Deep bite: Causes and treatment

An overbite (also known as a deep bite) is an extremely common oral condition. Mild to moderate deep bites that pose little risk of complications usually do not require correction. However, for severe cases or for cosmetic reasons, it is desirable to correct this situation to bring back a more complete smile. Correcting an adult overbite may take a little more time and patience as the jaw is fully developed. However, there are several effective treatment options for people of all ages. Here, this article will help you understand what a deep bite is, what causes it, and the most effective treatments.

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• 1. What is a deep bite?
• 2. Distinguish between deep bite, overbite and reverse bite 
• 3. Causes of deep bite
• 4. The severity of the condition
• 5. Complications of a deep bite
• 6. Treatments 

1. What is a deep bite?

The depth of bite is determined by the ratio of surface coverage of the maxillary incisors to that of the lower incisors in the vertical direction. Normal bite depth is 2 -3 mm. Biting depth increases when this level is exceeded. 

As increased bite depth contributes to occlusal abnormalities or is the result of malocclusion. This case is common in people with crowded, crooked teeth; or there is a mismatch between the size and position of the jawbone and teeth. 

Deep bite occurs in class II malocclusion. This type of malocclusion is more common but less common than type I (crowded incisors).

The orthodontist measures the depth of the bite on the percentage of coverage between the upper and lower teeth. Excessive biting can be 30%, 50% or 100%. The larger the percentage, the more severe the bite is and the more complex treatment is required.

The vast majority of underbites can be successfully treated with only the right orthodontic intervention: sometimes, some severe underbites may require oral surgery to achieve the best results, in addition to orthodontic care.

Deep bite was determined according to the longitudinal coverage of the 2 upper and lower incisors

2. Distinguish between deep bite, overbite and reverse bite 

• Key bite: 

When there is a horizontal space between the upper and lower incisors (sometimes called "protruding teeth"). People who are overbite may also be bitten too deeply.

• Bite back: 

When the upper incisors are positioned behind the lower incisors when the mouth is closed, instead of in front as in a normal bite. Another term for crossbite is used when the posterior teeth of the upper jaw are more lingual than the lower teeth.

3. Causes of deep bite

The cause of this condition can be genetic; or because of abnormalities in development (bad habits such as: tongue thrusting; excessive pacifier use or thumb sucking). Or a combination of the two. Excessive compression of the bone is the result of an uneven growth of the jawbone, which causes the teeth and jaw to develop improperly.

There are two causes of excessive deep bite, including:

• Due to the jawbone

The most common cause of overgrowth is the size and shape of a child's teeth and jaw (heredity). The jaw size may be too large or too little space for the teeth to align properly. If left untreated, this type of misalignment can also lead to crowded, crooked, or misaligned teeth.

• Due to teeth

Childhood habits that involve pushing the tongue against the back of the front teeth can cause a deep bite. These habits include: prolonged use of pacifiers and bottles; thumb sucking and tongue thrusting. If your child already has a genetic predisposition to deep bite, these habits can worsen the condition.

Other common causes include:

• Early loss of baby teeth, without restoration, can lead to misalignment.
• Breathing disorders, such as sleep apnea, are also associated with this form of malocclusion.
• At any age, nail biting and chewing on hard objects can lead to a deep bite.
• Excessive teeth grinding is one of the causes of a deep bite. This condition causes the lower teeth to touch the palate behind the upper teeth when the mouth is closed; damage the bone around the upper front teeth. This can lead to loss of upper front teeth and/or excessive tooth trauma.

4. The severity of the condition

5. Complications of a deep bite

Deep bites should be treated as soon as possible. If children are not treated early, they are more likely to need jaw surgery in adulthood. Over time, you may also experience severe pain, jaw problems, and oral health.  

Common complications of untreated overbite include:

• Increased risk of tooth decay

Children, adolescents and adults with deep bite; are more likely to have tooth decay. This is because enamel wears down faster, creating the perfect environment for tooth decay to form.

• Increased risk of gum disease

In a severe anterior bite, the lower incisors often come into contact with the gum line at the back of the upper front teeth. This can lead to receding gums. That's when gum tissue moves toward the apex and exposes more of the tooth's roots. Gum disease, such as gingivitis or periodontal disease, is more likely to develop.

• Severe jaw pain & temporomandibular disorder (TMJ)

TMJ causes severe pain and dysfunction in the jaw and the muscles that control jaw movement. Without treatment for an excessively deep bite, TMJ can form over time. Common symptoms include: pain in the jaw, neck, and face, stiffness, headaches, and earaches.

 Other complications when left untreated include:

•  Difficulty chewing, speaking and swallowing
•  Severe headache and discomfort
•  Crooked teeth and changes in mouth structure

6. Treatments 

The choice of treatment depends on: the age of the patient, the severity of the deviation, and the cause of the bone or teeth. The earlier an overbite is corrected, the less likely it is to develop: cavities, gum disease, and TMJ. Orthodontists recommend waiting until a child is seven years old to seek treatment (when baby teeth begin to fall out and permanent teeth erupt). Adults can still get treatment, but options are limited because the teeth and jaw are fully developed. Depending on the individual patient, surgery is usually necessary for adults.

Common treatment options for an overbite include:

• Tooth extraction

Extracting baby teeth is a common treatment option for young children. If your child has a smaller jaw, extraction will make room for the permanent teeth to align. Orthodontists do not recommend removing permanent teeth in adults. Although, in severe cases, it may be necessary to have the tooth extracted to allow the tooth to move easily.

• Braces

Braces help to successfully treat most overbite and underbite conditions. These orthodontic appliances apply gentle pressure to align the teeth into the correct alignment. Braces treatment lasts from 18 months to three years. The use of an intraoral adjunct appliance (Herbst device), in combination with braces, is also common.

• Clear tray braces

 If you are looking for a more cosmetic treatment option, clear aligner braces may be a good option for you. Consult your dentist to see if you are a good fit for this treatment

• Headgear facial device

In addition to braces, a headgear may be necessary in the treatment of a deep bite. This type of cap consists of a strap that goes around the patient's neck and attaches to the patient's brackets. The device helps to hold the patient's teeth and upper jaw in the correct position while the lower jaw shifts forward.

• Jaw surgery (Orthopedic surgery)

Jaw surgery is a complex and expensive treatment option. Adults with excessive protrusion and fully developed jaws often require surgery. Orthopedic surgery will include steps such as: examination, X-ray and general anesthesia. Then the jaw bone will be cut, shaped and repositioned by the oral surgeon. This type of surgery is aimed at orthopedic; requires a collaborative treatment between an orthodontist and an oral surgeon. 

In addition to being expensive, it can also take several months to recover. Fortunately, most cases of deep bite do not require surgery and can be effectively managed using one of the above treatments. 

• Maintenance Instrument

Although retainers cannot correct an overbite; but they are very important to maintain results after orthodontic treatment of deep bite. Whether with braces or clear aligners, you will be asked by your doctor to wear appliances to maintain the results of your treatment. Your orthodontist will schedule a follow-up visit in 6 months to monitor your results. Make sure you always use your retainer correctly so that the overbite doesn't come back. 

A deep bite can cause many dental and cosmetic problems. However, with the help of dental treatments such as orthodontics, surgery, .. this problem will almost be overcome. Ideally, treatment should be initiated as soon as possible to avoid the consequences of prolonged deep bite. In all cases, you should consult with your dentist to determine the best treatment plan for you. 

Doctor Truong My Linh