How Orthodontists Evaluate Your Bite and Facial Structure

Most people think of orthodontics as simply straightening crooked teeth. In reality, an orthodontic evaluation looks at much more than the appearance of your smile.

Orthodontists assess how your upper and lower teeth fit together, how your jaws relate to one another, and how your teeth and jaws contribute to your facial proportions. These factors can influence chewing, speech, oral hygiene, tooth wear, comfort, and appearance.

If you’ve ever wondered whether your bite is developing normally, or you’ve noticed uneven tooth wear, difficulty biting, or changes in the way your jaws meet, understanding what an orthodontist evaluates can help you know when a professional assessment may be useful.

Why Your Bite Matters

Your bite, known clinically as your occlusion, describes the way your upper and lower teeth come together when you close your mouth.

In a well-functioning bite, the upper front teeth typically overlap the lower front teeth slightly, while the back teeth fit together in a stable and balanced way. Orthodontists also look at factors such as tooth position, arch shape, jaw relationships, and dental midlines.

When the teeth or jaws do not align properly, the condition is known as a malocclusion. Depending on its type and severity, malocclusion may contribute to:

• Uneven or excessive tooth wear
• Difficulty biting or chewing certain foods
• Tooth crowding that makes cleaning more difficult
• Increased risk of some dental problems when plaque is difficult to remove
• Speech difficulties in some cases
• Cheek or soft-tissue biting
• Changes in smile appearance or facial profile

Jaw discomfort may also occur in some people, although temporomandibular joint disorders, often referred to as TMD or TMJ problems, are complex and are not necessarily caused by a person’s bite alone.

An orthodontic evaluation helps determine whether a bite difference is simply a variation that does not require treatment or a problem that could benefit from correction.

Common Bite Problems an Orthodontist Identifies

Orthodontists evaluate several common types of bite and alignment problems.

Overbite or deep bite: The upper front teeth overlap the lower front teeth more than usual. In more severe cases, the lower teeth may contact the gum tissue or roof of the mouth.

Underbite: The lower front teeth sit in front of the upper front teeth when the mouth is closed. This can result from tooth position, jaw position, or a combination of both.

Crossbite: One or more upper teeth sit inside the lower teeth rather than outside them. Crossbites can occur in the front or back of the mouth and, in some cases, may be associated with a shift in the way the jaw closes.

Open bite: Some upper and lower teeth do not meet when the back teeth are together. Open bites can have several contributing factors, including tooth position, jaw growth patterns, tongue posture, or childhood oral habits.

Crowding: There is not enough space in the dental arch for the teeth to align normally, causing teeth to overlap, rotate, or erupt out of position.

Spacing: Excess space between teeth can occur because of tooth size, missing teeth, jaw size, or other factors.

Dental midline discrepancy: The center lines of the upper and lower front teeth do not align. A small difference may not be clinically significant, while a larger discrepancy can sometimes indicate differences in tooth position or jaw relationships.

How Facial Structure Fits Into the Evaluation

Teeth do not exist independently of the jaws and surrounding facial structures. For that reason, orthodontists evaluate facial proportions alongside the bite.

Several features may be considered.

Facial profile: From the side, an orthodontist looks at the relative positions of the forehead, nose, lips, and chin. A profile may appear relatively straight, more convex, or more concave depending in part on the relationship between the upper and lower jaws.

Facial symmetry: No face is perfectly symmetrical. However, noticeable differences between the left and right sides, such as the chin consistently shifting toward one side, may warrant further evaluation.

Lip position and closure: Orthodontists consider whether the lips rest together comfortably or whether noticeable effort is required to close them. Tooth position and jaw relationships can influence lip posture, although other factors may also contribute.

Vertical facial proportions: The height of the lower portion of the face is evaluated in relation to the rest of the face. Vertical growth patterns can influence both bite development and treatment planning.

Smile display: Orthodontists also look at how much tooth and gum tissue shows when you smile, how the teeth follow the curve of the lips, and whether the smile appears balanced with the rest of the face.

These observations do not determine treatment on their own. They are considered together with the bite, dental records, growth pattern, and the patient’s goals.

Signs That May Be Worth Discussing With an Orthodontist

You cannot accurately diagnose an orthodontic problem at home, but certain signs may justify a professional evaluation.

