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Updated on August 22, 2022

Crossbite: Types, Causes, Complications & Treatment

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What is a Crossbite?

A crossbite is a form of dental malocclusion (misalignment). It occurs when the upper and lower teeth do not align correctly.

In a crossbite, some upper teeth sit inside the lower teeth. The misalignment can either appear at the front of the mouth or the sides of the mouth.

two people looking at teeth x rays and 3d model

A crossbite is often confused with an underbite. However, the two are different malocclusions and require different treatments.

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Different Types of Crossbites

There are two main classifications of crossbites, including:

Anterior Crossbite

An anterior crossbite is a lingual occlusion of the upper anterior teeth (incisors and canines) with the lower anterior teeth.

In this type of malocclusion, some or all of the upper anterior teeth are behind the lower anterior teeth. In some cases, the lower front teeth completely hide the upper front teeth.

Posterior Crossbite

A posterior crossbite is the opposite of an anterior crossbite. In this type of malocclusion, the top posterior teeth (upper molars) sit inside the bottom posterior teeth.

Between 8 and 16 percent of children have a posterior crossbite.

Posterior crossbites are usually due to the irregular narrowing of the palate and teeth in the upper jaw and can develop on one or both sides of the mouth.

crossbite malocclusion scaled 1

Signs and Symptoms of a Crossbite

In addition to abnormal alignment of the teeth, signs and symptoms of a crossbite include:

  • Jaw pain or discomfort
  • Difficulty biting or chewing
  • Mouth breathing
  • Speech problems, including a lisp

Without treatment, a crossbite can lead to tooth decay and gum disease.

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What Causes a Crossbite?

The cause of a crossbite can be attributed to various factors, including: 

Genetics

The primary cause of a crossbite is genetics. Some people are born with a larger lower jaw and smaller upper jaw.

Since narrow palates and teeth anomalies can run in the family, a crossbite may result once the teeth begin to grow in. 

An orthodontist may recommend a growth modification device if this is the case. The device widens a child’s upper jaw early on to prepare for orthodontic treatment once the permanent teeth start to grow in.

Mouth Breathing

Mouth breathing can alter facial growth.

Breathing through the mouth typically happens during sleep. If a child already has a small upper jaw and suffers from mouth breathing, they have a higher chance of developing a crossbite.

Delayed Eruption of Permanent Teeth

Over-retained teeth are baby teeth that do not fall out at the appropriate age. These baby teeth prevent the eruption of the underlying permanent teeth. 

If the permanent tooth erupts and causes a crossbite, orthodontic correction may be necessary.

Childhood Habits

Sucking habits can alter jaw growth in children. These habits include:

  • Thumb sucking
  • Finger sucking
  • Using a bottle or pacifier excessively

Learn more about how to keep your kids' teeth healthy.

What Problems Can a Crossbite Cause?

Common risk factors associated with untreated crossbites include:

  • Tooth chips or cracks caused by abnormal occlusion between the upper and lower teeth
  • Increased risk for cavities and gum disease, such as gingivitis and periodontal disease
  • Receding gums, a serious oral condition that exposes tooth roots to infection and decay
  • Trouble closing your mouth
  • Pain when biting or chewing
  • Headaches and jaw aches
  • Severe toothaches

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How To Fix A Crossbite

Crossbite correction typically involves orthodontic devices or surgical treatment. Several orthodontic appliances and procedures are available.

Clear Aligners (Invisalign)

Clear aligners are a common orthodontic treatment for crossbites.

Invisalign is the most effective and well-known brand of clear aligners. Aligners cover the entire biting surfaces of the upper and lower teeth. This allows a tooth in a crossbite to move freely without being affected by the opposing teeth.

Braces

Braces are capable of treating most crossbite cases. If only a single tooth is in a crossbite, braces can correct it without help from additional orthodontic appliances.

If more than one tooth is in a crossbite, a dental expansion appliance or headgear may be used with braces.

Rapid Palatal Expander (RPE)

An orthodontist may recommend dental expansion in combination with braces or clear aligners for severe crossbites. Rapid palate expanders (RPE) widen narrow dental arches and correct posterior crossbites.

The appliance fits over molars in the upper jaw, and a screw connects the device in the middle. To activate RPEs, you turn the screw a small amount every day.

Reverse-Pull Headgear (Face Mask)

Reverse pull headgear consists of pads that attach to the forehead and chin with a facemask frame in between.

Patients connect rubber bands from the anchorage device on the braces to the frame. Reverse pull headgear shifts the upper jaw forward. The goal is to align the teeth in the upper and lower jaws over time.

Jaw Surgery

In the most severe cases, jaw (orthognathic) surgery may be recommended. 

Surgery is used to treat underbites, overbites, crossbites, and advanced sleep apnea. During the procedure, an oral surgeon strategically moves the upper and lower jaws.

Jaw surgery costs anywhere between $20,000 and $50,000.

Can Veneers Fix A Crossbite?

Veneers are capable of fixing mild crossbites in adults only.

If you have a stable bite and want to change the shape and color of your teeth, veneers might be an option. 

However, veneers are more expensive and invasive than orthodontic treatment. Speak with your dentist or orthodontist to determine the best option.

How Long Does it Take to Fix a Crossbite?

Treatment time varies depending on age and severity of the crossbite. Crossbites that are diagnosed in childhood are typically easier to fix. This is because a child’s jaw isn’t fully developed and their bone is softer and easier to manipulate. 

Orthodontic correction in adults is possible but may require more time and additional appliances.

Correcting a crossbite with metal braces typically takes between 6 months and 2 years. Very mild cases may only take up to 8 months. If you need jaw surgery, treatment will be longer, especially when you include recovery time.

How Much Does it Cost to Fix a Crossbite?

The treatment cost for fixing a crossbite varies greatly, from a couple thousand dollars (braces) to $20,000 (jaw surgery).

Health insurance may help cover some expenses if the treatment is medically necessary, i.e. the bite causes problems that negatively affect your daily life.

Summary

  • A crossbite is a specific malocclusion (misalignment) of one or more teeth
  • Crossbites are common and can lead to other dental problems if left untreated
  • A crossbite can cause pain, speech problems, and difficulty biting and chewing
  • Common causes of crossbites include genetics and childhood behaviors
  • Treatment for a crossbite may include braces or clear aligners, removable appliances, or, in severe cases, jaw surgery

What’s Next?

The most popular at-home clear aligner kits can be found right here:

Learn about the different brands and what they offer.

7 Sources Cited
Last updated on August 22, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Almeida, Renato Rodrigues De, et al. “Posterior Crossbite - Treatment and Stability.” Journal of Applied Oral Science, Mar-Apr 2012.
  2. Piancino, Maria Grazia, and Stephanos Kyrkanides. Understanding Masticatory Function in Unilateral Crossbites. Wiley Blackwell, 2016.
  3. Proffit, William R., et al. Contemporary Orthodontics. Elsevier/Mosby, 2019.
  4. Recognizing and Correcting Developing Malocclusions: a Problem-Oriented Approaches to Orthodontics. Wiley, 2015.
  5. Sterling, Evelina Weidman. Your Child's Teeth: a Complete Guide for Parents. Johns Hopkins University Press, 2013.
  6. Malocclusion of teeth.” National Institutes of Health National Library of Medicine, 24 Jan. 2022.
  7. Malocclusion in Children.” Stanford Medicine, n.d.
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