Skeletal vs. Dental Orthodontic Problems: What’s the Difference?


Straightening crooked teeth or improving a bad bite (malocclusion) is a job that is usually handled by an orthodontist. But in order to solve certain types of bite problems, an orthodontist sometimes needs to team up with another type of dental specialist: an oral surgeon. Whether or not this is necessary largely depends on whether the problem is dental or skeletal in nature. What’s the difference?

An orthodontic problem that has a dental origin means that only the teeth are out of alignment. That means the problem can be solved simply by moving the teeth into better positions – usually, with braces or another type of orthodontic appliance. An example would be if your front teeth are tilted towards each other or there is a gap between them.

Some bite problems, however, are skeletal in nature – meaning that they result from the alignment of your jaws. For example, a severe underbite (where the top teeth bite inside the bottom teeth instead of over them) can result from a lower jaw that’s too far forward. A deep bite, where the upper teeth cover all the lower teeth, may mean the lower jaw is too far back. And some cases of overcrowding result from jaws that are simply too small to accommodate the teeth. What can be done about problems like these?

The solution may depend on how old the person is when they seek treatment. Skeletal orthodontic problems are not a simple matter to fix—but they are much easier to deal with when treatment starts before jaw growth is complete. Most children experience a major growth spurt that occurs around the time of puberty (which is different for every child). If the problem is identified before then, the child can benefit from a type of treatment called “interceptive orthodontics”—yet another reason why all children should be seen by a dentist regularly!

Interceptive treatment is performed by an orthodontist using special appliances—for example, headgear and/or palatal expanders—that can influence the way in which the jaws will grow. Headgear appliances can pull a developing jaw forward, or hold it back; palatal expanders can widen the roof of the mouth (palate) so that there is more room to accommodate teeth that have yet to grow in. Both of these devices are used in conjunction with braces.

For an adult who has stopped growing, treating a skeletal problem may require jaw (orthognathic) surgery. In this procedure, which is performed in a hospital by an oral surgeon, the fully developed jaw is actually repositioned. Dental orthodontic problems in adults, however, can usually be treated simply with braces or clear orthodontic aligners.

Sometimes bite problems result from a combination of dental and skeletal issues, and the teeth may need to be realigned with braces by an orthodontist before any jaw surgery is performed.

But no matter what the cause, it’s hard to overstate how beneficial the transformation in a person’s appearance can be, how much better their bite will function, and how dramatically their confidence can be lifted in the process.

If you are concerned about bite problems in yourself or your child, schedule an appointment with your family dentist. He or she can let you know whether the problem is dental or skeletal (or both), and refer you to the appropriate specialist.


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