Anterior open bite – detailed

➤ Thumb or digit sucking open bite

• Thumb or digit sucking causing a dental open bite should be corrected in early treatment if the child is motivated to stop their habit (Cobourne and DiBiase 2010)

➤ Tongue thrusting open bite

• A true tongue thrust needs to be managed in early treatment with a multidisciplinary approach. A referral to a speech pathologist and orthodontist is recommended.

➤ Ectopic incisors

• Ectopic incisors can sometimes cause a dental open bite and should be managed in early treatment. The reasons for the ectopic incisors are discussed in their dedicated page.

➤ Airway or associated problems requiring treatment

• Other associated problems are upper airways resistance from hypertrophied adenoids, tonsils or chronic rhinitis.
• These patients become obligatory mouth-breathers and often have transverse deficient maxilla with posterior crossbites. These conditions need referral to an orthodontist and ENT.

Trouble incising food

• Often a chief concern and treatment indication is the inability to incise foods with the front teeth due to the lack of anterior occlusion.

Difficulties with speech

• Anterior open bites are often associated with speech difficulties. lisping and abnormal tongue function. This can be a significant disability to the patient requiring treatment.

Appearance of the open bite

• A mild anterior open bite is rarely a cause of concern to the patient, however it can be to the parents.
• A severe open bite accompanied with facial features as seen in extra-oral features will often be a significant concern to both the patient and parents.

Severity of the open bite

• There is no strict guideline on the severity of an open bite to treat/refer.
• IOTN (Brook and Shaw 1989) rates an open bite >1mm as mild, >2mm as moderate, >4mm as severe need of treatment/referral.

Skeletal open bite

• A skeletal open bite is where there are hyperdivergent maxilla and mandible skeletal planes (Sassouni 1955). A dental open bite may be present if the dentoalveolous has not been able to compensate for the skeletal open bite.
• Treatment via referral to an orthodontist is indicated depending on the severity of the facial appearance or dental open bite.

Airway or associated problems requiring treatment

• Other associated problems are upper airways resistance from hypertrophied adenoids, tonsils or chronic rhinitis.
• These patients become obligatory mouth-breathers and often have transverse deficient maxilla with posterior crossbites. These conditions need referral to an orthodontist and ENT.