How We Treat a Crossbite

What is a Crossbite? Many orthodontic problems are obvious, but this may be one you never heard of before. According to the American Association of Orthodontists, a crossbite is “a misalignment of teeth, where upper teeth fit inside of lower teeth,” involving either a single tooth or groups of teeth, either in the front or back of the mouth, or both.

When teeth align correctly, upper teeth naturally fit on the outside of lower teeth. Chewing and biting are painless and easy with correct alignment. Poorly aligned bites, on the other hand, can lead to problems like cracked or broken teeth and/or worn enamel due to the repeated irregular contact between upper and lower teeth.

There are two kinds of crossbite. A posterior crossbite affects the back teeth, causing the upper teeth to rest inside the bottom teeth. An anterior crossbite occurs in the front, with top teeth sitting behind the bottom.

Here at Jungle Roots, we often explain a crossbite by comparing the upper and lower teeth to a shoe box and a shoe box lid. When you place a lid on a shoebox, the upper lid fits over the outside of the box to create a snug and perfect fit. With the mouth, the upper teeth should fit similarly over the bottom.

Most concerning is the fact that studies have shown that some crossbites exist in childhood which are not corrected naturally over time. In fact, it’s been revealed that one to sixteen percent of all children have a posterior crossbite before their permanent teeth come in, while four to five percent have an anterior crossbite. Sadly, if these issues are left uncorrected, the patient’s health can be impacted in serious ways.

What causes a crossbite?

A crossbite can be caused by several issues, including:

Genetics
Prolonged thumb-sucking
Tongue-trusting
Delayed loss of baby teeth.
Poorly matched teeth and jaw sizes
Unusual eruption of permanent teeth
Missing Teeth
Pacifier or bottle drinking far past infancy
Injury to the mouth or jawbone
Poor chewing habits

Of course, genetic causes cannot be prevented in most cases, but other causes can. For children under the age of seven, some behaviors that lead to a crossbite may be changed in order to prevent the development or worsening of a crossbite. Monitoring children to ensure they stop thumb-sucking habits between the ages of two and four, for example, can help prevent this development.

Potential Consequences of Not Treating the Issue

Treating a problem like a crossbite while the jaw and teeth are still developing is best. During this time problems are more easily corrected, and early treatment can prevent the problem from worsening or creating other problems. In the process, any other underlying problems would likely be quickly discovered. This is why a crossbite is most easily addressed and most frequently advised for treatment during a patient’s childhood.

What if parents, caregivers, or patients prefer to wait and leave issues untreated, hoping or believing they will correct themselves over time?

Why is it Important to Treat, and Not Ignore, a Crossbite?

The potential consequences of not treating a crossbite when a patient is young include the possible eventual development of:

Inappropriate jaw shifting
Uneven jaw growth
Wearing down of enamel
Jaw pain
TMJ
Misaligned teeth
Problems with chewing
Headaches, earaches, and other pain
Tooth decay
Gum disease
Tooth erosion
Problems with speech
Problems with breathing during sleep
Unnecessary stress on the jaw muscles
Possible neck, shoulder, and back pain
Teeth grinding and abnormal growth
Asymmetrical growth of facial features
Problems with self-esteem

Considering these possibilities, it’s easy to see why childhood is the best time to address (or take action to prevent) a crossbite, and any such issues must not be ignored. But what exactly can be done and at what ages?

Since one of the habits with the greatest potential to contribute to problems like a crossbite is thumb-sucking, this is a good place to start.

How can thumb sucking be harmful?

Although thumb-sucking is perfectly natural and helps a young child learn to self-soothe, continuing the habit beyond a certain age can be harmful as it may cause their anatomy to change in an unhealthy way.

You may be able to see the shape of their mouth changing, especially in the area of their primary teeth, as the roof of their mouth and supporting bones are also affected. In some cases, their palate can narrow and lead to the development of a crossbite.

