When to Worry About Your Child's Bite: A Parent's Guide
The Question Most Parents Ask Too Late
At Dr Gray Dentistry in Durban, one of the most common things Dr Gray hears from parents of children with established bite problems is some version of the same sentence: "I noticed something was off a while ago, but I wasn't sure if it was serious enough to do anything about."
This hesitation is completely understandable. Children's teeth go through dramatic, sometimes alarming-looking changes during the mixed dentition years, the period when baby teeth are being lost and permanent teeth are erupting. Gaps appear, teeth come through at strange angles, the smile looks crowded and uneven for a while before things settle. Much of this is entirely normal, and parents who rush to seek treatment for every developmental quirk are sometimes told to simply wait and monitor.
But not everything is a phase. Some bite problems genuinely warrant early assessment and intervention, and the cost of waiting — in terms of the complexity of the eventual correction needed — can be significant. Knowing the difference between what is worth monitoring and what needs attention is one of the most valuable things a parent can understand about their child's dental development.
First: What Is Normal During Dental Development?
Before discussing what to worry about, it helps to clarify what is normal — because many things that alarm parents during the mixed dentition years are entirely expected parts of development.
The ugly duckling stage
Between approximately ages seven and nine, as the upper permanent incisors erupt, it is completely normal for a gap to appear between the two upper front teeth and for those teeth to flare slightly outward. This is sometimes called the ugly duckling stage, and in most children it resolves naturally as the upper canines erupt later and push the front teeth together. Parents who see this gap and immediately assume their child needs braces are often reassured that it will close on its own.
Temporary crowding
As the permanent teeth erupt, they are often larger than the baby teeth they are replacing. Temporary crowding during this phase is common and does not necessarily indicate that the child will have significant crowding long term. The jaw continues to grow during this period, and space that appears inadequate at age eight may be sufficient by age eleven as the jaw develops further.
Slightly uneven eruption
Permanent teeth do not always erupt in a perfectly straight, symmetric pattern. A tooth that appears slightly rotated or off-centre during early eruption will often improve as it continues to emerge and the adjacent teeth erupt alongside it. Minor asymmetries in eruption timing between the left and right sides are common and generally self-correcting.
Spacing in the primary dentition
Gaps between baby teeth are normal and desirable. Primary teeth are smaller than the permanent teeth that will replace them, and spacing in the baby dentition provides the room that will be needed when the larger permanent teeth erupt. A child with well-spaced baby teeth is in a better position than one whose baby teeth are already crowded.
Signs That Warrant a Prompt Assessment
While many developmental variations are normal, the following signs consistently warrant a professional assessment rather than a wait-and-see approach:
A crossbite
As discussed in detail in the crossbite post in this series, a crossbite — where one or more upper teeth bite inside the lower teeth — should be assessed promptly at any age. A posterior crossbite with a jaw shift is particularly important to address early because the asymmetric jaw loading it creates affects jaw development and facial symmetry in ways that worsen over time. Unlike many developmental variations, crossbites do not self-correct and typically worsen if left untreated.
An underbite
An underbite — where the lower front teeth sit in front of the upper front teeth when biting — is one of the most important bite problems to identify and assess early. Underbites in children can reflect either a dental issue where individual teeth are in the wrong position, or a skeletal issue where the lower jaw is more prominent than the upper. The skeletal form of underbite is best addressed during the growth years when functional appliances can encourage forward development of the upper jaw and modification of lower jaw growth. Once growth is complete, the options narrow considerably and surgery may become the only way to address a significant skeletal underbite.
If a child's lower teeth consistently sit in front of the upper teeth on biting, this should be assessed as soon as it is noticed — there is no benefit to waiting.
An open bite that persists after a habit has stopped
As discussed in the thumb sucking post in this series, an anterior open bite caused by thumb sucking or dummy use that persists after the habit has been stopped, or that is present in a child who has already stopped the habit and whose permanent front teeth have erupted, warrants assessment. Open bites that do not self-correct after habit elimination need orthodontic attention.
A significant deep bite
A deep bite — where the upper front teeth cover too much of the lower front teeth on closing, sometimes to the point where the lower front teeth bite into the palate — is a bite relationship that places significant stress on the front teeth and the jaw joint over time. Severe deep bites in children warrant assessment, particularly where the lower front teeth are contacting the palate, as this can cause gum damage and tooth wear.
