What Is an Open Bite?
An open bite means your front teeth don't touch when you bite down. There's a visible gap between upper and lower front teeth even when your back teeth are together.
Unlike overbite (vertical overlap) or underbite (jaw position), open bite is about a lack of vertical contact. You might have 2–6mm of space between front teeth when biting.
Why Open Bites Happen
| Cause | Age of Onset | Treatability | Notes |
|---|---|---|---|
| Tongue thrust | Childhood | Very treatable | Habit of pushing tongue between teeth |
| Mouth breathing | Childhood | Treatable with habit correction | Dry mouth changes palate position |
| Thumb sucking (past age 4) | Childhood | Treatable with habit stop | Prolonged sucking prevents tooth eruption |
| Skeletal open bite | Genetic (evident by adolescence) | Difficult; may require surgery | Jaw structure creates space |
| Vertical maxillary excess | Genetic | Usually requires surgery | Upper jaw too vertical |
| High-angle jaw pattern | Genetic | Difficult; may require surgery | Jaw grows downward excessively |
| Tongue size (macroglossia) | Birth | Very difficult; surgery often needed | Large tongue takes up mouth space |
| Airway obstruction | Childhood | Address underlying cause first | Mouth breathing to compensate for blocked nose |
Mild Open Bite (1–3mm gap)
Treatment approach: Braces + habit correction
Most mild open bites can be corrected with traditional orthodontic treatment:
- Duration: 18–28 months (longer than typical braces due to need for vertical control)
- Cost: $3,000–$7,000
- Method: Braces with special techniques to intrude upper front teeth and extrude lower front teeth, closing the gap
- Habits: Elimination of tongue thrust (with help from speech-language pathologist) is crucial
- Retention: High relapse potential—permanent retention (nighttime wear) is essential
Success rate: High if tongue thrust can be eliminated. Without habit correction, teeth may re-open.
Moderate Open Bite (4–5mm gap)
Treatment approach: Braces + habit correction + possible TMD evaluation
Moderate open bites still respond well to braces but require:
- Longer treatment duration (24–30 months)
- More precise vertical force control
- Possible speech-language therapy for tongue thrust
- Careful monitoring for TMJ issues (vertical malocclusion stresses TMJ)
Cost: $4,000–$8,000 Success: Good, but more dependent on habit change and compliance
Severe Open Bite (6mm+ gap)
Treatment approach: Often requires jaw surgery + braces
Severe open bites frequently have a skeletal (jaw structure) component. Braces alone can't change jaw structure.
Two-phase treatment:
Phase 1 (Braces Pre-Surgery): 12–18 months - Align teeth, correct root positions - Prepare teeth for surgical bite change - Cost: $3,000–$6,000
Phase 2 (Orthognathic Surgery): Single procedure - Upper jaw surgery (maxillary advancement or setback) - Lower jaw surgery if needed (mandibular advancement) - Reposition jaw to close the open bite permanently - Cost: $15,000–$30,000 (often partially covered by insurance as medical necessity)
Phase 3 (Braces Post-Surgery): 6–12 months - Fine-tune bite after jaw heals - Cost: $2,000–$4,000
Total timeline: 24–42 months from start to finish
Braces-Only Treatment for Open Bite
How it works: Special braces techniques focus on closing the vertical gap:
- Intrusion mechanics: Applying downward force on upper front teeth (unusual—normally teeth extrude)
- Extrusion mechanics: Lifting lower front teeth upward
- Vertical elastics: Special rubber bands pull front teeth together
- Precision wire sequences: Specific wires designed for vertical control
Challenges: - Teeth naturally resist intrusion (it's against normal eruption) - Treatment takes longer than standard alignment - High relapse rate if retention isn't perfect - TMJ stress from vertical force
When it works best: - Mild open bites (under 3mm) - Dental open bite (teeth are the problem, not jaw structure) - Young patients (still growing)
When it fails: - Skeletal open bite (jaw structure is the problem) - Severe gaps (6mm+) - Persistent tongue thrust habits - Poor retention compliance
Combination Approaches
Braces + Speech Therapy For children with tongue thrust causing open bite: - Orthodontist provides braces/expansion - Speech-language pathologist retrains swallowing and tongue position - Duration: 2–3 years (therapy often concurrent with braces) - Success: High if child is motivated and cooperative
Braces + Airway Management If open bite is secondary to mouth breathing: - Treat underlying cause first (allergies, nasal obstruction, sleep apnea) - ENT may intervene (nasal surgery, allergy treatment) - Then orthodontic treatment proceeds - Success: Better outcomes when airway is optimized first
Surgery vs. Non-Surgery Decision Matrix
| Factor | Favors Braces Only | Favors Surgery |
|---|---|---|
| Gap size | Under 4mm | 6mm+ |
| Jaw structure | Normal | Abnormal (high angle, vertical excess) |
| Age | Younger (still growing) | Older teen/adult (growth complete) |
| Skeletal pattern | Horizontal jaw | Vertical jaw |
| Cause | Habit, dental | Structural, genetic |
| Timeline tolerance | Can wait 2+ years | Want faster results |
| Cost tolerance | Limited budget | Can afford $15,000+ |
| Severity | Mild-moderate | Severe |
Long-Term Outcomes and Relapse
Open bite is the most relapse-prone malocclusion. Here's why:
- Tongue naturally pushes forward during swallowing (which happens 600+ times daily)
- Vertical space tends to open if not actively held closed
- Teeth naturally erupt (try to close the gap, which works against treatment)
- Habits are hard to break (tongue thrust returns if you're not vigilant)
Prevention: - Permanent or very-long-term retention (nighttime every night, indefinitely) - Fixed bonded retainers on lower front teeth - Vivera or rigid retainers (not soft ones, which allow relapse) - Speech therapy for ongoing habit reinforcement
Key Takeaway
Mild open bites respond well to braces (18–28 months), but severe open bites (6mm+) usually need jaw surgery plus braces (24–42 months total). The biggest challenge is preventing relapse—open bite recurs easily without lifelong retention.
If your orthodontist recommends braces for open bite, ask: 1. What's my specific gap size and cause? 2. Is this dental (teeth) or skeletal (jaw) open bite? 3. What's your success/relapse rate for cases like mine? 4. If braces don't work, would surgery be needed? 5. What retention plan prevents relapse?
Don't ignore open bite advice to treat it—early correction is much easier than severe open bite correction. And prepare for long-term retention; your teeth want to relapse, and you'll need to prevent it actively for years.