Reasons for Treatment

Common Problems | TMJ | Thumb Sucking | Tongue Thrusting

Common Problems

When a person’s teeth or jaw structure do not fit together properly, orthodontic treatment may be necessary to straighten teeth and promote ideal function. These problems, often referred to as malocclusions (or bad bites), can cause speech difficulty, premature wear of the teeth and protective enamel and even increase the chance of injury to teeth and jaw joints, if left untreated. Below are actual photographs of patients treated in our office.


In an underbite, the lower jaw extends out, causing the lower front teeth to sit in front of the upper front teeth.

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Spacing problems may be caused by missing teeth or they may only be a cosmetic issue.

Before After

Upper Front Teeth Protrusion

The appearance and function of your teeth are impacted by upper front teeth protrusion. It is characterized by the upper teeth extending too far forward or the lower teeth not extending far enough forward.

Before After


Crowding occurs when teeth have insufficient room to erupt from the gum. Crowding can often be corrected by expansion, and many times, tooth removal can be avoided.

Before After


In a crossbite, the upper teeth sit inside the lower teeth, which may cause tooth stratification and misaligned jaw growth.

Before After


In an overbite, the upper front teeth extend out over the lower front teeth, sometimes causing the lower front teeth to bite into the roof of the mouth.

Before After


Proper chewing is impacted by an openbite, in which the upper and lower front teeth do not overlap. Openbites may be caused by habits such as thumb sucking or tongue thrusting.

Before After

Dental Midlines Not Matching

Dental midlines that do not match are evident when the back bite does not fit and match appropriately. This may negatively impact jaw and proper dental function.

Before After

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The “Temporomandibular Joint,” more commonly referred to as the “jaw joint,” assists in the basic opening and closing movements of the jaw. Unfortunately, this joint is a common area for recurring pain. Although conventional wisdom suggests that “popping” sounds in the jaw indicates a TMJ dysfunction, this is not always true. Many times, your jaw is functioning properly even if a “popping” sound is present when chewing or talking.

We offer a TMJ exam that evaluates the joint tissue in the “hinge” of the jaw. Possible problems include swelling, deterioration of the joint tissue or damaged joint tissue (which cushions the jaw bones during the opening and closing movement of the mouth). Common pain relievers and cold compresses can provide temporary relief for most cases of TMJ.

For more serious cases of TMJ, we will recommend alternate treatments. Often, we will suggest using a mouth guard to relieve teeth grinding. In some cases, we will instruct you to use orthodontic appliances or retainers to alleviate discomfort or redirect positioning of the TMJ joint. For the most severe cases of TMJ, we may recommend certain invasive procedures.

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Thumb Sucking

You may be concerned about your child’s thumb sucking and wonder if it is harmful, at what age your child should stop, or what could happen if your child doesn’t stop.

Sucking is a natural reflex that relaxes and comforts babies and toddlers. Children usually cease thumb sucking when the permanent front teeth are ready to erupt. As infants get older, the sucking "sensation" can serve many purposes. Sucking a thumb or finger or pacifier or anything within reach can make a baby feel secure and happy. Young children may also suck to soothe themselves and it can help induce sleep. Typically, children stop between the ages of 2 and 4 years.

But over time, sucking can cause problems with the alignment of the teeth as well as cause changes to the roof of the mouth. Thumb sucking that persists beyond the eruption of primary teeth can cause improper growth of the mouth and misalignment of the teeth.

The length and the intensity of the sucking are two main factors that determine the severity of the dental problems that may result. For example, if a child just rests their thumb passively in their mouths, he or she is less likely to develop problems in contrast to a child who vigorously sucks a thumb or other item. If you notice prolonged and/or vigorous thumb sucking behavior in your child, please talk to your dentist.Regardless, if you detect changes in your child’s teeth you should consult your dentist to evaluate the specific situation.

Tips to Stop Thumb Sucking

  • It is important to praise children for not sucking, rather than to scold them when they are.
  • Children often suck their thumbs when feeling insecure or when they need comfort. Focus on correcting the cause of the anxiety and provide comfort to your child.
  • For an older child, involve him or her in choosing the method of stopping.
  • In our office, our philosophy is to offer encouragement to a child and explain what could happen to their teeth if they do not stop sucking.

If the above tips don’t work, remind the child of their habit by bandaging the thumb or putting a sock on the hand at night. There are also over-the-counter paint-on bitter medications to coat the thumb as a deterrent.

We have also found that the book "David Decides", written about ideas to stop thumb sucking, can be effective in stopping thumb sucking in children. This book is readily available at bookstores and online at sites like

One solution to thumb sucking is an appliance called a "fixed palatal crib." This appliance is put on the child's upper teeth by an orthodontist. It’s placed behind on the upper teeth on the roof of the mouth. The crib consists of semicircular stainless steel wires that are fastened to molars using steel bands. The stainless steel wires fit behind the child's upper front teeth, and they are barely visible. The crib usually stops the habit of thumb sucking within the first day of use.

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Tongue Thrusting

Tongue thrusting occurs when the patient presses his or her tongue against the front teeth, usually when swallowing, speaking or resting the tongue. If thrusting is constant, this can cause problems with teeth alignment and must be fixed. A significant percentage of orthodontic patients have some form of tongue thrust habit that caused the displacement of their teeth and/or affected jaw development causing them to need braces. Persistence of a tongue thrust may prolong orthodontic treatment, prevent correction or cause relapse of the orthodontic result.

We prefer to correct tongue thrusting by giving patients a tongue thrusting appliance. This appliance, similar to a mouth guard, is usually worn at night. Other times, a more permanent appliance is prescribed and can be only be adjusted by our office.

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