Just One Crooked Tooth

Many patients have “only one crooked tooth” that bothers them, and they come in hoping we can fix it without messing with the rest of their smile. Even on the rare occasions where there is just one tooth out of alignment, fixing it is often more involved than it appears at first glance. Here’s why…

Teeth Exist as Part of a Set
Each tooth exists as part of a set. Not only does each tooth have teeth on either side of it, but it also has teeth opposing it in the other arch (the upper teeth bite against the lower ones). Orthodontists must consider how the crooked tooth interacts with the others to create an appropriate treatment plan.

Reshaping the Teeth Can Provide Some Space
Most teeth are crooked because there is not enough room for them to be straight. Before they can be turned and moved into place, space must be created. Although it may be possible to make the space by “shaving down” the crooked tooth or those around it, many times removing the amount of enamel required would damage the teeth involved. Even if interproximal reduction (IPR) could create the needed space, patients still need braces on the neighboring teeth to provide the anchorage required for the movement.

Aligning Teeth Usually Moves Them Forward
When crowding is addressed by spreading out the teeth rather than shaving them down, they usually move forward, requiring more space than when they are overlapping. In the upper, this creates more “overbite” or protrusion. Correcting this new overbite requires treatment in the lower arch, even if the teeth down there look fine.

Clearance Must Be Created to Move the Bottom Teeth
In the bottom arch, the forward movement required to align overlapping teeth is only possible if the lower incisors don’t collide with the uppers. If there is insufficient clearance between the lower incisors and the backs of the upper teeth, orthodontic treatment is needed to move the upper teeth forward or the lower teeth down (opening the bite). In other words, straightening a single lower tooth may require moving the teeth in both arches.

Closing Space in the Upper Also Requires Clearance
When the single crooked tooth is associated with space in the upper, aligning it and closing the space requires moving the teeth inward towards the tongue and palate. This movement is desirable if a patient has excessive overbite. If the bite is normal, however, moving the teeth backward may cause them to collide with the teeth in the lower arch. Before this “retraction” is attempted, your orthodontist must move the lower teeth out of the way to create the necessary clearance. As explained above, this can be achieved by moving the lower teeth down (opening the bite) or back, usually by performing IPR. Again, correcting a single tooth in the upper usually requires moving the teeth adjacent to it and those that oppose it.

Most Orthodontic Patients Need Braces on All the Teeth
Patients with crooked teeth expect to have full braces. Those with only one crooked tooth may be surprised to find out they need full braces too. Now you know why most patients require brackets on all their teeth to achieve their best smile!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho and Albuquerque, New Mexico. He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen’s 30+ years of specialty practice and 10,000+ finished cases qualify him as an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. Copyright laws protect the opinions expressed here and can only be used with the author’s written permission.