Most people know they want a straighter smile — but fewer know exactly what’s causing the issue or how it’s typically treated. Orthodontic conditions range from simple crowding to complex bite relationships, and the right treatment depends entirely on what you’re actually dealing with. This guide covers the seven most common orthodontic conditions, what each one means, why it matters beyond appearance, and how it’s typically treated.
The first step in any orthodontic journey is understanding what you’re working with. Many patients come in with a general sense that something isn’t right — teeth feel crowded, the bite doesn’t feel even, or they’ve been told they have an overbite but aren’t sure what that means. This guide is designed to give you a clear, plain-language picture of the most common orthodontic conditions before you walk in for a consultation.
| 01 — Crowding
What it is: Crowding occurs when there isn’t enough space in the jaw for all the teeth to fit properly. Teeth overlap, rotate, or get pushed out of alignment as they compete for space. It’s the most common orthodontic condition and affects both children and adults. Why it matters beyond appearance: Crowded teeth are harder to clean effectively. Toothbrush bristles and floss can’t reach the surfaces between overlapping teeth, which increases the risk of cavities, gum disease, and long-term tooth loss. Beyond hygiene, significant crowding can affect bite function and the wear pattern of teeth over time. How it’s typically treated: Braces or Invisalign® are both highly effective for crowding. For children, palatal expansion may be used first to create space before full treatment. The degree of crowding determines whether teeth need to be extracted to create space — a decision Dr. Mansour evaluates carefully and conservatively. Good candidate for: Braces (metal or ceramic) or Invisalign® depending on severity. WildSmiles® for children who want designer bracket options. |
| 02 — Spacing and Gaps
What it is: Spacing issues occur when there is too much space between teeth — either a single gap between two teeth (most commonly the upper front teeth) or generalized spacing throughout the mouth. Spacing can result from teeth that are naturally smaller than the jaw, missing teeth, or habits like thumb sucking. Why it matters beyond appearance: Gaps between teeth trap food and can contribute to gum irritation over time. Larger gaps can also affect speech and chewing efficiency. For many patients, the primary concern is cosmetic — but closing gaps often improves bite function as well. How it’s typically treated: Braces or Invisalign® close gaps by moving teeth together. The approach depends on the size of the gaps and the overall bite relationship. For single gaps between front teeth, Invisalign® is often highly effective and produces excellent cosmetic results. Good candidate for: Invisalign® (especially for single front gaps) or braces for generalized spacing. |
| 03 — Overbite
What it is: An overbite occurs when the upper front teeth overlap the lower front teeth vertically by more than the normal amount — typically defined as more than 2–3mm of overlap. A deep overbite means the upper teeth significantly cover the lower teeth when biting down. This is one of the most common bite issues treated in orthodontics. Why it matters beyond appearance: A significant overbite puts excessive stress on the front teeth and can cause the lower front teeth to bite into the roof of the mouth (palate). Over time, this wears down tooth surfaces and can contribute to TMJ symptoms, jaw pain, and headaches. Deep overbites that are untreated in childhood often become harder to correct in adulthood. How it’s typically treated: Overbites are corrected through a combination of tooth movement and bite repositioning. Braces with elastics are one of the most effective treatments — the elastics apply force that moves the upper and lower jaw into a better relationship. Invisalign® with mandibular advancement features can also be effective for overbite correction in appropriate cases. For children, early treatment during jaw growth can produce better outcomes. Good candidate for: Braces with elastics for most cases. Invisalign® with mandibular advancement features for selected adult cases. Phase 1 treatment for children. |
| 04 — Underbite
What it is: An underbite occurs when the lower teeth sit in front of the upper teeth when biting down — the opposite of the normal bite relationship. It can involve just the front teeth or the entire bite, and may be caused by the position of the teeth, the jaw, or both. Why it matters beyond appearance: Underbites place abnormal stress on the front teeth and jaw joints. They can cause uneven tooth wear, chewing difficulties, and speech issues. Significant underbites often have a skeletal component — meaning the lower jaw is positioned too far forward relative to the upper jaw — which becomes harder to treat as growth stops. How it’s typically treated: For children, early treatment during the growth phase can guide jaw development and reduce the skeletal component of the underbite — sometimes eliminating the need for jaw surgery later. For adults with mild to moderate underbites, braces or Invisalign® can address the tooth position component. Significant skeletal underbites in adults may require a combination of orthodontics and orthognathic (jaw) surgery for complete correction. Good candidate for: Phase 1 intervention for children during growth. Braces or Invisalign® for tooth-position underbites in adults. Surgical referral for skeletal cases. |
