What This Guide Covers
This guide explains what a crossbite is, how it affects your teeth and jaw, and the main ways orthodontists correct it. It is written for adults and parents of children who have been told they may have a crossbite.
A crossbite is a type of malocclusion, which is the clinical term for teeth that do not line up correctly when you close your mouth. In a normal bite, the upper teeth sit slightly outside the lower teeth. In a crossbite, one or more upper teeth close behind or inside the lower teeth instead. [1]
Crossbites can involve a single tooth or an entire group of teeth. They can affect the front of the mouth, the back, or both sides. The right treatment depends on the type of crossbite, its cause, and the patient's age. An orthodontist is the dental specialist who diagnoses and treats these cases.
Understanding Crossbites: Types, Causes, and Risks
A crossbite happens when the upper and lower jaws or teeth do not align properly, causing one or more upper teeth to bite inside the lower teeth. Understanding the type you have helps guide treatment.
Anterior vs. Posterior Crossbite
There are two main categories of crossbite. An anterior crossbite affects the front teeth. One or more upper front teeth close behind the lower front teeth. This is sometimes confused with an underbite, but an underbite typically involves the entire lower jaw sitting forward.
A posterior crossbite affects the back teeth, usually the premolars or molars. In this case, one or more upper back teeth sit inside the lower back teeth when you bite down. Posterior crossbites can occur on one side (unilateral) or both sides (bilateral). [1]
Orthodontists also classify crossbites by their origin. A dental crossbite means the teeth themselves are tilted or positioned incorrectly, but the jaw bones are normal. A skeletal crossbite means the upper jaw (maxilla) is too narrow or the lower jaw (mandible) is too wide. Some patients have a combination of both.
What Causes a Crossbite
Several factors can lead to a crossbite. Genetics play the largest role. If a parent has a narrow upper jaw or a wide lower jaw, their child may inherit a similar jaw shape. [2]
Childhood habits can also contribute. Prolonged thumb sucking, pacifier use past age three, or mouth breathing may alter how the palate develops. Losing baby teeth too early or too late can shift permanent teeth into crossbite positions. In adults, trauma to the jaw or poorly positioned dental restorations may contribute as well.
What Happens If a Crossbite Is Not Treated
An untreated crossbite does not correct itself. Over time, the misalignment can cause several problems. The jaw may grow unevenly because the bite forces are not balanced. This can lead to noticeable facial asymmetry, especially when a posterior crossbite causes the lower jaw to shift to one side. [1]
Teeth in crossbite receive abnormal pressure during chewing. This often leads to enamel wear, chipping, or fractures. The gums around teeth in crossbite may recede, exposing the root surface and increasing sensitivity. [2]
The temporomandibular joint (TMJ), the hinge connecting your jaw to your skull, may also be affected. Unbalanced bite forces can contribute to TMJ pain, clicking, and limited jaw movement. In children, an untreated crossbite can alter the growth pattern of the face and jaw in ways that become harder to correct with age.
Age Recommendations and Treatment Timing
The best time to begin crossbite correction depends on the patient's age, jaw development, and the severity of the problem. Early evaluation gives the widest range of treatment options.
Why Early Evaluation Matters for Children
The American Association of Orthodontists recommends that every child have an orthodontic evaluation by age 7. [1] At this age, a mix of baby teeth and permanent teeth is present. An orthodontist can spot a developing crossbite before it worsens.
Between ages 7 and 10, the midpalatal suture (the growth plate in the roof of the mouth) has not yet fused. This means a palatal expander can widen the upper jaw by gently separating this suture. The bone fills in naturally over several months. This window of growth makes treatment simpler, faster, and more predictable than waiting until adolescence or adulthood.
Not every child with a crossbite needs immediate treatment. Sometimes an orthodontist will monitor the situation and intervene only when the timing is right. This approach is called observation or "watchful waiting."
Treatment Timing for Teens and Adults
In teenagers, the midpalatal suture may be partially fused. Expansion is still possible in many cases, but it may require more force or a bone-anchored expander. Results vary depending on the individual's skeletal maturity.
In adults, the palatal suture is typically fully fused. A traditional palatal expander alone is usually not enough to widen the upper jaw. Adults with skeletal crossbites may need surgically assisted rapid palatal expansion (SARPE), a procedure where a surgeon creates small cuts in the bone so an expander can do its work. For mild dental crossbites in adults, braces or clear aligners may be sufficient without any surgical intervention. [1]
Treatment Options and What to Expect
Crossbite correction typically involves widening the upper jaw, repositioning teeth, or both. Your orthodontist will recommend a treatment plan based on your specific diagnosis.
Palatal Expanders
A palatal expander is a device cemented to the upper back teeth. It applies gentle outward pressure to widen the upper jaw over time. A parent or the patient turns a small screw in the center of the device once or twice a day, following the orthodontist's instructions.
