Crossbite: causes, symptoms, diagnosis and treatment methods at the orthodontist for children and adults

CausesTypesSignsStages of deviationFormsHow to avoidConsequencesTreatmentComplications

Crossbite is a disorder in which several teeth in the lower jaw overlap parts of the upper jaw and vice versa. Along with reverse incisor overlap, it is a common pathology that begins at the time of intrauterine development of the fetus, or develops as a result of childhood habits. Note that if at least one tooth in a row violates the overlap, it will be a crossbite and will require treatment to prevent complications.

This disorder causes severe physical discomfort in patients due to developing facial asymmetry. It can be detected visually, by external examination or by smiling, which also causes a number of problems when communicating. However, it is possible to correct a bite of any complexity - you need to go to the clinic for an appointment with an orthodontist. Orthodontic systems will help return teeth to their original position, correct your smile and remove any discomfort in just a few years of treatment.

Causes

Cross occlusion, like many malocclusions, begins in early childhood during the development of permanent teeth. The reasons can be factors that depend on the person (improper or poor oral hygiene, physical trauma, the formation of bad habits since childhood), as well as health problems or congenital pathologies (jaw structure, impaired development of the dentition, lack of a number of substances and vitamins).

The most common reasons:

improper development of the jaws. This is affected both by a lack of calcium, which is necessary for the formation of teeth and strengthening the jaw, and by a delay in the appearance of permanent dentition. Often, normal development is disrupted by congenital and hereditary anomalies, otolaryngological diseases suffered in early childhood. As a result, the resulting problems progress with age, gradually distorting the dentition;
improper closure of baby teeth. During normal development, baby teeth wear down evenly, thereby closing together. Disorders appear when the wear of the fangs is lower than that of the rest of the dentition - they begin to slip, displacing the entire jaw. Subsequently, permanent teeth will initially grow incorrectly;
loss of baby teeth. As is clear from the example above, normal development of primary teeth is necessary for jaw development and preparation for permanent dentition. Caries, physical trauma or early loss displace permanent teeth, which disrupt future closure;
negative habits. Placing objects in the mouth, shifting the jaw to the side - these initially insignificant impacts, when constantly repeated, lead to growth deviations and further malocclusions.

In an adult, healthy person, the risk of developing cross-occlusion is much lower, since the jaw system is already formed without anomalies. The cause may be external factors, such as poor-quality prosthetics with crowns or veneers, as well as facial injuries that lead to tooth loss or jaw injury. It is important to constantly maintain the correct bite, and if it is violated, to correct the deviations in a timely manner.

Correction of this malocclusion pathology in adults

Combined orthodontic treatment, which often includes orthognathic surgery, helps correct crossbites in adults. However, surgery is not required in all cases. For example, a malocclusion formed at the level of the dentition can be eliminated with braces or aligners.

Also, there is a special plate that is installed in the required place to correct the position of the dentition.

If there is severe crowding of teeth, doctors may decide to remove some of them. People with a crooked jawbone are referred for an osteotomy, a surgery to correct bone deformities. It is performed under general anesthesia, after which the patient remains in the hospital for some time. It is necessary to understand that the surgical stage does not cancel the wearing of orthodontic structures. That is, in order to correct a crossbite, the patient will have to wear braces or mouth guards both before and after surgery.

In orthodontics, fast and slow expansion of the upper jaw is used to eliminate this pathology. The fast stage is characterized by the use of a large expanding force of a special apparatus. The necessary expansion of the jaws by this method is achieved in a short period of time by opening the median palatal suture, followed by its overgrowth with new bone tissue.

The slow stage, which after the expansion itself, also includes the gradual formation of newly formed bone tissue, which may take a couple of months. Slow expansion is less traumatic and therefore preferable.

Let's take a closer look at certain types of orthodontic structures that can be used to eliminate crossbite.

In case of bilateral lingual form of this disease, a mouthguard is used on the lower teeth with an expanded platform, which will create conditions for the expansion of the lower dentition and possible narrowing of the upper one.

