What Is A Crossbite & How Do You Correct It

Crossbite teeth and jaw alignment

When someone has a crossbite, teeth on the opposing arches (upper and lower) don’t line up appropriately. Typically with a crossbite you’ll see the upper teeth tilted slightly inward and the lower teeth outward. Generally, this condition is one that your dentist will screen for during routine checkups or when performing an orthodontic evaluation.

Crossbite

There are two types of crossbites that someone can have:

1) Anterior Crossbites

This type of crossbite causes one of the front teeth to overlap it’s biting partner in an irregular manner. Maybe one tooth is jetted out or tilted too far in one direction. It’s different from an overbite or underbite, in that it has more to do with the biting relationship of teeth than it does the jaw anatomy.

2) Posterior Crossbites 

A posterior crossbite involves back teeth (molars and premolars). Usually, it’s when the upper molar is tilted inward and hits the middle of the lower molar. Technically speaking, upper molars should always slightly overlap the lower ones. Even if it looks like they’re hitting end-to-end, there could possibly be an issue going on.

Common Symptoms 

1) Misaligned Teeth

Crossbites aren’t always obvious. But if you have a moderate to severe case, you’ll be able to tell that the upper and lower teeth don’t bite together properly. Usually there are a couple of teeth slanted either too far toward the cheek or too far away from it.

2) Biting Your Tongue Or Cheek Frequently 

Assuming your teeth line up properly, biting your cheek or tongue every now and then isn’t unheard of. But if you’re repeatedly biting them on a daily basis to the point that they have permanent marks or scar tissue, you need to talk to your dentist about how to correct a crossbite before things get worse.

3) Atypical Facial Profile

Your teeth provide underlying structural support to your lips and cheeks. So, if your facial profile seems “off” or different on one side, it could be due to something like a crossbite in your teeth.

4) Difficulty Biting Or Chewing On One Side Of Your Mouth

Do you notice yourself chewing your meals more on one side of your mouth than the other? Pay attention the next time you eat. It might be a subconscious habit that you don’t even realize you’re doing. In reality, the shift to one side could be your body’s way of saying that the teeth on the other side don’t line up correctly.

5) Tooth Enamel Wear Or Dental Problems

Last but not least, do you notice your teeth wearing down and developing flat areas? Are you experiencing broken fillings or worn-out dental crowns? If you have a crossbite, teeth will usually suffer from premature wear in that immediate area.  

Crossbite Causes 

1) Childhood Habits

Anything that applies pressure to teeth or your child’s mouth can alter the alignment of their bite. It could be chewing their nails, finger sucking, lip sucking, or always carrying a pacifier around in their mouth. Even tongue habits or the way your child swallows can lead to long-term anatomical changes that can only be corrected with orthodontic therapy or surgery.

2) Genetics

Sometimes we “inherit” a smaller jaw from one parent and larger teeth from the other. If there’s not enough space for our teeth to set side-by-side, it can press some of them out of the way. It’s a perfect recipe for crossbites. Not all crossbite causes are genetic, but a lot of orthodontic issues do tend to run in families.

3) Tooth Loss

Sometimes people have congenitally missing teeth, meaning they never had them to start with. Others have missing teeth because of an emergency extraction or the tooth being removed for some other reason. When extra space is created in your bite by a missing tooth, it can then alter the alignment of all of the other teeth throughout your entire mouth. The gradual shifting and drifting out of place isn’t restricted to the immediately adjacent teeth. Think of it more like books on a bookshelf, and how one end can tilt over even when a book on the complete opposite side is removed.

4) Tumors Or An Injury

An athletic injury, automobile accident, falling off a bicycle, or even irregular growths such as tumors can alter the alignment of teeth. Depending on where and how severe your injury was, there may be other factors at play (such as root canal treatment or an emergency extraction.) Tumors, however, can physically press teeth out of the way or grow around them. Your dentist routinely screens for such pathology when he or she takes a full-mouth “panoramic” X-ray.

5) Mouth Breathing

When your mouth is at rest, you should have your lips closed together, teeth slightly apart, and be breathing out of your nose. If a child has severe nasal congestion or other airway blockage, they may be more prone to mouth breathing and changes in the positioning of their tongue and lips. Without those soft tissues resting against your teeth, it’s completely possible for them to not line up correctly.

Complications From Overbites 

Bottom line, when teeth don’t meet together properly it can have an overall impact on both those specific teeth as well as the function of your overall mouth.

First and foremost, you’ll start to see the tooth enamel at that location wear out far quicker than it should. Even though enamel is the hardest structure in the entire human body, it can’t withstand irregular or tooth-on-tooth wear. In the long run, all that pressure can lead to needing restorative work like tooth fillings or dental crowns.[1] But then again, those can’t stand up to the extra wear either.

Then you have an increased risk of tooth decay and gum disease. Both of these conditions are statistically more likely to occur around crooked or misaligned teeth, which is exactly what a crossbite is.  

