Fixing a Crossbite: You Don't Always Need Braces

Fixing a Crossbite: You Don't Always Need Braces
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Fixing a Crossbite: You Don't Always Need BracesClinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. What Is a Crossbite?
  2. Crossbite Types
  3. Crossbite Correction
  4. What Happens If You Do Not Fix It?
  5. How Braces Work
  6. Ongoing Dental Treatment
  7. References
While braces are often used to correct bite issues, you don’t necessarily need braces to correct a crossbite. Special orthodontic appliances may be used, and often, clear aligners are part of the treatment protocol.

What is a crossbite?

A crossbite is a type of malocclusion, or misalignment of the teeth or jaw. In an average, healthy bite, your upper teeth should fit just slightly over your lower teeth, with the points of the molars fitting into the grooves of the opposite molar.

If you have a crossbite malocclusion, it is probably hereditary. One of your parents may have a crossbite, often an off-set jaw that you may have noticed as you grew up.

With a crossbite, the upper teeth typically fit inside the lower teeth, which can cause misalignments in a single tooth or a group of teeth like your molars. This can then lead to problems with plaque buildup since food particles get stuck in the area, and you cannot clean the surfaces of your teeth as well. Other issues include wear and tear on the enamel, leading to fractures or cracks; teeth grinding, which can cause pain in your jaw; and gum disease from these types of damage.

Fortunately, crossbites can be fixed easily. In many cases, you don’t need braces to correct the issue.

Crossbite vs Healthy Bite

Types of crossbites.

Between 1 and 16 percent of children develop a posterior crossbite, and between 4 and 5 percent develop an anterior crossbite, before their permanent teeth come in. As their adult teeth erupt, a pediatric dentist can start to add orthodontic appliances to their changing mouths, keeping jaws aligned, improving jaw shape, and straightening teeth.

However, many people experience changes in their oral alignment as they get older, even if they had braces as a child. This is due to genetics more than anything else. Adults may need to revisit orthodontics a few times throughout the course of their lives, and this is totally normal.

There are two basic types of crossbite.

Anterior Crossbite
This occurs when one or more of the top teeth sit behind the bottom teeth. This is specifically a misalignment of your teeth and not of your jaw, which is an overbite.
Posterior Crossbite
This occurs when the back upper teeth sit inside the back, bottom teeth.
Crossbites are a problem involving a smaller jaw and misaligned teeth, and they may take special orthodontic devices to correct, but part of that treatment may involve at-home clear aligners

How are crossbites corrected?

One of the main causes of a crossbite is an underdeveloped jaw. Treatment for crossbites can involve multiple types of devices to straighten your teeth and widen your jaw. Typically, these devices can be used in concert with each other, so your jaw reaches an ideal size as your teeth become perfectly aligned.

Devices that may be employed to improve a crossbite include:

Palatal or Maxillary Expander
This is a device that settles on the palate and attaches via the upper teeth, which gradually widens the upper jaw with regular turns of a special key on the device. This appliance is needed for moderate to severe cases of jaw expansion. It will remain in place until the dentist removes it.
Removable Expander
This is a device that adults wear at night to widen their upper palate, in cases where only minimal expansion is needed.
Surgically Assisted Rapid Palatal Expansion
A surgeon performs a procedure that intentionally breaks the jawbone in several places, allowing it to be reset and stimulate bone growth to increase the jaw’s size. Afterward, the customer will wear a customized device to support their jaw as bones grow back in place.
Braces or Aligners
Since teeth may be crooked or crowded from jaws that led to a crossbite, dentists often recommend either clear aligners or braces to adjust the size of the jaw. These will be worn at the same time as the palate expander.

You may not need every one of these treatment options. If you have mild or moderate crossbite problems, you may only need a removable expander and aligners. In fact, you could have such a low-risk crossbite that you do not need the expander unless you have cosmetic concerns about your teeth.

Correcting even a mild crossbite can improve your oral health and self-esteem.

crossbite before and after

What happens if you don’t treat a crossbite?

You may not worry about your crossbite for a lot of reasons.

The crossbite might only affect your back teeth, while your front teeth appear straight and healthy. The crossbite might not be very apparent in the front, so you are happy with your smile being slightly askew. Or, you may not be concerned about the outward appearance of your teeth, as long as you get regular dental checkups and cleanings.

It is true that your crossbite might not affect your oral health now. But if it is left untreated, it is possible for it to get worse. This might not change the surface appearance of your teeth, but it can cause underlying health problems that can lead to strain, pain, and tooth damage.