| 05 — Crossbite
What it is: A crossbite occurs when one or more upper teeth sit inside (rather than outside) the lower teeth when biting. It can affect the front teeth (anterior crossbite) or the back teeth (posterior crossbite), and may involve one tooth or several. A posterior crossbite often causes the jaw to shift to one side when biting, which can be easy to miss without a clinical evaluation. Why it matters beyond appearance: A crossbite that causes the jaw to shift creates asymmetric forces on the jaw joints and facial muscles. Left untreated, it can contribute to uneven jaw development in children, facial asymmetry over time, and TMJ symptoms. Early treatment — during childhood when the jaw is still growing — is particularly effective for crossbite correction. How it’s typically treated: For children, palatal expansion is often the treatment of choice for posterior crossbites, widening the upper jaw to correct the width discrepancy. For anterior crossbites, partial braces may be used. For adults, braces or Invisalign® can correct tooth-position crossbites. Skeletal crossbites in adults may require surgical-assisted expansion. Good candidate for: Palatal expander for children with posterior crossbite. Braces or Invisalign® for tooth-position crossbites. Surgical options for adults with skeletal crossbite. |
| 06 — Open Bite
What it is: An open bite occurs when the front teeth don’t touch when the back teeth are closed together — there’s a visible gap between the upper and lower front teeth even when biting down. Open bites can be caused by habits like thumb sucking or tongue thrusting, jaw growth patterns, or a combination of factors. Why it matters beyond appearance: An open bite makes biting into food with the front teeth difficult or impossible. It often leads to compensatory habits — patients unconsciously adapt their bite and chewing patterns, which can increase strain on the back teeth and jaw joints. Open bites caused by tongue posture or thrust tend to be more challenging to maintain after treatment without addressing the underlying habit. How it’s typically treated: Braces are generally more effective than Invisalign® for open bite correction, particularly significant cases. Habit appliances may be used for children whose open bite is driven by thumb sucking or tongue thrust. For skeletal open bites in adults, orthognathic surgery may be required for complete correction. Good candidate for: Braces for most cases. Habit appliances for children. Myofunctional therapy referral when tongue posture is a contributing factor. |
| 07 — Relapse (Teeth That Have Shifted After Previous Treatment)
What it is: Relapse occurs when teeth shift back toward their original positions after orthodontic treatment — most commonly because retainers weren’t worn consistently after treatment ended. It’s one of the most common reasons adults seek orthodontic treatment, and it’s more treatable than many people assume. Why it matters beyond appearance: Beyond the cosmetic issue, relapse can undo the bite correction achieved during the original treatment. A bite that was properly aligned and then relapsed may cause the same wear patterns, TMJ stress, or hygiene challenges that motivated treatment in the first place. How it’s typically treated: Relapse cases often require less movement than the original treatment, which means shorter treatment time and typically lower cost. Invisalign® is frequently the most efficient option for relapse cases, particularly when the degree of shifting is mild to moderate. Commitment to retainer wear after re-treatment is essential — the SPOCS 5-year Retainer Program is designed specifically for this. Good candidate for: Invisalign® for mild to moderate relapse. Braces for more significant relapse. 5-year Retainer Program enrollment strongly recommended at debanding. |
How Do I Know Which Condition I Have?
Some orthodontic conditions are obvious from a quick look in the mirror — a gap between front teeth, visible crowding, or a lower jaw that juts forward. Others — like a posterior crossbite that causes the jaw to shift, or a deep overbite that’s contributing to TMJ symptoms — require imaging and a clinical assessment to identify correctly.
Many patients have more than one condition at the same time. Crowding and an overbite are frequently seen together. A crossbite often accompanies a narrow palate and crowding. The treatment plan addresses the full picture, not just the most visible issue.
The only accurate way to know what you’re dealing with is a proper evaluation — which includes clinical photography, CEPH and panoramic X-rays, and a hands-on exam. At SPOCS, this is all included in a complimentary consultation at no charge.
One More Thing Worth Knowing
Orthodontic conditions that seem purely cosmetic often have functional consequences that become more significant over time — bite wear, TMJ stress, hygiene challenges, and jaw development issues. The best time to evaluate is before a condition worsens. For children, the AAO recommends a first evaluation by age 7. For adults, there is no age at which an evaluation stops being worthwhile.
Not sure what type of orthodontic case you have? Book your complimentary evaluation at SPOCS — includes CEPH + PANO imaging at no charge. Call 727-242-8000 or schedule online. No referral needed.
