How to ensure your child’s teeth grow properly

Malocclusion is many a times a cosmetic problem that can affect a person’s self-esteem. In addition, crooked teeth are difficult to keep clean hence there is a risk of tooth decay, gum disease, or loss of teeth. Severe malocclusion can cause difficulties in eating and speaking.PHOTO | FILE

What you need to know:

  • Malocclusion is the imperfect positioning of teeth implying that teeth arrangement is crooked or one has a poor bite.
  • Dental malocclusions can be caused by external factors such as injury or by internal factors such as genetics

Occlusion is defined as the position of teeth when the jaws are closed. Normally, teeth should fit easily in the mouth without spacing or crowding, with the front upper teeth sitting slightly in front of the lower front teeth. Malocclusion is the imperfect positioning of teeth implying that teeth arrangement is crooked or one has a poor bite.

According to Dr Johnson Wambugu, a dentist, malocclusion occurs when teeth are not aligned in their correct position or there is a problem with jaw size hence teeth may drift out of place. Jaws normally give space and support to the teeth.

Malocclusion is many a times a cosmetic problem that can affect a person’s self-esteem. In addition, crooked teeth are difficult to keep clean hence there is a risk of tooth decay, gum disease, or loss of teeth. Severe malocclusion can cause difficulties in eating and speaking.


Dear Doc,

My teeth do not fit properly in my mouth. What is the cause of this?



Dear Gwen,

What you probably have is a form of malocclusion. There are several causes of malocclusion and are classified as either extrinsic or intrinsic factors. Extrinsic factors include hereditary (where malocclusion runs in the family), birth defects such as cleft lip and palate, trauma during or after birth caused by injury when learning how to walk, poor posture like in the case of children who are stoop-shouldered, diseases like tonsilitis, malnutrition, and respiratory conditions like asthma where a child breathes through the mouth.

Some childhood habits can also cause malocclusion. For example thumb-sucking, nail or lip biting, tongue thrusting, long-term use of pacifiers and prolonged bottle feeding. However, once the sucking habit or pacifier use has been stopped, the teeth naturally start returning to their normal positions.

Intrinsic factors include too much space that causes spacing and drifting of teeth or too little room that causes crowding for teeth, abnormal number of teeth — having six incisors instead of the normal four, abnormal tooth size or shape, premature loss of milk teeth, delayed eruption of permanent teeth, improper dental restorations such as crowns, a thick lowly attached frenum (a fold of tissue that connects tongue or lip to the jawbone), and prolonged retention of milk teeth. The milk teeth thus should be removed at the correct age so as to create space for permanent teeth.


Dear Doc,

My daughter had perfect milk teeth. However, when she shed her milk teeth, I realised the permanent ones were crowded. I am worried that may affect her beauty. Are there treatments for this kind of problem?

Mama Tess


Dear Mama Tess,

First let me assure you that crowding of teeth is a common problem among children. There are different types of treatment available depending on what caused the malocclusion. For example, some children may need functional appliances to correct or modify jaw growth during growth spurts.

This is a period of time when a child’s height, bone, and muscles increase rapidly and it is most obvious during infancy and teenage years of 11 years for girls and 13 years for boys. Other children may require some procedures to intercept the problems as early as between seven to 10 years.

The treatment may also involve extracting some teeth to create space in case of tooth size- jaw size discrepancy. However, permanent teeth are rarely removed unless it is absolutely necessary. Braces are usually used to correct most malocclusions.

An early intervention of treatment with partial braces can be done at the age of nine when crowding is little to align the permanent teeth. More comprehensive treatment is usually done at age 12 when all milk teeth have been lost and the child can wear full braces.

Braces work better for children because they are still growing. They work by slowly correcting bites by moving teeth to the right position. Treatment can take 18-24 months but adjustments need to be done every six to eight weeks.

Braces can also be used to straighten an adult’s teeth. However, problems related to jaw size and form are usually corrected through surgery. Because teeth tend to naturally drift out of place even after wearing braces, a device known as retainer is put in the mouth to prevent teeth from moving back to their original position.