When the cause of crossbite is unilateral underdevelopment of the upper jaw, then on the side of improper closure, a mouthguard is made for the lower jaw with an inclined plane, which extends under the upper teeth from the palatal side and, when closed, promotes their displacement to the buccal side, while simultaneously stimulating the growth of the alveolar process of the upper jaw. During the treatment, the inclined plane is corrected if necessary. During this period, activators of various designs can be used. Such activators have springs, screws and other attributes to correct the position of the teeth and jaw.

Frenkel apparatus

It is possible to eliminate crossbite without opening the palatal suture, by shifting the lower jaw with further growth of its articular process. Here is a short list of activators that are used most often: Frenkel function regulator, Klammt activator, Janson bionator, Andresen-Goipl activator.

Often, during correction, an orthopedic screw is used, which consists of 2-3 tubes and a fixing frame.

Sometimes, in combination with activators that regulate the position of the teeth, jaw and chewing joints, caps with a chin sling and rubber traction are used. The Angle apparatus and Katz crowns are also used to combat such ailments as crossbite.

A person who has this problem will have to wear braces and retainers for a long time, the exact timing of which is determined by the attending physician. He will examine you at certain intervals, checking the dynamics of the recovery processes.

Kinds

Facial asymmetry is a common symptom for any type of crossbite. However, even with its presence, such occlusion has several forms. They depend on the position of the jaw and teeth relative to the normal position. In particular, the disorder can begin in the anterior region - then the jaw noticeably protrudes forward, protruding, even if the mouth is closed. Disorders are also common in the lateral regions, shifting the jaw to the side depending on the curvature. Most often, orthodontists diagnose a “scissor” bite, in which the upper row of teeth completely overlaps the lower one, forming a picture typical for this type of occlusion

Buccal and lingual occlusion are considered from the point of view of the position of the dental row - which of the jaws covers the other in a normal position. The first is associated with excessive development of the lower jaw, due to which it overlaps the upper one. The lingual one has the same signs, but exactly the opposite - the upper jaw covers the entire lower jaw.

Orthodontists also study the distribution of occlusion. The violation can happen to one or two teeth, or affect the entire jaw row. Moreover, the first violation threatens to develop into a more extensive stage if treatment is not started on time.

How to correct children's bite?

After diagnosis, a specialist will suggest the correct method to parents.

Babies need to be bottle-fed with the correct nipple and ensure that they do not sleep in the same position.
Older children should chew solid foods, while more often loading the deformed side of the dentition.
If there is a one-sided curvature of the cusps of individual teeth, the doctor can lightly grind them to remove them from the pathological bite.
It is imperative to monitor how the child swallows and breathes.
Prematurely lost milk teeth must be promptly replaced with special children's dentures, to which children very quickly get used to.

If there is a need to expand the jaw, special expanders are used, and a pressure bandage that separates the bite helps slow down the development. More serious defects are corrected with specialized structures - a function regulator, an activator, a plate and mouthguards, and at 10-12 years of age, after the primary dentition has changed to a permanent one, braces are used.

Signs

Crossbite can be determined by external signs, without special instruments. Depending on the size of the lesion, several teeth or the entire dentition of the lower jaw will overlap the corresponding upper ones, as if intersecting. In a normal position, they should close tightly.

Also a common symptom of occlusion distortion is facial asymmetry, which is noticeable even with the mouth closed. Due to the incorrect position, the jaw moves to the side along with the chin, which is noticeable to the naked eye. Note that noticeable asymmetry does not appear in all cases, or may be the cause of other disorders that are not necessarily related to teeth.

However, correcting a crossbite is necessary because it causes physical discomfort - the teeth cling, wear off each other, and cause multiple problems. In general, improper jaw position negatively affects the entire system. Joints develop unevenly, which leads to their dysfunction, bones become bent, which in the long term can only be corrected by surgery. Moreover, the consequences can overtake the patient even after a course of treatment, as a result of which orthodontists prescribe additional medications or training.

