Crossbite teeth: what it is and how to fix it

When we talk about a healthy bite, we are referring to a proper alignment between the upper and lower teeth. When this harmony is disrupted and the teeth do not fit together as they should, a condition known as crossbite may be present.

Such  malocclusion is quite common and can lead to both aesthetic and functional issues. Crossbite teeth can cause uneven wear, jaw discomfort, and even difficulty in chewing properly. The ideal time to correct it is during childhood, around the age of six, when the bones are still developing. By contrast, treatment in teenagers and adults tends to be much more complex.

In this article, we will explore when and why crossbite occurs, its possible consequences, and treatment options for correction. Keep reading to learn everything you need to know!

What are crossbite teeth?

A crossbite occurs when some or all of the upper teeth sit inside the lower teeth when biting down. In a normal bite, the upper teeth slightly overlap the lower teeth, allowing for proper alignment. When this balance is disrupted, it can lead to jaw misalignment, uneven pressure on the teeth, and potential oral health issues.

Crossbite can affect a single tooth or multiple teeth and may involve both the front (anterior) and back (posterior) teeth. If left untreated, it can cause more than just aesthetic concerns, leading to chewing difficulties, speech problems, jaw pain, and even facial asymmetry.

How to tell if you have a crossbite

Some common signs and symptoms of crossbite include:

• upper teeth sitting inside the lower teeth when biting down.
• jaw pain or discomfort, especially while chewing.
• uneven tooth wear due to misalignment.
• frequent cheek or tongue biting while eating or speaking.
• headaches, jaw tension, or muscle strain in the face.
• facial asymmetry or shifting jaw movements.

If you experience any of these symptoms, it’s best to consult a dentist or orthodontist for an evaluation. Early diagnosis, especially in children, makes treatment easier and more effective.

Types of crossbite

Crossbite can be classified based on its location in the mouth:

Anterior crossbite

• • affects the front teeth (incisors and canines).
  • the upper front teeth sit behind the lower front teeth.
  • can resemble an underbite, but usually involves only a few teeth rather than the entire jaw.

Posterior crossbite

• • involves the back teeth (molars and premolars).
  • the upper molars and premolars sit inside the lower teeth instead of slightly overlapping them.
  • can lead to jaw misalignment and difficulty chewing.

Unilateral vs. bilateral crossbite

• • Unilateral crossbite: affects one side of the mouth, leading to uneven chewing and possible facial asymmetry.
  • Bilateral crossbite: affects both sides of the mouth, causing a more severe misalignment and functional issues.

Additionally, based on its origin, crossbite can be classified as:

• Skeletal crossbite: caused by an underdeveloped upper jaw or an overdeveloped lower jaw.
• Dental crossbite: The jaw size is normal, but the teeth erupt in the wrong position.
• Mixed crossbite: a combination of skeletal and dental issues affecting both jaw structure and tooth alignment.

What causes crossbite?

Crossbite can be caused by several factors. Some of the most common include:

• Genetics: Crossbite teeth often run in families, meaning that genetics play a significant role in jaw development. If parents or grandparents have crossbite, their children are more likely to inherit their jaw shape and size issues that lead to misalignment.

• Irregular jaw growth: If the upper jaw (maxilla) grows too narrow or the lower jaw (mandible) grows too wide, it can result in crossbite.

• Delayed or abnormal tooth eruption: If baby teeth fall out too early or too late, it can affect how permanent teeth grow in, leading to misalignment. Overcrowding of teeth may also push some upper teeth behind the lower teeth, causing crossbite.

• Mouth breathing: Habitual mouth breathing can impact the development of the upper jaw, making it narrower than normal and increasing the likelihood of crossbite.

• Childhood habits: Thumb sucking, prolonged pacifier or bottle use, or tongue thrusting can affect jaw development and contribute to crossbite.

Why crossbite should be treated: risks of ignoring it

Leaving a crossbite untreated can lead to serious dental and health complications over time. While crossbite may seem like a minor misalignment, it can cause pain, functional problems, and long-term damage to your teeth and jaw.

What happens if crossbite teeth are not treated?

• Uneven tooth wear and damage: When teeth do not align properly, certain teeth bear more pressure than others. This can lead to:

• • • excessive wear and chipping of teeth. 
    • enamel erosion, increasing the risk of cavities.
    • tooth fractures due to uneven force distribution.

• Jaw pain and TMJ disorders: A misaligned bite puts stress on the temporomandibular joint (TMJ), which connects the jaw to the skull. Over time, this can lead to:

• • • jaw pain or discomfort, especially when chewing.
    • clicking or popping sounds in the jaw.
    • headaches, migraines, or muscle tension in the face and neck.
    • Temporomandibular joint disorder (TMD/TMJ) can cause chronic pain and difficulty opening or closing the mouth.

• Speech difficulties: Severe crossbite can affect speech clarity, making it harder to pronounce certain sounds. Lisping, slurring, or difficulty forming words properly may develop due to poor tooth alignment.

• Increased risk of gum disease and tooth decay: Misaligned teeth are harder to clean properly, leading to:

• • • plaque buildup in hard-to-reach areas.
    • gum inflammation and periodontal disease.
    • tooth decay, as bacteria and food debris become trapped in misaligned teeth.
    • Gum recession exposes the tooth roots and makes them more vulnerable to infection.