Dear Doc,

I have crooked teeth and I am concerned that my children will be affected too. How can I prevent this and can a dentist help?

Worried Parent


Dear worried Parent,

The problem of malocclusion can be very difficult to prevent especially if it is as a result of genetics. However, preventing some childhood habits such as thumb sucking and limiting the use of pacifiers and bottle-feeding may help reduce problems in jaw development. Additionally, detecting malocclusion early enough can help reduce severity and the length of treatment required to correct the problem. Children should also have their first orthodontic visit at the age of five to six years.

This can help intercept problems of malocclusion such as cross bites early. The dentist checks whether all teeth are present and that they are following the correct path of growth. He or she will also supervise the loss of milk at the correct times. For example, a milk molar tooth should not come out before age of eight to nine.

A space-maintainer may be used in cases of premature loss of milk teeth due to tooth decay or injury. This is an appliance that is placed on the neighboring tooth following loss of a tooth to keep it from drifting into the resulting space after the extraction.

Another evaluation should be done between ages eigh to nine years to ensure that canines, especially the upper ones are growing in their right position. Annual checkups also help diagnose any problem early.



A normal occlusion or normal bite

The way lower and upper teeth sit when the jaws are put together. Normal fit is when the upper teeth sit slightly forward over the lower teeth and there are no spaces or crowding when the teeth bite together. 


This occurs when there is too much space resulting into gaps between the teeth. The spacing may be because of jaws being bigger than normal or smaller teeth than normal. A good example is the space in the front, upper incisor teeth also known as diastemma. 

Crowded teeth

This occurs when there is little space for all teeth to fit in the jaw due to smaller jaw size or larger teeth than the existing space in the jaw. The teeth are therefore displaced or may be in a twisted position. 

An Overjet

This is the distance between the edges of the upper teeth and the lower teeth when the jaws are put together. The normal space between lower and upper teeth when they overlap is about 2-4mm. However, this space can go beyond 4mm hence the overjet is increased and the teeth seem protruded. This may signify a skeletal problem such as a small lower jaw or a large upper jaw. 

Cross bite

A cross bite is also known as a reverse overjet. This is when one or more of the upper teeth fit or bite on the inner side of the lower teeth.  It can happen in the front and/or in the sides of the mouth. 

A Deviated midline

This is when the front middle line between the upper front teeth does not match with the middle line of the lower front teeth. 

An overbite

This is the overlapping of the lower teeth by the upper teeth. The normal overbite is about 3-5mm (about 20-30% of the height of the lower incisors). 

A deep bite

This means the overbite is too large almost covering the whole of lower teeth. Often, the lower incisors cannot be seen and in serious cases they may bite into the roof of the mouth. 

An Open bite

This occurs when teeth do not overlap or the lower and upper incisors do not meet when biting hence creating a gap directly into the mouth. In this case there is no overbite. 

Congenitally missing teeth

This is the nonexistence of a tooth or teeth that should naturally be present. Lack of tooth development, trauma like injury, as well as other hereditary factors can cause missing teeth. 

Impacted tooth

This is a tooth that gets blocked as it erupts or pushes through the gum. The impacted tooth stays stuck in the gum tissue.  It can be as a result of poor positioning of the developing tooth bud hence the tooth does not erupt in its proper position. Wisdom teeth (the third set of molars) are usually the most impacted teeth though premolars and canines can also be impacted. Crowding of teeth or premature loss of primary teeth can cause impacted teeth. 

Teeth transposition

Transposition means that the tooth has erupted in another tooth’s space. It most times happens if there are disturbances during eruption of the tooth. 

Teeth Rotation

This occurs when a tooth twists or tips out of the normal position.

There are orthodontic treatments available to correct these problems. Various orthodontic procedures help correct the way teeth and jaw line up and consequently improve appearance.

Therefore, all children need to have an orthodontic review by age five to six years. This will help identify presence of malocclusion and the right treatment is given on time.


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