The danger of a malocclusion is that the patient does not always notice it. The disorder develops over time, the sensations adapt to it, and as a result, the patient notices the consequences of the anomaly too late. In the case of children, this is especially important, so parents must be attentive. It is necessary to stop negative habits, and at the first signs of occlusion distortion, contact an orthodontist for a clear diagnosis.

Prevention and prognosis

Prevention of such a defect as crossbite should begin during a woman’s pregnancy. She should lead a healthy lifestyle, watch her diet, and exercise moderately. It is also important to avoid all kinds of infections and viruses. To do this, it is better to avoid visiting crowded places and communicating with carriers.

After the baby is born, he needs constant monitoring. At this stage, it is important to choose the right pacifier and pacifier, and, if possible, do without these devices. To do this, it is better to consult a pediatric dentist or pediatrician. It is also necessary to ensure that the child does not get carried away with thumb sucking or toys, and does not receive any injuries to the facial part of the head.

The prognosis of such a malocclusion depends on how well the treatment was carried out. Often the defect can be completely removed.

Important! Do not forget that at the initial stage only a specialist can identify dental deformation. Therefore, it is necessary to visit the dentist regularly from the moment the first baby teeth grow.

Stages of Deviation

Cross-occlusion develops differently depending on the size of the problem. The most common dentoalveolar form is the initial one, in which the problem begins directly with the teeth. An uneven row due to developmental anomalies causes discomfort, which is why the jaw is subsequently fixed incorrectly in adulthood. If the dental alveolar form is not corrected in time, it will develop into a more serious one.

The skeletal one distorts the position at the level of bone tissue. It develops as a consequence of the dentoalveolar form, or becomes the initial cause of crossbite due to a violation of the formation of the jaw. Note that it is more difficult to treat than the first one - surgery is often required to correct such deep disorders. The dentoalveolar one is corrected with the help of veneers or aligners.

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What are the differences between bite forms?

It is possible to distinguish what type of malocclusion is manifested in a patient visually. If the central line of the dentition coincides, then everything is in order with the facial skeleton. Since the jaw slides to the wrong position only when it is closed, the problem is at the level of the teeth, and it is quite easy to fix it - a long course of treatment with aligners is enough for this.

If the line does not match, then this indicates improper formation of the jaw. Developed asymmetry, atypical proportions of the chin, all this is a consequence of the skeletal form of the disorder. Only surgical intervention or a combined effect will restore the correct shape of the jaw.

How to avoid

The bite is formed while the body is still developing. As a result, the child’s different habits become fixed in his development, which is why violations occur. For example, if a child specifically changes the position of the jaw out of interest or experiment, causing it to become incorrect for a long time, supports it with his hand, or often touches only the teeth that are emerging, all this can provoke their deviation. It is worth checking the child’s sleeping place. Incorrect pillow height contributes to the curvature of the spine and jaw displacement.

You can notice a displacement of a child’s jaw without professional skills. In this case, it is worth showing him to an orthodontist to correct the bite. The doctor will carefully examine the anomaly, find the causes of the disorder and give a number of recommendations - habit correction and exercise. In childhood, the problem is corrected quickly if the child follows the recommendations, but in adults it is much more difficult to treat.

Consequences

Crossbite in permanent teeth causes many consequences with long-term exposure. Therefore, when detected, it is important to begin correction. For example, the dentoalveolar form subsequently turns into a skeletal form, which can no longer be corrected by orthodontic mechanisms - only by surgical intervention to correct the facial skeleton.

An incorrect bite creates an uneven load on the joints, as a result of which they begin to develop with poor posture. This distorts the growth of permanent teeth, contributes to their abrasion on other surfaces, which leads to caries and destruction of enamel. Teeth clinging to each other lead to chipping, development of cracks and wedge-shaped defects, contribute to gum problems and injure the mucous membranes.

Please note that the symptoms will not necessarily manifest themselves in full, since their appearance is influenced by various factors. However, if crossbite treatment is not started, improper load on the teeth will significantly increase the risk of abrasion and, as a result, destruction. In addition, constant joint pain will appear as a result of dysfunction and uneven development of the joints.

