How to fix crowded teeth

Behind each flawless smile is a story of proper oral care, yet for many, that story is complicated by dental crowding. Having crowded teeth is not just a cosmetic issue of overlapping teeth. It’s an anguish even in your daily brushing and flossing. It can even lead to a lack of confidence in social life. 

In this article, we will discuss in detail why crowding happens, how it impacts your oral health, and the available solutions to restore your aesthetic and function. 

Crowded VS normal teeth

It’s important to know the difference between crowded and normal teeth for early recognition of any signs of abnormality, which in turn simplifies treatment and prevents future complications.

• Normal teeth are ideally straight and aligned in their place without any crookedness, drifting, or overlapping. 
• On the other hand, crowded teeth are misaligned, tilted, drifted, rotated, overlapping, or crooked teeth due to insufficient space, resulting in an unattractive smile. 

What causes crowded teeth?

Dental crowding can result from various factors. Including the following causes: 

1. Genetics: it’s the most common cause. This can happen in Several scenarios:
   • When a patient inherits the narrow jaw from one parent and large tooth size ”width” from the other. This mismatch leads to inadequate space for teeth, resulting in crowded teeth. 
   • Or the patient might have large teeth relative to a normal jaw size, leading to the same crowded result. 
   • If patients have extra teeth-“supernumerary teeth”– meaning the patient develops more than the normal number of teeth. These extra teeth take the place of normal ones, leaving no space for them to grow in their normal position. It’s common to see “Down Syndrome”. 
   • Cleft lip or palate: a congenital condition affecting the normal development of both the lip and upper jaw or one of them. Leading to severe crowding. 
2. Prolonged childhood habits: any mouth-related persistent habits, over time, apply constant pressure that affects the jaw shape and moves teeth from their natural position, causing crowding. Habits such as:  
   • thumb sucking
   • tongue thrusting 
   • mouth breathing 
   • Prolonged use of binkies and soothers resulted in pacifier teeth 
   • Lip bitting 
3. Early loss of baby teeth that preserves the space for permanent ones. Any loss of teeth will leave a space where the neighbouring teeth will drift into this gap, changing tooth alignment. If no space maintainer is used to preserve this space, permanent teeth won’t erupt in their supposed-to-be place. 
4. Side caries on baby teeth, ”proximal Caries”, which negatively affects the arch length, decreasing the available space for permanent teeth. 
5. Impacted third molar: A bilateral impacted third molar may show mild crowding in the lower anterior teeth. By putting pressure on neighbouring teeth, causing what is called “late teen crowding”. 
6. Medical issues: any pathological condition like cysts or tumours in the jaw, which can push teeth away from their normal position and make teeth overlap each other. 

Severe teeth crowding treatment 

Extremely crowded teeth are treated using different techniques. Depending on the severity of the case, the patient’s age, and needs. Orthodontists often use one or a combination of the following treatment options to achieve the optimum result. 

We can categorise treatment according to age: 

Treatment of crowded teeth in children

At this stage, the jawbone is still growing, so orthodontists use different techniques to widen a narrow jaw or to cut off bad habits. 

1. Jaw expansion by a palatal expander, a custom-made palatal expander which rests on the palate and anchors on the upper first molar teeth, is activated in stages and gradually widens the bony base, creating space for the adult teeth to erupt in their space.
2. Habit-breaking appliance: There are different appliances designed to remind the child and physically stop these harmful habits. 
   • The palatal crib prevents the thumb from reaching the palate. It stops the child from experiencing pleasure while thumb sucking. Remind him to stop the habit. 
   • The tongue crib, a metal device, acts as a physical barrier to stop the tongue from pushing teeth forward. 
   • An oral screen appliance is a removable appliance placed between teeth and lips to force the child to breathe from the nose only, instead of mouth breathing.
   • Lower Lip bumper, a fixed appliance, consists of a plastic-coated wire on the outer surface of the teeth, fixed on the back teeth on both sides of the lower jaw, to reduce the pressure of the lips and allow the front teeth to align well. 
   • The Myobrace appliance is a soft appliance that covers the whole tooth surface, with a small tongue tag on the inner surface, to train the tongue to position in its normal place. It works to stop more than one habit: mouth-breathing and tongue thrusting. 
3. Planned serial extraction of baby teeth: An orthodontist resorts to extracting these teeth in moderate-severe crowding cases. Creating a gap for front teeth to move into (driftodontics).
4. Braces and wires: a special technique called “2×4”, consists of 4 braces placed on the 4 front adult teeth, “permanent incisors”, in addition to 2 tubes placed on the back molars to correct minor misalignment in front teeth. 

This early intervention of teeth crowding in childhood can often avoid the need for permanent teeth extraction or surgeries in the future. 

