Space between top and bottom teeth

My two year old has a space between her top teeth and bottom teeth. I can fit the tip of my pinky in it! Her top "pointy" teeth "sit" behind her bottom "pointy" teeth. Could this be a problem with jaw alignment? Or will this correct itself when her permanent teeth come in? If not, what will need to be done to correct it? Should I take her directly to an orthodontist, or does she need to be recommended by a dentist?


The "pointy" teeth to which you refer are most likely the canines or cuspids. The condition you describe sounds as if your daughter might have a Class III malocclusion. This basically means that the lower teeth are in front of the upper teeth. This might be a true skeletal discrepancy or a "pseudo-class III" relationship. If an upper and lower tooth or teeth are incorrectly related, this tooth malposition can cause the lower jaw to shift forward during closure, otherwise known as a pseudo-class III relationship; therefore, the occlusion (relationship of upper and lower teeth) must be evaluated to determine if tooth alignment or jaw alignment is responsible for the position of your daughter's teeth.

At this point in your daughter's development, however, orthodontic treatment is not necessarily recommended. Evaluation by a general dentist and/or a pediatric dentist may be done now with an eye to future orthodontics. Early orthodontic intervention at about 6 years old may be warranted in order to use your daughter's growth potential to correct the malocclusion.

Future orthodontic treatment may include the following possibilities. If it is determined that your daughter simply has a crossbite (tooth, not jaw, malalignment), a removable retainer may be used to separate the upper and lower teeth and push the offending tooth or teeth into proper position. Occasionally, if the condition is severe, a removable appliance may not be adequate in resolving the crossbite. If this is the case, fixed orthodontic techniques (i.e. bands, brackets, wires, etc.) may be used to correct the condition. If it is determined to be a skeletal class III malocclusion, fixed orthodontics, including possible headgear and arch expanders, will most likely be necessary.

At this time, I recommend that your daughter see the dentist anyway for an initial visit to be introduced to the dental office. Depending upon her level of cooperation, she could be evaluated for cavities and occlusion. At least, the dentist may get a view of the relationship of the upper and lower teeth. Her development should be closely monitored at each subsequent 6 month visit to determine if orthodontic treatment is warranted and when it should begin. If it appears as if the malalignment continues as she grows but your dentist does not refer you to an orthodontist by the age of 6 or 7 years old, I recommend consulting with an orthodontist anyway. If your dentist does not give you a referral, check with the local dental school or dental society. Then, you and the orthodontist can determine if treatment should begin at that time or later.

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