Teeth that are significantly out of position
A permanent tooth that erupts completely outside the dental arch — sitting in front of or behind all the other teeth, or erupting in a clearly displaced position — warrants prompt assessment. This is particularly common with the upper canines, which have the longest and most complex eruption path of any tooth and are the most frequently displaced. Early identification of a displaced canine allows interceptive treatment that can guide the tooth into its correct position — options that are no longer available once the tooth has fully erupted in the wrong place.
A tooth that should have erupted but hasn't
If a permanent tooth is significantly delayed in erupting compared to the equivalent tooth on the other side — more than six months behind — this warrants investigation. A tooth that is present in the jaw on X-ray but not erupting may be impacted, blocked by an overlying baby tooth that has not been lost, or obstructed by a supernumerary tooth or other pathology. Early identification allows the cause to be addressed before the impacted tooth causes damage to adjacent teeth or becomes significantly harder to bring into the arch.
Jaw clicking, pain, or restricted opening in a child
As discussed in the TMJ section of this content library, jaw sounds and jaw pain are not exclusively adult problems. A child who complains of jaw pain, whose jaw clicks consistently, or who has difficulty opening their mouth fully warrants assessment. Jaw dysfunction in a growing child has implications for jaw development and warrants early evaluation.
Significant crowding in the primary dentition
While spacing in the baby teeth is normal and desirable, significant crowding of the baby teeth is a red flag. The permanent teeth are larger than the baby teeth, so if there is already insufficient space in the primary dentition, the permanent dentition will be more crowded still. Significant primary dentition crowding identified early allows interceptive treatment to create space before the permanent teeth erupt, potentially avoiding extractions later.
A jaw that shifts to one side on closing
If the jaw appears centred when open but shifts noticeably to one side as the child bites together, this is a functional shift — typically associated with a posterior crossbite. As discussed in the crossbite post, a functional jaw shift affects jaw development and facial symmetry and should be assessed promptly rather than monitored.
Mouth breathing, snoring, or disrupted sleep alongside dental signs
The combination of dental and jaw signs with airway and sleep concerns is a pattern that warrants a comprehensive assessment. As discussed throughout this child development series, the jaw and the airway are inseparable, and a child who shows both sets of signs needs an evaluation that addresses both together.
The Right Age for a First Assessment
While this post focuses on signs that warrant prompt assessment regardless of age, the general recommendation discussed in the earlier post on child orthodontic assessment age applies here: a first proactive orthodontic assessment around age seven to eight is appropriate for most children, even in the absence of obvious concerns.
This early assessment is not necessarily a precursor to immediate treatment. For most children it produces one of two outcomes: reassurance that development is on track with a plan for periodic monitoring, or early identification of a specific problem where timely intervention will produce a meaningfully better outcome than waiting.
Neither of these outcomes is possible if the assessment never happens.
What to Expect at an Assessment at Dr Gray Dentistry
When parents bring a child to Dr Gray Dentistry for a bite assessment, Dr Gray takes a comprehensive approach that goes well beyond a visual check of the teeth.
The assessment includes examination of the bite relationship in multiple positions, palpation of the jaw muscles and joint, assessment of the breathing pattern and tongue function, review of any relevant X-rays, and a discussion of the child's dental and medical history including any habits, sleep concerns, or previous dental treatment.
At the end of the assessment, Dr Gray provides parents with a clear, honest summary of findings — explaining what is normal variation, what warrants monitoring, and what warrants treatment, with a frank discussion of timing, options, and what the consequences of different approaches are likely to be.
The goal is always to give parents the information they need to make a genuinely informed decision — not to rush into treatment where it is not needed, and not to defer treatment where acting early would meaningfully change the outcome.
When in Doubt, Get It Checked
The consistent message throughout this child development series is that earlier assessment produces better options. The growth window that makes certain interventions simple and effective during childhood closes gradually and then permanently. Concerns that feel minor or premature to raise are almost always worth raising — because the worst outcome of an early assessment is being told everything is fine and to come back in a year.
The worst outcome of waiting is discovering that a problem that could have been addressed simply during the growth years now requires a significantly more complex, more invasive, and more expensive solution.
Book Your Child's Bite Assessment at Dr Gray Dentistry, Durban
If you have noticed anything about your child's bite, teeth, or jaw that doesn't seem quite right — or if your child is approaching age seven and has never had an orthodontic assessment — Dr Gray at Dr Gray Dentistry in Durban, South Africa is the right person to see.
Dr Gray offers thorough, unhurried assessments of children's bite and jaw development, giving parents clear, honest guidance on what is happening with their child's teeth and what, if anything, needs to be done about it.
Book your child's bite assessment at Dr Gray Dentistry in Durban today.