Treatment of crowded teeth in adults

For adults, the situation is different because the jaw growth is complete. Orthodontists aim to straighten the teeth in the available space. Including the following options, such as: 

1. Dental Crowns: dentists may use crowns to correct crowded teeth as a quick treatment option to straighten teeth. By creating a new smile with well-aligned teeth covered with porcelain/zirconia crowns. 
2. Orthodontic Braces: By placing wires and brackets on the tooth surface, orthodontists can apply precise forces to straighten the teeth. Diverse types of braces are available (metal-ceramic).
3. Arch expansion appliances: In severe cases in which conventional braces are not enough for correction, orthodontists often seek to widen the bony base. We can still get some degree of expansion of the arch. Using special appliances (MARPE). Or using a surgically Assisted Rapid Palatal Expansion (SARPE). Creating room for the crowded teeth as well as improving the airway and breathing quality.
4. Tooth extraction: it’s a common treatment, especially when the jaw is narrow with no space for the teeth. Orthodontists usually extract the 1st premolar (tooth after canine) and wisdom teeth if impacted to create enough room for the remaining teeth. 
5. Lingual orthodontics: an invisible solution for severe crowding. like metal braces but cemented to the lingual “inner” surface of the teeth. Treating patients without any notice of orthodontic appliances.
6. An Interproximal Reduction (IPR) is an auxiliary treatment to create more space. It’s about the removal of a tiny amount of enamel surface, decreasing the width of the teeth. Creating space for proper teeth alignment. It’s frequently used alongside traditional braces or expansion in severe crowding.
7. Distalisation: a special technique in orthodontics, used to move the back teeth distally, “more backwards”, creating space in front of them. Using different appliances like the distal jet, which proved its ability to move molar teeth up to 3.2 mm backward. 
8. Orthognathic Surgery: used in severe cases when there is a significant bone defect that needs to be corrected surgically. It is often done in combination with conventional braces. 

How to fix crowded teeth without braces? 

While traditional methods are highly effective, for some patients, braces are not a cosmetic option, so they prefer Invisalign for crowded teeth.

Clear aligners, such as Invisalign, 3M Clarity Aligners, Dentsply SureSmile, and more high-end brands, are mainly made of a series of BPA-free, custom-made, medical-grade, custom thermoplastics, in the form of removable trays with special attachments called “composite engagers” that grip the tray in place to exert incremental pressure to move the teeth gradually. 

Clear aligners offer a perfect balance of aesthetics and comfort for adults and children, allowing patients to practise their social activities normally without a metallic display.

Alongside the aesthetics, as they are almost invisible, Invisalign proves the ability to straighten teeth and fix mild crowding, in addition to the smooth, hygienic trays and the ability to easily remove them for eating or oral hygiene, making it the most lifestyle-friendly option.

How long does it take to fix crowded teeth?

The duration of treatment to straighten the crowded teeth is different from one case to another. The time frame is related to the severity of the crowding and the biological response of the teeth. Additionally, the chosen treatment option plays a significant role in the timeline. It can range from 1 to 3 years to achieve a stable result in mild cases, with adherence to retainer appliance wearing for an adequate period of time to preserve the teeth and bone in their new positions. 

Complications of crowded teeth, if neglected

If you left crowded teeth without treatment, you could have more serious complications beyond just an unattractive look. Here are the most common complications: 

1. Calculus /tartar accumulation: crowded teeth create a trap zone that is difficult to clean with regular brushing and flossing. This allows more plaque and bacterial accumulation. With time converted into calculus and tartar, which needs a professional cleaning to remove it. 
2. Teeth decay: irregularities and overlapping teeth cause insufficient cleaning, which allows prolonged presence of bacteria and calculus. Over time, it leads to enamel breakdown, causing dental caries. 
3. Gum disease: persistent accumulation of bacteria and plaque along the gum line, resulting in gum inflammation. With neglect, this can develop into the formation of gingival pockets, gum recession, and periodontal disease. This ends with bone loss around teeth, and jawbone resorption complications.
4. Teeth wear: misaligned teeth cause some teeth to bear more force than others. This uneven pressure distribution leads to premature tooth wear. 
5. TMJ disorder: crowded teeth cause uneven pressure distribution across the jaw joint. This constant strain could lead to temporomandibular disorder, clicking sounds, and persistent headaches.  
6. Speech problem: Teeth crowding interferes with the tongue’s movement, affecting speech, causing lisps and difficulty pronouncing certain sounds.
7. Aesthetic issues: surely overlapped teeth look less attractive when compared to the perfect teeth trends, and thus significantly impact self-confidence and affect smile harmony. 

Oral care tips for your teeth crowding 

Crowded teeth require special care to prevent further complications. Here are the essential oral care tips for crowded teeth: 

1. Early diagnosis: It’s better to seek dental advice and see your dentist every 6 months for early detection, sparing more complicated intervention after cessation of growth.
   If parents doubt any chance of their child’s teeth crowding, they should seek dental consultation for early treatment.
2. Proper oral hygiene: In crowded areas, plaque and food are likely to accumulate. It’s important to use special tools and techniques like a water flosser or interdental brush in combination with traditional brushing. 
3. Healthy food, to maintain teeth and jaw health, starts with a healthy diet. Focus on eating fibrous, non-processed food to self-clean and maintain the teeth structure.
4. If you are a bruxer with crowded teeth, you should seek a dentist to fix this teeth crowding while protecting your teeth with a night guard, and know all the reasons why you grind your teeth at night to avoid them.
5. Periodic professional dental cleaning every 3 or 6 months for calculus removal, gum pockets treatment, before getting a gum infections.
6. Treatment of receding gums as a result of teeth crowding for a healthy smile.

FAQs

Teeth Crowding Treatment FAQs

Can you get veneers with crowded teeth?

Yes, only mildly crowded teeth can be camouflaged by porcelain/zirconia veneers. They don’t move any teeth; they only cover the crowded teeth to get a proper aesthetic result.