• Facial asymmetry and aesthetic issues: In growing children, untreated crossbite can lead to asymmetrical jaw growth, affecting facial appearance. Adults with untreated crossbite may notice:

• • • Uneven facial development, making one side of the face look different from the other.
    • Shifting jaw position, affecting the overall symmetry of the face.
    • self-consciousness or reduced confidence due to changes in facial structure.

• Trouble chewing and digestive problems: A crossbite can make chewing food properly difficult, leading to:

• • • inefficient chewing, which can impact digestion.
    • jaw fatigue or discomfort while eating.
    • avoiding certain foods, especially hard or chewy textures.

• Sleep apnea and breathing issues: In some cases, crossbite can contribute to sleep apnea, a condition where breathing repeatedly stops and starts during sleep. This happens because:

• • • The tongue sits too far back in the mouth, partially blocking the airway.
    • The soft palate collapses, restricting airflow.
    • Crossbite-related teeth grinding (bruxism) can worsen airway obstruction.

• Frequent headaches and muscle strain: Because crossbite causes an imbalance in the bite, it can place strain on the jaw muscles, leading to:

• • • Chronic headaches or migraines.
    • Tension in the jaw, neck, and shoulders.
    • Grinding or clenching (bruxism), which can further wear down teeth.

How to prevent crossbite

While crossbite can develop due to genetics, early detection and intervention can help prevent severe complications.

• Regular dental checkups: Routine visits to the dentist or orthodontist can detect early signs of misalignment. The American Association of Orthodontists (AAO) recommends that children schedule their first orthodontic evaluation by age 7 to catch and treat issues early.
• Correcting childhood habits: Discourage thumb sucking, prolonged pacifier use, or tongue thrusting, as they can affect jaw growth. Encourage nasal breathing instead of mouth breathing to promote healthy development.
• Using space maintainers for baby teeth: If a child loses baby teeth too early, a space maintainer can prevent shifting and reduce the risk of developing a crossbite.

If you suspect you or your child has a crossbite, don’t wait to seek professional advice. The sooner it is diagnosed, the easier it is to correct.

Crossbite teeth treatment options

The treatment for crossbite depends on the patient’s age and the severity of the condition. While early intervention can make correction easier, adults with more severe cases may require surgical options.

Treatment for kids and teens

• Palatal expanders: A widely used treatment for growing children, a palatal expander gradually widens the upper jaw to correct misalignment. It is most effective between ages 6 to 12, when the palate is still flexible. The treatment typically lasts 5 to 6 months, followed by a retention phase to maintain results.
• Skeletal anchorage expansion (MARPE): in older adolescents, mini screws placed in the palate can enhance bone expansion, providing a more stable and effective correction.
• Reverse pull headgear: used for anterior crossbites or underbites, this removable orthodontic appliance encourages forward jaw growth in young children.
• Habit appliances: For children with thumb-sucking or tongue-thrusting habits, fixed appliances help eliminate these behaviors and prevent further jaw misalignment.

An orthodontist will assess each case and recommend the most suitable approach based on growth stage, severity, and individual needs.

Treatment for teenagers and adults

For those who miss early intervention, there are orthodontic and surgical options to treat crossbite in adolescence and adulthood.

• Braces: Traditional braces apply constant pressure to gradually shift misaligned teeth into place. The treatment usually lasts 18 to 24 months, with options including metal, ceramic (sapphire), or lingual braces for a more discreet look.
• Clear aligners: an effective, removable alternative for mild to moderate crossbites. Treatment duration varies but typically lasts 12 to 24 months.
• Tooth reshaping and crowns: In minor cases, reshaping teeth with fillings, crowns, or veneers will improve alignment quickly, often in just a few sessions.
• Myofunctional therapy: Strengthening oral and facial muscles through exercises can help correct functional habits contributing to crossbite.

Treatment for severe crossbite in adults

For adults with skeletal crossbite, non-surgical options may not be enough. When jaw misalignment is significant, orthognathic surgery may be required.

• Surgical palatal expansion: Since adult jawbones are no longer growing, a surgical-assisted palatal expander may be used to widen the upper jaw before orthodontic treatment.
• Jaw surgery (orthognathic surgery): This procedure repositions the upper or lower jaw to achieve proper alignment. It is always combined with orthodontic treatment to prepare the teeth before surgery and fine-tune alignment after recovery. The full process typically takes around 3 years, covering:

• • • Pre-surgical orthodontics (to align teeth before surgery)
    • Jaw surgery (to reposition the jaw)
    • Post-surgical orthodontic refinements (to finalize bite alignment)

Regardless of age, the earlier crossbite is diagnosed, the easier and more effective the treatment will be. Children’s jawbones are more adaptable, making early intervention the best approach. Even adults can benefit from modern orthodontic and surgical solutions.

Crossbite teeth can cause pain, uneven wear, and long-term dental complications if left untreated. Early diagnosis and treatment with expanders, braces, or aligners can correct misalignment and improve oral health and facial aesthetics.

If you or your child show signs of crossbite, don’t wait. Consult a dentist or orthodontist as soon as possible to explore the best treatment options. Taking action early can prevent future complications and help achieve a healthy, well-aligned smile for life!