And finally, there’s the issue that a crossbite causes added strain to the muscles and joints moving your teeth around. When they have to function irregularly — like to chew and break down your meals three times a day — it can take a toll on your TMJ. Without knowing when or how to correct a crossbite, it may evolve into a chronic and painful case of TMJ disorder (TMD). By that point you’re left trying to manage two issues rather than just one, but the fact that TMD has developed will compound the issue and lead to additional oral health woes.

Correcting A Crossbite (Treatments)

How to correct a crossbite will depend on exactly which teeth are involved and how severe it is.

1) Removable Retainer

A retainer can help keep teeth where they’re at, so that misalignment doesn’t get any worse. You might need a retainer if you’re a child whose mouth is still growing or an adult who is having to delay orthodontic treatment.

2) Braces

Orthodontic systems using traditional bracket and wire systems are extremely effective for correcting crossbites (not to mention other types of malocclusions.) Braces use the pressure of an archwire to pull or push the offending tooth back into the correct bite curvature.

3) Aligners

Clear aligner systems (think Invisalign or ClearCorrect) can work on some crossbites, but it just depends on how severe they are. You’ll want to work with a certified provider to find out if you’re an ideal candidate for this treatment option.

4) Upper Jaw Expander

Palatal expanders help to safely and naturally widen the roof of your mouth (palate). They’re frequently used when the upper jaw is too narrow or there is a crossbite involving the upper back teeth.

5) Reverse-Pull Face Mask

Headgear is typically for the purpose of modifying growth patterns in the mandible (lower jaw.) But if an underbite or underjet is one of the causes of your crossbite, it can help you avoid surgery in the future.

Crossbite Surgery

When you’re trying to figure out how to correct a crossbite, surgery usually isn’t one of them. That being said, if you have a severe case of misaligned teeth — that also involves an underjet, underbite, or severe overbite — and you’re suffering from serious side effects, surgery may be necessary. But it’s probably highly unlikely if a crossbite is all that you’re dealing with.  

Oral surgery is usually reserved for the most complex orthodontic cases and only when the upper and lower “jaws” do not and cannot fit together. Well before surgery is ever recommended, your dentist will probably refer you to an orthodontist or an oral surgeon. Both of these specialists tend to work together when it comes to treating severe bite irregularities. Although one of them may be able to answer your questions about surgery, it will probably be crucial to visit with both of them for a consultation first.[2] As they co-plan your treatment, you’ll be able to determine whether surgery is truly necessary.

Fortunately for most people with crossbites, orthodontic therapy or similar appliances are usually all that’s required. Even specialists agree that surgical procedures should be reserved for instances where non-surgical therapies are not helpful. If your orthodontist is able to treat your crossbite using a set of braces, there’s a really high chance that you won’t need any type of surgery at all.

Crossbite Vs. Underbite

An underbite and crossbite are fairly similar. With a crossbite, there are typically only a few teeth involved. But an underbite is more of a jaw-related anatomical issue or one that involves several teeth at a time. You’ll see more consistency in an underbite, since all of the teeth in that area are involved. But with a crossbite it will seem like certain teeth are out of sorts.

When you see an underbite, it’s the lower front teeth overlapping the upper front teeth. They might cover a portion of the teeth or seem to protrude out more (which is technically called an “underjet.”)

On the other hand, crossbites usually involve back teeth (not always, just usually). There may be crowding, a narrow arch, or a wide jaw. What you see is a tooth or two tilted out of the natural curvature of your “arch” of teeth. It doesn’t line up with its neighbors and as a result, it doesn’t properly bite against the opposing arch either.[3]

Most people will usually consider underbites to be more severe than crossbites. Especially since the treatment for a crossbite tends to be a lot less involved and usually doesn’t require surgery. But that doesn’t make it any less important when it comes to keeping your smile healthy!

When To Talk To Your Dentist

Chances are that your dentist will spot your crossbite before you do. Most dentists will perform at least some type of basic bite assessment during your routine checkup. Since teeth tend to shift over time — particularly as we get older or experience tooth loss — your dentist will want to keep an eye on changes in your bite from one visit to the next.  

But if you haven’t seen a dentist lately OR you’re noticing some irregular wear or cheek biting in one area, it’s time to go ahead and plan a checkup. Anytime you have a crossbite, teeth crowding, or other bite issues, it can impact the chances of cavities and gum disease too. Preventative care is always important and, in this case, it might involve treating your malocclusion (tooth misalignment.)

Overview

When you have a crossbite, teeth on the upper and lower jaws slightly overlap each other in an atypical manner. Some tilt in one direction while others shift another way, altering the overall curve of your occlusion (biting pattern.) How to correct a crossbite starts with recognizing the warning signs and seeing your dentist routinely for regular checkups and screenings. If you’re starting to develop a crossbite or notice that it’s getting worse, plan to intervene before any unwanted side-effects start to pop up. You’ll be glad that you did!