Symptoms of pathology

One of the visible symptoms is undoubtedly facial asymmetry:

the corners of the lips are at different heights, which is why the smile is displaced (curved);
the jawline is deviated from the central axis.

Visual asymmetry in crossbite is not the only sign; it is also observed:

incorrect position of teeth in the mouth, crowding;
changes in the functioning of the temporomandibular joint (temporomandibular joint). This causes discomfort, unpleasant sensations, pain when yawning, opening the mouth wide; uneven load on teeth leads to rapid wear and easy accessibility of caries damage;
wedge-shaped defect;
tension in the jaw muscles, leading to frequent pain;
injuries to the mucous membrane of the cheeks due to involuntary biting.

In addition to the above symptoms, a displacement of the transverse bite is sometimes accompanied by a speech defect in the pronunciation of hissing and hissing sounds.

Treatment

Modern orthodontics can correct malocclusion of any complexity - from several teeth to a complete correction of the jaw. For this, various influences are used. For mild forms of curvature, long-term treatment with orthodontic mechanisms is sufficient, while severe problems will have to be corrected during surgery.

As we indicated above, the shape of the jaw is formed in childhood, so treatment should begin in the early stages. Only an orthodontist can make a final diagnosis and recommendations. If a child has occlusion pathologies, self-medication can cause complications.

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Treatment of children's bite takes place after examination. The images taken and their analysis help formulate a treatment plan based on the current form of the disorder. As a rule, braces are prescribed for correction, but they are inferior to aligners. These medical mouth guards work on a similar principle - they create constant micropressure on the teeth, gradually aligning them in the desired direction. However, unlike braces and plates, aligners are almost invisible and can be easily removed for cleaning and oral hygiene, so it will be easier for the child to follow the recommendations regarding them.

Orthodontics distinguishes two methods of how to treat crossbite:

orthodontic treatment. As in the case of children, correction is carried out by orthodontic mechanisms. A popular method is aligners, which combine convenience and effectiveness. The standard course lasts from one and a half to two and a half years, depending on the degree of correction;
surgical intervention. Often combined with the installation of braces, this method allows you to correct violations in the development of jaw bone tissue. Surgery is used as a last resort when the jaw itself requires correction.

In some cases, surgery may be contraindicated due to complications. At the same time, aligners cannot completely correct the dentition due to their complexity. Then an incomplete correction is carried out under the supervision of an orthodontist to avoid relapse in the future.

Diagnostics

To accurately determine the presence of this disease, it is necessary to undergo a series of examinations, the results of which will shed light on the complexity of crossbite and the causes of its occurrence. An orthodontic diagnosis is preceded by a complete clinical, functional and instrumental examination.

During the initial consultation, the orthodontist examines the face and oral cavity, palpates and auscultates the temporomandibular joint, performs the necessary functional tests, and compares objective data with complaints and anamnestic information.

To study the problem more deeply, it is necessary to conduct a teleroentgenogram and an orthopantomogram of the head. When the lower row of teeth is displaced, it is necessary to take an x-ray of the temporomandibular joint.

During the examination, the type and form of crossbite, its etiology, and associated disorders are determined, which affects the volume and sequence of implementation of treatment measures.

A detailed determination (multi-faceted diagnosis) of the presence of a given problem and the degree of its complexity directly affects the success of subsequent treatment.

Complications during treatment

Cross occlusion leads to jaw development problems that may persist after treatment. Most often, joint dysfunction occurs because the load on it changes due to a change in the position of the teeth. It can be expressed both in poor jaw function and in periodic pain.

Complications are corrected by consistent exercises prescribed by the orthodontist, along with painkillers. Today, orthodontic methods make it possible to predict possible complications and eliminate them in a short time, preventing the progression of problems.

Do you want to correct your crossbite? We are waiting for you at the PROPRICUS clinic!

The leading expert of the clinic, Nana Gezalova, is doctor No. 1 in the Invisalign rating. This is a talented orthodontist with 15 years of experience and extensive experience working with Invisalign aligners. She personally trains the clinic’s orthodontists and strictly controls the quality of treatment for each patient.
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