Crossbite correction depends on your age, the type of crossbite, and how severe it is. Children under 10 have the simplest path because their jaw bones are still growing and respond well to expansion devices. Adults can achieve the same results, but treatment often takes longer and may require surgery for significant skeletal discrepancies. The good news: crossbites are among the most treatable bite problems in orthodontics, with lasting results in about 80% of cases.
What a Crossbite Actually Is
In a normal bite, your upper teeth sit slightly outside your lower teeth, like a lid on a box. A crossbite reverses that relationship: one or more upper teeth sit inside the lower teeth instead. This can happen in the front of the mouth (anterior crossbite) or along the sides (posterior crossbite), and it can affect one side or both.
Crossbites fall into three categories, and the distinction matters because it determines which fix will work:
- Dental crossbite: The teeth themselves are tilted in the wrong direction, but the jaw bones are properly aligned. This is the mildest form and often involves just one or two teeth.
- Functional crossbite: The jaws are normal, but a premature contact point (often a baby tooth or a canine) forces the lower jaw to shift forward or sideways to close comfortably. Remove the interference, and the bite corrects itself.
- Skeletal crossbite: The upper jaw is genuinely too narrow or the lower jaw too wide. This requires actual bone changes, not just tooth movement.
A functional crossbite has a telltale sign: if you can guide your jaw straight and get an edge-to-edge bite, the problem is positional rather than structural. A true skeletal crossbite won’t let you do that. Your orthodontist will check this relationship to plan the right approach.
Signs You or Your Child Has a Crossbite
Crossbites don’t always cause pain, so they’re easy to miss. In children, the most common red flag is a visible jaw shift when biting down. The child closes their mouth and the lower jaw slides to one side to find a comfortable resting point. Other signs include a smile that looks off-center, one side of the bite touching before the other, a noticeably narrow upper jaw, or front teeth that overlap in the wrong direction (lowers in front of uppers).
Over time, an uncorrected crossbite can lead to asymmetric jaw growth, chipped or worn-down teeth, gum recession on the affected teeth, and clicking or shifting in the jaw joint. Research suggests that crossbites affecting both the front and back teeth simultaneously may increase the risk of jaw joint pain, though the link between crossbites and full-blown TMJ disorders is weaker than many people assume. The more established concern is uneven wear and asymmetric facial development, especially in growing children.
Palatal Expanders for Children
For kids with a posterior crossbite caused by a narrow upper jaw, a rapid palatal expander is the standard first-line treatment. This device fits against the roof of the mouth and attaches to the upper back teeth. A parent turns a small screw once or twice a day, gradually widening the two halves of the upper jaw at the midline suture, which hasn’t yet fused in children.
Age matters significantly here. Before age 10, expansion tends to be parallel and even from front to back, producing a symmetrical result. After age 12, expansion becomes more V-shaped, with more widening in the front than the back and more at the bottom than the top. For the most uniform correction, treatment before age 10 is ideal.
The expansion phase itself is quick, typically lasting a few weeks. After the desired width is reached, the expander stays in place as a passive retainer for several months while new bone fills in the gap. The whole process increases palatal volume significantly, which can also improve breathing. Some children will need braces afterward to fine-tune tooth alignment, but the skeletal correction is the heavy lifting.
Braces and Clear Aligners
When a crossbite is dental rather than skeletal (the jaw is fine, but teeth are tilted the wrong way), braces or clear aligners can move individual teeth into the correct position. This applies to both anterior and posterior crossbites involving a small number of teeth.
For a single tooth in anterior crossbite, treatment can be straightforward. Brackets or aligners tip the upper tooth forward and the lower tooth back into proper overlap. Mild posterior crossbites in adults can sometimes be corrected with braces alone using cross-elastics, small rubber bands that hook between upper and lower teeth to pull the upper teeth outward and the lower teeth inward.
Clear aligners have become increasingly effective for mild to moderate crossbites, though they work best when the problem is truly dental. If there’s a skeletal component, aligners alone won’t widen the jaw bone. They can, however, be combined with expansion devices or used in the finishing phase after skeletal expansion is complete.