If left untreated, further issues can develop. The good news is that there are ways to help a young child break their thumb or finger-sucking habit! Some suggestions are:

Figure out when the child is doing the thumb-sucking. Is it an attempt to soothe themselves because they’re overly tired and can’t fall asleep? Are they hungry? Is it fear or anxiety? If you can figure out the root of the behavior, you can work with the child on releasing the habit. Replacing the behavior with something else, such as holding a favorite toy or stuffed animal, or giving them a hug instead, can eventually wean the child from thumb-sucking. Reminding the child calmly and pleasantly when you see them thumb-sucking can be helpful, too.
Some caregivers have had success when covering the child’s hands with socks at times they’re likely to suck their thumb, or placing band aids over the thumb/fingers, or making reward systems with stickers and charts to increase motivation. Others have attached the desired behavior to a milestone, i.e. “once they turn four, they are too big to suck their thumb anymore” in hopes the child will cooperate with the change as they will want to be a successful new 4-year-old.

You can read more about how we address prolonged thumb-sucking and potential issues that may arise if allowed to continue too long here.

When to Consider Orthodontic Treatment

When seeking early intervention orthodontic treatment, the time period when patients have both permanent and primary teeth generally works best. This phase is particularly advantageous because the teeth and bones are malleable and move most easily, allowing for optimal results.

There are exceptions, however, so if you happen to see that your child’s jaw is poorly aligned (or they’re having a similar problem) earlier than this, we’d like to schedule a complimentary consultation with them at age 7 or earlier. At this consultation, we’ll assess your child’s growth, the development of their teeth, palate, and supporting bones, and evaluate what, if any, type of intervention they will need.

Most children won’t be mature enough for orthodontic treatment until the age of 7. When deciding which treatment to use, aside from evaluating their teeth and physical development, we will also ask our patient and their parents some questions to assess their maturity. We will ask questions like:

Does your child brush their teeth independently?
Did they get their 6-year molars in yet?
Have you talked with your child about the possibility of visiting the orthodontist and why it might be helpful?
Does your child regularly see the dentist?
Does your child express themselves emotionally?

If all the answers are yes, we will likely decide they meet the maturity level necessary for a consultation, and schedule them in for one. (5)

Treatment Options and How Long It Takes

Overall, the way we treat a crossbite is determined on a case-by-case basis, with some benefiting from the use of an expander, or a habit reminder, and others being corrected with limited braces.

Treatment for issues like crossbite is frequently done in phases, as it is easier to guide the growth in younger children. We can guide the growth and correct a posterior crossbite with an expander, or if there is just a crossbite of the front (anterior) teeth, that can be corrected with limited braces. It may occasionally require procedures like extraction of baby or permanent teeth. The length of time to complete full treatment varies widely for children, teens, and adults, taking anywhere from 18 months to 3 years to complete.

If thumb sucking is causing the problem, we may recommend a habit reminder. Customized and made to fit the roof of the mouth (also called the palate), there are appliances we use which are designed to take away the comfort of thumb/finger-sucking. These devices, called a thumb crib or thumb reminder, are not removable and remain where placed through the entirety of the treatment until the habit stops entirely.

We may also employ other devices to correct issues like a crossbite and a combination may be appropriate, especially if there are multiple issues being treated. Our orthodontic team can advise you on which would be useful to your treatment. Some possibilities may include:

Removable orthodontic appliances (like palatal expanders, also to widen the upper jaw)
Full or partial braces
Clear aligners
Maxillary expanders
Surgical assistance
Orthodontic arch wires designed to widen a person’s arches and their smile
Elastics (rubber bands like those used with braces)
Headgear
Dental restorations (Bonding, capping, or reshaping the teeth)
Tooth Removal

Conclusion

Since misalignment from crossbites can lead to so many other problems impacting not only the mouth, but also jaw, neck, and shoulder regions, it’s crucial to get an orthodontist involved for a consultation at the earliest opportunity. While it’s certainly best treated in children, there are options for adults as well. So, don’t let your age or how long you’ve had the crossbite stop you from seeking an appointment. The right treatment is out there for you, so don’t hesitate to pick up that phone and schedule your complimentary consultation with us today!

At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.