Potential problems of untreated crossbites include:

  • The jaw shifting to one side, causing muscle strain, chewing problems, and an uneven facial appearance.
  • Lopsided growth of the jaw in children, leading to uneven pressure on the teeth, which can cause tooth decay and loss later in life.
  • Wearing down of tooth enamel on one side, causing cracking or a higher risk of cavities.
  • Tooth decay, gingivitis, and periodontitis.
  • Tooth loss from damage or decay.
  • TMJ, or teeth grinding leading to muscle pain and headaches.
  • Pain and muscle tension in other areas, including the shoulders and neck.
  • Sleep apnea or snoring that disrupts sleep, which can increase the risk of other health issues, including heart disease or diabetes.
  • Trouble speaking clearly.
  • Difficulty biting into food or chewing well, which increases the risk of digestive issues, diabetes, and heart problems.

Even small changes in the alignment of your teeth can increase your risk of oral health problems. In children, crossbites are easier to fix because the jaw is still growing. Adult crossbites can develop and get worse over time, but they can still be addressed by orthodontics.

Adult crossbites might not change your smile at first, but you may notice jaw pain or tension. You might also develop problems with your teeth, such as cracking, which increases the risk of gingivitis or other oral health infections.

If you develop a gum infection, this can damage other teeth, not just those with too much pressure from lopsided muscles. Once this damage begins, you might have bad breath, the appearance of stained teeth, and even teeth that move out of alignment.

Treat crossbites early.

Small crossbites may not cause immediate problems, but it is best to talk to your dentist if you are concerned. In general, it is better to get treatment for crossbites than to ignore them.

It is important to treat crossbites early, so you can avoid serious oral health problems later. Ongoing damage to your oral health can make the crossbite worse, along with other issues.

Getting clear aligner treatment early can improve your smile overall — not just the appearance of your front teeth but also the health of your back teeth. You will not only look great but also feel great, knowing your appearance translates to better physical health overall.

How braces fix crossbites.

Treatment for the crossbite depends on its severity and often will include multiple treatment options used together. For example, braces are commonly included in the treatment plan along with a palate expander to straighten misaligned teeth.

Crossbites caused by overcrowding and misaligned teeth can be moved and corrected with orthodontic treatment, such as braces.

For long-term results, treatment (including orthodontics at a young age, before the bones are fixed) can provide a more stable correction. Braces can be used to move the teeth into a more optimal position.

In severe cases of crossbite, braces are used with a palate expander to move the teeth, change the shape of the jaw, and hold the teeth in a more permanent and improved position.

Braces can hold the teeth in place for longer. After braces treatment is complete, retainers are often used to hold the teeth in the corrected position. Braces are a more intensive and invasive treatment, often with long-term results, for crossbite correction.

Braces can be a more permanent fix, but they are not always necessary with mild cases of crossbite. When the crossbite is less significant, treatment plans using a removable expander and/or aligners can be sufficient.

Ongoing dental treatment after your crossbite is fixed.

The more intensive procedures to treat a crossbite are intended to be permanent or at least last for many years. In fact, the treatment plan itself may take a couple years to complete.

Low-impact treatments may expand your jaw, but they may not prevent your teeth from moving around later in life. You could still need aligners at some point, even after crossbite treatment.

If you find that your teeth have moved again, you likely feel frustrated. Fortunately, there are better solutions available today to improve your teeth alignment.

You do not even have to go to an orthodontist to get straight teeth. With doctor-monitored, at-home aligners, you can make a mold of your teeth and palate at home, which is sent to an orthodontist for evaluation. That professional will determine if aligners can correct your crossbite. If you’re a candidate, they’ll create a treatment plan for you, have clear aligners made for you, and instruct you on when to switch to each new set of aligners.

Often, at-home aligner treatment does not take longer than six months, making it a great option for people who have mild or moderate crowding, bite issues, crooked teeth, or gaps in their teeth.

At-home aligners can give you the power to manage your oral health without the embarrassment of bulky braces, the expense of orthodontist visits, and the time-consuming process of dealing with older orthodontic devices. While it is not the best option for everyone, you may be able to use at-home aligners alongside other orthodontic treatments or after a different course of treatment has been completed.

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Malocclusion of Teeth. (February 2018). MedlinePlus.

Orthodontic Treatment for Posterior Crossbites. (August 2014). Cochrane.

Management of Anterior Dental Crossbite With Removable Appliances. (April-June 2013). Contemporary Clinical Dentistry.

What Is a Crossbite? (November 2019). American Association of Orthodontists (AAO).

Crossbite: Effects and Treatments. Colgate.

How to Straighten Teeth Without Braces. Colgate.

Posterior Crossbite - Treatment and Stability. (March-April 2012). Journal of Applied Oral Science (JAOS).

What Is a Crossbite? (November 2019). American Association of Orthodontists (AAO) blog.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.