Surgical Correction for Adults
Once the midline suture of the upper jaw fuses (typically by the late teens), a standard palatal expander can’t split the bone apart. Adults with a narrow upper jaw and a transverse discrepancy greater than about 5 millimeters generally need surgically assisted rapid palatal expansion, known as SARPE.
During SARPE, a surgeon makes strategic cuts in the bone to release the upper jaw from surrounding structures, then attaches an expansion device. The patient begins turning the expander about four days after surgery, typically achieving around 1 millimeter of widening per day. In one documented case, 8 millimeters of total expansion was achieved over 10 days. The expansion device then stays in place for up to a year while the bone heals and stabilizes.
Most SARPE patients transition to braces or aligners about six months after surgery to align the teeth within the newly widened arch. Total treatment time varies, but the combined surgical and orthodontic process typically takes one to two years. For adults with more complex skeletal discrepancies that go beyond just width, a more extensive jaw surgery (Le Fort I osteotomy) may be recommended, which can correct multiple dimensions of jaw misalignment at once.
Fixing a Functional Crossbite
Functional crossbites are the most rewarding to treat because the jaw structure is normal. The problem is a premature contact that forces the jaw off-track. In children, this is sometimes a baby tooth whose shape pushes the jaw sideways. Simply reshaping or removing that tooth can resolve the crossbite entirely.
In other cases, a tongue habit or low tongue posture contributes to the problem. When the tongue chronically rests low in the mouth instead of against the palate, it fails to provide the outward pressure that helps the upper jaw develop width. This is where orofacial myofunctional therapy, essentially physical therapy for the tongue and facial muscles, plays a supporting role. The exercises train proper tongue posture at rest and during swallowing, which helps maintain correction after orthodontic treatment. Research shows this therapy significantly improves tongue elevation strength, resting tongue posture, and tongue position during swallowing. Without addressing the underlying tongue habit, relapse is more likely because the muscular forces that contributed to the crossbite haven’t changed.
Relapse Rates and Long-Term Stability
A 2024 systematic review and meta-analysis found that roughly 1 in 5 children who have a posterior crossbite corrected will experience some degree of relapse at long-term follow-up. Specifically, 19.5% of treated patients had their crossbite return, and about 19% of the total expansion achieved (including intentional overexpansion) was lost over time.
This is why orthodontists routinely overexpand, building in a buffer to account for the expected settling back. Retainers are also critical. After expansion, a fixed or bonded retainer on the upper arch helps hold the new width while the bone fully mineralizes. Removable retainers are an option as well, but they depend entirely on compliance. The retention phase typically lasts at least a year after active expansion, and many orthodontists recommend longer.
Myofunctional therapy appears to improve long-term stability by addressing the soft-tissue forces that act on the teeth around the clock. If the tongue rests in the right position and swallowing patterns are normal, the teeth have a better chance of staying where they’ve been moved. Appliances alone can’t override years of abnormal muscle patterns once they’re removed.
Choosing the Right Treatment Path
The fix for your crossbite comes down to two questions: is the problem in the teeth or the bone, and are you still growing? Here’s a simplified breakdown:
- Child under 10 with a narrow upper jaw: Rapid palatal expander, possibly followed by braces in the teen years.
- Child or teen with one or two teeth in crossbite: Braces or aligners to reposition the individual teeth.
- Child with a functional crossbite: Remove the interference (sometimes as simple as adjusting a tooth), address any tongue or muscle habits.
- Adult with a mild dental crossbite: Braces or clear aligners with cross-elastics.
- Adult with a skeletal crossbite over 5 mm: SARPE surgery followed by orthodontic finishing, total timeline of one to two years.
If you’re an adult wondering whether you’ve “missed the window,” you haven’t. The treatments are more involved than they would have been in childhood, and recovery takes longer, but the outcomes are comparable. The real cost of waiting is the accumulated wear, gum recession, and jaw compensation that build up over years of biting in a misaligned position.