Childhood Malocclusion: Causes, Early Symptoms, and Orthodontic Advice
Malocclusion is among the leading reasons children seek dental care. Its formation is influenced by a complex interplay of factors, including daily habits, breathing patterns, nutrition, and the overall development of the maxillofacial complex. For this reason, modern orthodontic assessment is no longer viewed simply as a step toward an attractive smile — it is an essential component of ensuring long-term health, proper function, and overall well-being.
What is occlusion?
In a physiologically correct occlusion, the upper incisors slightly overlap the lower ones (typically by 2–4 mm), while the posterior teeth meet in a way that allows effortless chewing, biting, and speech.
When this harmony is disrupted, the consequences extend far beyond appearance. Altered occlusion can affect breathing efficiency, jaw functionality, facial proportions, articulation, and the child’s general quality of life.
Orthodontist Nina Arutinova points out that malocclusion usually stems from two major origins: intrinsic and external.
- Genetic factors: According to Dr. Arutinova, heredity accounts for up to 80% of all bite-related anomalies. A child may inherit jaw structure, the configuration of dental arches, and a number of growth characteristics that determine how their occlusion develops;
- External influences: Among the most detrimental functional habits is mouth breathing. When it becomes persistent, it gradually alters tooth position, reshapes facial features, and negatively impacts overall health.
Under healthy conditions, a child should breathe through the nose — illness is the only acceptable exception. This makes it essential for parents to observe the child’s breathing throughout the day: during sleep, play, and rest. Special attention should be given to signs of sleep apnea, when breathing momentarily pauses and then restarts.
Dr. Arutinova also emphasizes that bruxism, or involuntary grinding of the teeth, is extremely common in childhood. Although it was once thought to be related to parasitic infections, modern scientific evidence has fully disproven this notion. Current research indicates that bruxism is closely linked to the functional development of the maxillofacial region as well as the child’s psycho-emotional state.
A variety of factors influencing neurosomatic regulation can contribute to bruxism, including:
- Family or social stress, which raises muscle tension and disrupts sleep quality;
- Emotional strain and anxiety, particularly prominent in preschoolers and children entering school;
- Periods of rapid physical growth, during which the body undergoes adaptation that may temporarily increase activity in the masticatory muscles.
In clinical practice, bruxism during the mixed dentition phase is often regarded as a physiologically normal phenomenon. As primary teeth are replaced by permanent ones, the spatial relationship between the jaws naturally shifts. This transitional process may be accompanied by a characteristic crunching or grinding sound. Treatment is generally not required unless the habit causes discomfort, disturbs sleep, or leads to additional symptoms.
When should a child visit an orthodontist?
Dr. Arutinova recommends scheduling the first orthodontic evaluation at around six years of age, when the first permanent molars begin to erupt. This stage is particularly important, as the jaws are experiencing active growth and the foundation of the permanent bite is being established.
During the initial appointment, the orthodontist conducts a comprehensive, interdisciplinary assessment of the maxillofacial region, evaluating:
- Dental and oral structures: the shape of the dental arches, tooth inclination, proportional relationships, and alignment;
- Facial symmetry and profile: the balance between the jaws, muscular harmony, and overall morphology;
- Breathing patterns and tongue posture: whether nasal or mouth breathing predominates, and how the tongue functions at rest and during swallowing.
Timely evaluation makes it possible to identify irregularities at an early stage, when correction is typically simpler and more effective.
How parents can recognize the early signs of malocclusion
While the final diagnosis must be made by a qualified orthodontist, parents can look for several warning signs:
- Reduced nasal breathing that gradually shifts to habitual mouth breathing;
- Disturbed sleep or snoring, often linked to partial airway obstruction;
- Difficulties with sound articulation or persistent speech irregularities;
- A mismatch between the midline of the face and the midline of the teeth.
If these symptoms appear regularly, it is advisable to consult a specialist sooner to prevent the condition from progressing.
Why early assessment matters?
Occlusal correction is most effective in early childhood, when the maxillofacial structures are still developing and can be guided more easily. That said, modern orthodontic technologies also make it possible to treat adults successfully — the process may simply require more time.
Early referral to an orthodontist helps minimize the need for complex interventions in the future, reduces the overall duration of treatment, and supports the proper development of the bite along with harmonious facial growth.