These include:

• Your upper and lower front teeth do not meet when you bite down
• Your lower front teeth sit in front of your upper front teeth
• You frequently bite your cheeks, lips, or the roof of your mouth
• Your teeth appear to be wearing unevenly
• Your jaw noticeably shifts to one side when you close your mouth
• You have significant crowding, overlapping teeth, or large spaces
• You have persistent difficulty biting or chewing
• Your jaw locks, becomes painful, or has limited movement
• Your chin or jaw appears noticeably shifted or asymmetric

Jaw clicking or popping by itself does not always indicate a problem that requires orthodontic treatment. However, persistent pain, locking, limited movement, or difficulty using the jaw should be evaluated by an appropriate dental or medical professional.

Frequent mouth breathing may also be worth discussing with a healthcare professional. Because it can have several possible causes, including nasal or airway issues, evaluation may involve a dentist, orthodontist, physician, or ear, nose, and throat specialist depending on the situation.

What Happens During an Orthodontic Evaluation

A comprehensive orthodontic assessment may include several steps.

1. Clinical examination

The orthodontist examines your teeth, bite, gums, jaw movement, and dental alignment. They may also assess how your jaws and teeth relate to your facial features.

2. Facial and dental photographs

Photographs help document your smile, profile, tooth alignment, and facial proportions. They can also provide a baseline for treatment planning and progress.

3. X-rays when clinically appropriate

A panoramic X-ray can provide information about the teeth, roots, jawbones, and developing teeth.

A cephalometric X-ray, which is a side-view image of the head, may be used to evaluate relationships between the teeth, jaws, and skull. Not every patient requires the same type of imaging, and the records used depend on the clinical situation.

4. Digital scans or impressions

Digital scans or traditional impressions create an accurate model of the teeth. These models allow the orthodontist to study tooth positions and plan potential movements.

5. Discussion of concerns and goals

Orthodontic treatment is not based on measurements alone. The orthodontist will also ask what concerns you most, whether that involves function, appearance, dental health, or a combination of factors.

One of the most important parts of the evaluation is determining whether a problem is primarily dental, involving the position of the teeth, or skeletal, involving the position or growth of the jaws.

That distinction can significantly affect the available treatment options.

Treatment Options Based on the Evaluation

Treatment recommendations depend on the person’s age, growth pattern, bite, tooth position, jaw relationships, and treatment goals.

Possible options may include:

• Traditional braces, which provide precise control over many types of tooth movement
• Clear aligners, which can treat many orthodontic problems when used in appropriately selected cases
• Palatal or maxillary expansion, which may be used in certain patients with a narrow upper dental arch or upper jaw
• Growth-modifying or functional appliances, which may be considered for selected growing patients
• Orthodontic elastics, which can help modify how the upper and lower teeth fit together during treatment
• Orthognathic, or corrective jaw, surgery combined with orthodontics, which may be considered for significant skeletal discrepancies, particularly after facial growth is complete

There is no single appliance that is best for every bite problem. Effective treatment depends on an accurate diagnosis before appliances or aligners are selected.

When Should You Get Evaluated?

Children: The American Association of Orthodontists recommends that children have an orthodontic checkup no later than age 7. This does not mean every child needs treatment at that age. An early assessment can help identify developing problems and determine whether monitoring or early intervention is appropriate.

Teens: Adolescence is a common time for comprehensive orthodontic treatment because many permanent teeth have erupted and growth may still be occurring.

Adults: Adults can also benefit from orthodontic treatment. Treatment may be considered to improve tooth alignment, bite function, oral hygiene, dental wear, or smile appearance. Orthodontics may also be coordinated with restorative or periodontal dental care when needed.

The Bottom Line

Your bite, teeth, jaws, and facial proportions are closely related, which is why an orthodontic evaluation involves more than checking whether the teeth look straight.

An orthodontist considers how your teeth fit together, how your jaws relate to each other, how your face is proportioned, and whether your current alignment is affecting function or dental health.

Some bite differences require treatment, while others may simply need monitoring or no treatment at all. A professional evaluation can help distinguish between the two and clarify which options, if any, are appropriate for your individual situation.