment.
Phase 1 orthodontic treatment starts when a child is still growing and has a mix of permanent teeth and baby teeth. Using an appliance, such as a palatal expander, a Herbst appliance, or another Phase 1 solution, we guide jaw growth and development to prevent or minimize jaw misalignment, address an emerging bite problem, and create space for the permanent teeth to erupt.
Once we achieve the orthopedic goals of Phase 1 treatment, kids have a resting period followed by Phase 2 treatment, where we use braces or clear aligners to straighten the permanent teeth and fine-tune the bite.
When early intervention is needed, a two-phase approach can make future treatment easier and help kids avoid extractions and jaw surgery down the road.
Tooth-Bone-Borne or Bone-Borne Appliances
For teens and adults who are done growing or nearing the end of their facial growth, traditional appliances likely won’t be enough to fix skeletal misalignment. In some cases, Dr. Khanna may recommend a treatment such as miniscrew-assisted rapid maxillary expansion (MARPE).
MARPE uses small temporary anchorage devices, or mini screws, that either anchor directly to the palate (bone-borne) or to both the palate and the teeth (tooth-bone-borne). This provides enough force to widen the maxilla.
For select patients with specific jaw discrepancies (i.e., a narrow palate or skeletal crossbite), this approach is an excellent way to achieve skeletal expansion without jaw surgery.⁴ However, it’s not appropriate for every patient and type of jaw discrepancy.
Surgical Orthodontics
If jaw misalignment is severe, surgical orthodontics might be the best way for adult patients to achieve dramatic, stable results.⁵ This type of treatment involves a collaboration between your orthodontist and an oral and maxillofacial surgeon.
Typically, you start by getting braces or aligners to position the teeth properly. Then the oral surgeon performs corrective jaw surgery (orthognathic surgery) to physically reposition one or both jaws. Finally, you get braces or aligners again to align the teeth and create a healthy bite.
Having a misaligned jaw does not mean you automatically need corrective jaw surgery. In fact, thanks to advances in materials and treatment planning technology, we can achieve outstanding results for more adults than ever before without surgery.
How Does Dr. Khanna Evaluate Your Teeth, Jaw, and Bite?
When you visit Fresh Orthodontics in Brooklyn, we start by taking diagnostic records (i.e., digital X-rays and photos). Then, Dr. Khanna performs a comprehensive oral exam.
He evaluates your:
- Tooth position
- Bite
- Upper and lower jaw relationship
- Facial proportions
- Overall oral health
- Growth and development (for kids and teens)
Dr. Khanna uses his findings to determine why your teeth and jaw fit together the way they do. Once he has an accurate diagnosis and you’ve discussed your concerns and goals, he offers personalized treatment recommendations.
He then designs your treatment around your unique facial anatomy and features, teeth, and bite to help you achieve the right balance of health, function, and aesthetics.
The Bottom Line
Jaw misalignment isn’t always obvious, which is why seeing an experienced orthodontist for an evaluation is important. They’re trained to notice even subtle signs and create the right treatment plan.
If not addressed, a misaligned jaw can affect your long-term oral health and your ability to bite and chew, speak clearly, and even breathe normally.¹
Fortunately, there are tried-and-true treatments for a misaligned jaw and bite, ranging from Phase 1 appliances to braces and clear aligners to jaw surgery. The first step is getting the right diagnosis.
Ready to Explore Treatments for a Misaligned Jaw?
Whether you suspect you have a misaligned jaw, you’ve been diagnosed with malocclusion, or you’ve never had an orthodontic evaluation before, the team at Fresh Orthodontics can help.
Our local Brooklyn orthodontist, Dr. Khanna, will assess your teeth, jaw, and bite to find out what’s really going on, walk you through your options, and create a personalized treatment plan that fits your lifestyle.
Schedule a complimentary consultation with Dr. Khanna today to get started!
Sources:
- Institute for Quality and Efficiency in Health Care (IQWiG). (2023, February 13). Misaligned teeth and jaws: What are misaligned teeth and jaws? InformedHealth.org. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK553384/
- American Association of Oral and Maxillofacial Surgeons. (2021). Corrective jaw surgery. https://myoms.org/what-we-do/corrective-jaw-surgery/
- Aldayel, A. M., AlGahnem, Z. J., Alrashidi, I. S., Nunu, D. Y., Alzahrani, A. M., Alburaidi, W. S., Alanazi, F., Alamari, A. S., & Alotaibi, R. M. (2023). Orthodontics and temporomandibular disorders: An overview. Cureus, 15(10), e47049. https://doi.org/10.7759/cureus.47049
- Labunet, A., Iosif, C., Kui, A., Vigu, A., & Sava, S. (2024). Miniscrew-assisted rapid palatal expansion: A scoping review of influencing factors, side effects, and soft tissue alterations. Biomedicines, 12(11), 2438. https://doi.org/10.3390/biomedicines12112438
- American Association of Orthodontists. (n.d.). Orthodontic surgery: Enhancing your smile’s foundation. https://aaoinfo.org/treatments/orthodontic-surgery/