The active expansion phase typically lasts 2 to 4 weeks. After that, the expander stays in place for several months while new bone fills in the gap. Total time wearing the expander is usually 6 to 12 months. [1]
Palatal expanders work best in children whose palatal suture has not yet fused. Patients may feel mild pressure or a tingling sensation around the nose during the first few days of expansion. A temporary gap between the two upper front teeth is normal and typically closes on its own or is corrected with braces afterward.
Braces and Clear Aligners
Braces use brackets bonded to each tooth and a wire that applies controlled force to move teeth into the correct position. They are effective for both anterior and posterior crossbites, especially dental crossbites where the jaw width is adequate but the teeth are misaligned. [1]
Clear aligners are removable trays that gradually shift teeth. They can correct mild to moderate dental crossbites in compliant patients. Each set of trays is worn for one to two weeks before moving to the next set. Clear aligners work best for cases that require tooth movement rather than skeletal expansion. [2]
In many cases, braces or aligners are used after palatal expansion to fine-tune tooth positions. Treatment with braces or aligners alone for a crossbite typically takes 12 to 24 months. The timeline depends on how many teeth need to move and whether other bite issues are present.
Jaw Surgery for Severe Cases
When the crossbite is caused by a significant skeletal discrepancy in an adult, jaw surgery (orthognathic surgery) may be the most effective option. This is typically considered when the upper jaw is substantially narrower than the lower jaw and expansion alone cannot correct the difference.
Surgically assisted rapid palatal expansion (SARPE) involves a surgeon making precise cuts in the maxillary bone under general anesthesia. An expander is then activated over the following weeks to gradually widen the jaw. Full healing of the bone takes several months.
In complex cases involving both jaw width and jaw length problems, a combined orthodontic and surgical treatment plan may be recommended. Braces are typically placed before surgery to align the teeth, then the surgery repositions the jaw, and braces remain afterward to finalize the bite. Total treatment time for surgical cases is often 18 months to 3 years. [1]
Retention After Treatment
After any crossbite correction, retention is critical. Teeth tend to shift back toward their original positions without a retainer. Your orthodontist will typically prescribe a retainer to wear full-time for several months, then nightly for an extended period. [1]
Some patients receive a fixed retainer, a thin wire bonded behind the front teeth. Others receive a removable retainer. The type depends on which teeth were moved and how stable the correction is. Consistent retainer use is the most important factor in maintaining crossbite correction long-term.
Crossbite Correction Cost and Insurance
The cost of crossbite correction varies widely depending on the treatment type, case complexity, geographic location, and provider. There is no single price that applies to every patient.
A palatal expander alone may range from $1,000 to $3,000. Braces for crossbite correction typically fall between $3,000 and $7,000. Clear aligner treatment ranges from $3,000 to $8,000. Surgically assisted expansion or full orthognathic surgery can range from $20,000 to $40,000, though this figure includes surgeon fees, anesthesia, and hospital costs. Costs vary by location, provider, and case complexity.
Many orthodontic offices offer payment plans that spread the cost over the length of treatment. Some offices also offer a discount for paying in full at the start of treatment. Ask the office about available options during your consultation.
Dental insurance plans that include orthodontic benefits typically cover a portion of crossbite correction, especially for children under 18. Coverage often has a lifetime maximum for orthodontic treatment, commonly between $1,000 and $2,500. Plans vary significantly, so reviewing your specific benefits before starting treatment is helpful. Medical insurance may cover part of the cost if jaw surgery is required, as orthognathic surgery is sometimes classified as a medical rather than dental procedure. [2]
When to See an Orthodontist for a Crossbite
An orthodontist should evaluate any suspected crossbite. A general dentist can identify the problem, but an orthodontist has the specialized training to determine whether the crossbite is dental, skeletal, or both, and to plan the appropriate correction.
You or your child should see an orthodontist if you notice any of the following signs:
- Upper teeth close behind or inside the lower teeth when biting down
- The lower jaw shifts to one side when closing the mouth
- Uneven tooth wear or chipping on specific teeth
- Jaw pain, clicking, or difficulty opening the mouth fully
- Facial asymmetry, especially in a growing child
- A general dentist or pediatric dentist has recommended an orthodontic evaluation
General Dentist vs. Orthodontist for Crossbite Treatment
A general dentist may offer clear aligner treatment for mild cases. However, crossbites often involve skeletal components that require specialized diagnosis. Cone-beam computed tomography (CBCT), a type of 3D X-ray, and cephalometric analysis are tools orthodontists routinely use to assess jaw width, tooth angulation, and growth patterns. [1]
If a palatal expander, surgical expansion, or combined treatment is needed, an orthodontist is the appropriate provider. For surgical cases, the orthodontist will work closely with an oral and maxillofacial surgeon. You can learn more about orthodontic specialists and what they treat on the orthodontics page.
Find an Orthodontist for Crossbite Correction
If you or your child has a crossbite, finding a qualified orthodontist is the first step toward understanding your treatment options. Use the My Specialty Dentist directory to search for orthodontists in your area. You can filter by location and read about each provider's background before scheduling a consultation. Visit the orthodontics page to start your search.
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