How to Fix an Open Bite: Causes, Treatment Options, and Cost
An open bite is a bite in which the front teeth do not touch when the back teeth are closed, leaving a visible gap. It is caused by habits such as thumb sucking or tongue thrust, by airway problems, or by jaw proportions. Correction combines orthodontics with addressing the cause, because an untreated cause reopens the bite.
Dr. Jenée Kaplan, DDS
Orthodontic residency and a Master’s degree at Loma Linda University. Member of the American Association of Orthodontists, the American Dental Association, and the California Dental Association.
What is an open bite?
In most bites the upper front teeth overlap the lower ones vertically. In an open bite that overlap is negative: with the back teeth fully closed, a gap remains between the upper and lower front teeth, and a patient can often pass their tongue through it without opening.
Open bites are usually anterior, at the front, but they also occur at the sides, where a few back teeth fail to meet. The front variety is the one patients notice, typically because biting into a sandwich or a slice of pizza does not work and they have learned to tear food with the back teeth instead.
This is the condition where cause matters most. An open bite is very often the visible result of a force applied thousands of times a day — a thumb, a tongue at rest in the wrong place, a mouth held open to breathe. Straightening the teeth without changing the force produces a correction that quietly reverses over the following years, which is why the assessment here extends beyond the teeth.
What causes an open bite?
- Thumb sucking and pacifier use
- The classic cause. A thumb between the front teeth for hours a day holds them apart and tips the uppers forward. If the habit stops early enough, the bite often recovers on its own; past about age five or six, the change tends to persist.
- Tongue thrust and low tongue posture
- A tongue that pushes between the front teeth when swallowing, or simply rests there, applies light force continuously. Light and constant beats hard and brief in tooth movement, which is why a resting posture can hold a bite open that braces are trying to close.
- Mouth breathing and airway obstruction
- Enlarged tonsils or adenoids, chronic nasal congestion, or allergy force mouth breathing, which changes the resting position of the jaw and tongue and is associated with a long face pattern and an open bite. Addressing the airway is a medical referral, not an orthodontic appliance, and it belongs early in the plan.
- Jaw growth pattern
- Some open bites are skeletal: the lower jaw grows downward and backward more than forward, so the front teeth are left apart no matter how well positioned they are. These are the hardest to correct and the most likely to need surgical help in an adult.
- Jaw joint problems
- Degenerative change in the jaw joints can shorten the back of the jaw and open the bite at the front, sometimes over months. An open bite developing in an adult with no prior history deserves a joint assessment before orthodontic treatment begins.
Why does an untreated open bite matter?
- Chewing. Front teeth that never meet cannot incise. Patients adapt so thoroughly that many do not report difficulty until asked what they do with an apple.
- Overload of the back teeth. All the chewing force concentrates on the teeth that do touch, which wear and fracture faster and carry more restorative work over a lifetime.
- Jaw muscle fatigue. A bite that only meets in a few places makes the muscles work harder to stabilize the jaw, and that shows up as tiredness or aching rather than sharp pain.
- Speech. Open bites affect speech more often than the other conditions on this site, particularly s, z and th sounds, because the tongue has a gap to escape through.
- Relapse. Uniquely here, the reason for treating the cause is that the correction depends on it. Open bites reopen more readily than most corrections, which is why the habit and the airway are addressed and not just the teeth.
How is an open bite treated?
Habit correction and airway assessment
Before or alongside appliances: stopping a thumb habit, retraining tongue posture and swallowing with a myofunctional therapist, and referring for an ear, nose and throat assessment where breathing is obstructed. In younger children this alone sometimes closes the bite.
Who it suits: Every open bite, at every age. It is the step most often skipped and the one that decides whether the result holds. An orthodontist who does not ask about snoring, allergy, or thumb habits in an open bite case has not finished the examination.
Braces
Fixed appliances close an open bite by intruding back teeth, extruding front teeth, or both, sometimes with small bone anchors that give the wire something immovable to push against. That control is what makes braces the standard choice here.
