Orthodontic problems, related to the alignment of teeth and bone, are prevalent among children and adolescents. Crossbite is one such very common orthodontic anomaly. Crossbite presents as misalignment of front teeth or back teeth or even both. If you close your mouth and your upper teeth sit inside your lower teeth rather than on the outside, it is known as a crossbite.

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It is a harmful condition because it can make your teeth wear down or chip off. It can also make your gums start to recede or make little notches above your gum line.

This type of damage can lead to painful gum problems like gingivitis or even bone and tooth loss. Hence it is crucial to treat crossbite in due time.

Let’s see in detail what is a crossbite, its effects on our teeth and appearances and how it can be treated.

What is a crossbite?

Crossbite is a misalignment of teeth which leads to a bad bite between the upper and lower teeth. A bad bite occurs when a patient either has anterior or posterior crossbite.

This misalignment of teeth is common in children transitioning from milk teeth to permanent teeth. But if this doesn’t correct on its own, orthodontic treatment is required.

The branch of orthodontics dealing with correction of crossbite in early stages is known as interceptive orthodontics. It involves placement of certain fixed or removable appliances in our mouth to help correct this misalignment. (1)

Adults suffer from this misalignment if they neglect crossbite in the early stages. Correcting this condition in the adult is a tedious process and is done by corrective orthodontics. This treatment is prolonged and may involve extraction of teeth.

If not corrected in time, crossbite can directly impinge on the underlying gums and cause gum inflammation. (2) Eventually, gum inflammation leads to bone loss and tooth loss.

Types

Anterior crossbite

In this condition, the upper front teeth are placed behind the lower front teeth.

Posterior crossbite

In this condition, there is a misalignment of back teeth, where upper back teeth lie outside of lower back teeth.

Signs & symptoms

One or more of the following signs depict this condition.

  • The upper and lower teeth don’t touch one another when you bite
  • Not being able to speak properly
  • Biting on the inner cheek and tongue more often, while speaking or eating
  • Pain in the jaw and neck
  • Pain in one or several teeth
  • Severe headaches

Causes

The most probable cause for a crossbite is a difference between tooth size and jaw size. When the jaws get narrower or teeth are abnormally large in size, there will be crowding of teeth and results in crossbite.

The following factors may be the leading cause for this condition –

Genetics

A lot of the crossbite cases are due to genes and are therefore hereditary.

Developmental anomalies

Other non-genetic causes, such as the abnormal eruption of teeth and delayed growth of teeth, might accelerate the development of crossbite. (3)

Delayed growth of teeth

Delay in the growth and eruption of one tooth leads to an imbalance in the growth of the subsequent erupting teeth. Delayed growth of teeth leads to an irregular spacing of teeth and results in crossbite.

Habits

Habits like thumb sucking, tongue thrusting, and mouth breathing are believed to accelerate and even possibly cause crossbite. These habits narrow the size of the arch.

Effects of crossbite

The following are the effects we see when a patient suffers from this condition.

Gingivitis

When we bite, the bite force goes down to the gums. Therefore, if we have an imbalanced bite, the gums will impinge and cause gingival inflammation.

The sudden onset of gingivitis or gum swelling further leads to a number of teeth problems like the recession of gums and teeth loss.

Severe Headaches

This misalignment of teeth is closely linked to a headache in adults and also in children. As you might teeth are not only for chewing, but they also support your facial muscles.

When your jaws aren’t correctly aligned, it puts a strain on the jaw muscles and joints. These are linked with nerves that go to the brain, and thus cause headaches.

These nerves also run down our neck and shoulders and may cause severe pain in those regions.

Tooth Decay

Brushing misaligned teeth due to their shape and position is difficult. Not being able to brush and floss properly can lead to tooth decay as it’s easy for bacteria to hit a tooth that isn’t cleaned.

Painful Bites

Crossbite snatches the luxury of biting on hard things, making it difficult to enjoy your favorite food at times. It also generates unbearable pain unbearable and therefore, it’s important that you consider treatment before it gets any worse.

Crossbite treatment

The best time to correct crossbite is as a child or as a teenager. But there are multiple treatment options available for adults as well. Treating the condition involves adjusting the teeth, palate or jaw with orthodontic appliances.

Teeth removal

One or more teeth may be extracted to make space for moving the teeth in proper alignment.

Palatal or maxillary expander and headgear

An orthodontist attaches a device to the upper teeth and palate that gradually widens the upper palate. Palatal expanders are most effective in children because palatal palates continuously grow in children.

They are fixed appliances. Headgears are attached to the head and chin externally and work same as palatal expanders.

Removable expander

A removable expander is a device that adults can wear at night to widen the upper palate when a minimal expansion is needed to correct a crossbite.

Surgically assisted rapid palatal expansion

A surgical procedure is done to break the jaw bone at several places and realigned intentionally. This surgery allows a wider expansion of the upper palate compared to palatal expanders.

Braces

As a treatment after palatal expansion, braces straighten and fix the upper and lower teeth to achieve a well-aligned bite.

Teeth bonding

Minor crossbites pertaining to only one or two teeth can be corrected using porcelain veneers or bonding of teeth.

Maintenance of crossbite treatment

Even after correcting the misalignment of teeth using the above procedures, you have to go for proper maintenance therapy. If post-treatment maintenance is not done, the crossbite might relapse. Let’s look at some maintenance therapy options –

Retainers

Retainers are removable appliances and are made of wires. They hold the treated teeth in position. Retainers should be worn from 6 months to 1 year depending upon the type and extent of misalignment of teeth.

Mouthguards

Same as retainers, mouth guards prevent any damage to the treated teeth and are worn at night to prevent teeth grinding and relapse of crossbite.

Flossing and oral hygiene

Flossing between treated teeth is very important as it keeps the harmful bacteria at bay. After correction of crossbite, the patient should brush twice daily and use an anti-bacterial mouthwash.

Over to you

Crossbite is a common orthodontic abnormality of teeth. It should not be neglected because it may lead to more serious problems like facial pain and temporomandibular disorder.

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However, this condition self-corrects in children. But if there is a persistent case of crossbite, orthodontic therapy will be required.

A proper bite is important for healthy jaws and a healthy body. An improper bite can lead to improper nutrition, low self-esteem due to a crooked smile and jaw pains.

Therefore, it is important to consult a dentist immediately if you are an adult and have an improper bite. Crossbite is completely curable, and post-treatment maintenance is important to prevent relapse.

If you close your mouth and your upper teeth sit inside your lower teeth rather than on the outside, it is known as a crossbite.
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