Who it suits: Most open bites. Bone-anchored mechanics in particular can close bites that were previously surgical cases. It remains demanding treatment with a real relapse rate, and patients deserve that framing at the start.
Clear aligners
Aligners have a mechanical argument in their favour here: the trays cover the biting surfaces of the back teeth, and the force applied through them may help intrude those teeth, which rotates the jaw closed at the front. The reasoning is sound; the clinical evidence behind it is thinner than the marketing suggests.
Who it suits: Mild to moderate open bites in consistent wearers, where they can be very effective. Not a solution for a large skeletal open bite, and not a substitute for addressing a tongue habit.
Surgical orthodontics
For a severe skeletal open bite in an adult, the upper jaw is repositioned surgically so the bite closes, with braces before and after. Bone anchorage has reduced how often this is needed, but it remains the right answer for the largest discrepancies.
Who it suits: Adults with a substantial skeletal open bite, particularly with a long face pattern. A consultation should say clearly whether a case is near this threshold rather than leaving the patient to wonder.
When is an open bite treated, and at what age?
Children
The best outcomes come from stopping the habit and clearing the airway while the bite can still self-correct. A reminder appliance may be used when gentler approaches have not worked. Many children treated at this stage need nothing further at the front later.
Teenagers
Comprehensive treatment closes most open bites at this age, with attention to tongue posture throughout rather than only at the end. Retention is planned as a long-term commitment from the first appointment, because it is doing more work here than in other cases.
Adults
Correction is achievable with bone-anchored mechanics or aligners in moderate cases, and surgically in severe ones. Adults also need the causes ruled out properly: an open bite that developed recently may be a joint problem presenting as a bite problem.
What does it cost to fix an open bite?
Orthodontic fees are quoted per case rather than per condition, because two people with the same diagnosis can need very different treatment. These are the factors that move the number up or down, so you know what you are being quoted on:
- Whether treatment is orthodontic alone or combined with surgery.
- Bone anchorage, which adds a minor procedure and its own fee, and often shortens treatment.
- Myofunctional therapy or an airway referral, billed by those practices rather than here.
- Treatment length, which in open bites tends to run longer than average.
- Retention, which in an open bite is more extensive and longer than for most corrections.
Ask for the fee, the payment schedule, and your insurance benefit in writing at the consultation, before you decide anything. Any orthodontic practice should give you all three without being pressed.
When should you see an orthodontist about an open bite?
- If a thumb or finger habit continues past about age four, before the bite change becomes established.
- By age seven for a first evaluation, particularly if the front teeth do not meet or the lips do not close at rest.
- If a child snores, breathes through the mouth habitually, or has ongoing nasal obstruction — this warrants a physician as well as an orthodontist.
- In an adult, if the front teeth have stopped meeting when they used to, which is a reason for prompt assessment rather than watchful waiting.
Questions patients ask about open bites
Can an open bite close on its own?
In young children, sometimes — if a thumb or pacifier habit stops early enough, the bite frequently recovers as the teeth settle. Once the habit has persisted past the early years, or in a teenager or adult, an open bite does not close without treatment.
Do clear aligners work for an open bite?
They work well for mild to moderate open bites, and have a real mechanical advantage: covering the back teeth helps intrude them, which closes the front. Severe skeletal open bites are beyond what trays can do, and a tongue habit will undo the result regardless of the appliance.
Why does an open bite come back?
Because the force that opened it is usually still there. Tongue posture, a persistent habit, or an unaddressed airway obstruction will reopen a bite that was closed correctly. This is why treatment here includes habit work and referral, and why retention is longer than usual.
Does an open bite need surgery?
Usually not. Bone-anchored orthodontic mechanics now close many open bites that would once have been surgical. Surgery remains the reliable answer for a large skeletal open bite in an adult, and a consultation should tell you plainly which side of that line your case falls on.
Is an open bite causing my lisp?
It may be. Open bites affect s, z and th sounds more often than other bite patterns because air escapes through the gap. Closing the bite can help, but speech is assessed by a speech-language pathologist rather than predicted from the teeth alone.