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Dental Care


What is a Crossbite and How is it Fixed?

By Dental Care, Orthodontics, Teen Orthodontics No Comments

As a board-certified orthodontist, Dr. Richard Chan is an expert in diagnosing, preventing and treating malocclusion, or an improper bite. There are different types of malocclusion and you’ve probably heard of a few of them like an overbite and underbite. One type that a lot of people are less familiar with is a crossbite. So, what is a crossbite? Our Juneau, Bothell, Monroe and Mill Creek orthodontist will be covering everything you need to know about this orthodontic concern.

What is a Crossbite?

Normally, your upper teeth overlap on the outside of the lower teeth when you close your jaws together. When you have a crossbite, however, one or more of your upper teeth bite inside of your lower teeth. A crossbite can involve several teeth or a single tooth and it can occur in the front of the mouth, back of the mouth or both. There are two main types of crossbites:

  • Anterior Crossbite: An anterior crossbite, or front crossbite, is when one or more front top teeth sit inside of the front bottom teeth.
  • Posterior Crossbite: A posterior crossbite, or back crossbite, is when one or more of the upper teeth in the back or on the side of the mouth sit inside of the lower teeth. A posterior crossbite can develop on one side of the mouth or, occasionally, both sides.

So, isn’t a crossbite the same as an underbite? No. With an underbite, the jaw and whole arch of top teeth are behind the bottom teeth.

What Causes a Crossbite?

  • Genetics The most common cause of a crossbite in children is genetics, which, unfortunately, means that many crossbites can’t be prevented. Usually, it’s a result of a small or narrow upper jaw and/or larger lower jaw, which can be inherited from one or both parents.
  • Delayed Loss of Baby Teeth When the baby teeth don’t fall out when they’re supposed to (over-retained primary teeth) and the permanent teeth are delayed in erupting, the other teeth may shift to compensate, creating misalignment, such as a crossbite.
  • Oral and Myofunctional Habits Oral habits like prolonged thumb sucking and pacifier use are another cause of malocclusion. The pressure from the thumb or pacifier can push teeth out of alignment and distort bone, resulting in a narrow palate and crossbite. Myofunctional problems like abnormal swallowing patterns can also cause a crossbite, because they too exert undue pressure.
  • Mouth Breathing Chronic mouth breathing in kids, which often happens at night, can impact jaw and facial development. It may lead to an elongated face and underdeveloped jaw, contributing to the development of a crossbite and other orthodontic concerns like crowding.
  • Cleft Lip or Cleft Palate A cleft lip and cleft palate happen when a baby’s lip or mouth doesn’t properly form when they’re in the womb. With a cleft lip, the sides of the lip don’t fuse during fetal development, while a cleft palate is when the roof of the mouth, or palate, doesn’t fuse completely, leaving an opening.Children with orofacial clefts are more likely to have dental issues. According to research published in BioMed Research International, the most common malocclusion among patients with total cleft of the lip, alveolar bone and palate was a crossbite.

Why Does a Crossbite Need to be Treated?

While it depends on the severity and type of crossbite, an untreated crossbite can lead to:

  • Excessive wear of the enamel and chipped or cracked teeth, because of the way the teeth come together when you bite down
  • Increased risk of tooth decay and gum disease, as misaligned teeth are harder to properly brush and floss
  • Gum recession, because certain teeth bear the brunt of the chewing forces. As gums recede, tooth roots are left exposed and vulnerable to decay and infection
  • Difficulty biting and chewing
  • Difficulty closing the mouth
  • Strain on the temporomandibular joints (TMJ) and chewing muscles, resulting in TMJ dysfunction and pain
  • Headaches and toothaches
  • Lopsided jaw growth since patients often compensate by shifting their jaw forward or to the side
  • Speech issues – a study found that a posterior crossbite can affect speech in children by altering the tongue position and making speech sound distorted

Does a Crossbite Require Interceptive Orthodontic Treatment?

Sometimes, a severe posterior crossbite does require interceptive orthodontic treatment, also called phase 1 orthodontic treatment. At Richard Chan Orthodontics, we rarely treat young children and can usually achieve excellent results with one phase of orthodontic treatment. However, there are cases where early interceptive treatment will help to prevent the lopsided jaw growth that can occur in patients with a crossbite.

In these instances, during phase 1 treatment, Dr. Chan uses certain orthodontic appliances, mostly commonly being a rapid palatal expander. A palatal expander is a fixed appliance that sits against the roof of the mouth. As you activate the expander by turning a key, it gently widens the upper jaw, which in children, consists of two halves that meet at the middle, called the midline suture. The suture isn’t yet fused, so the pressure from the device is able to shift the two halves of the jaw apart to correct the crossbite. 

When the desired amount of skeletal expansion is achieved, the appliance is left in for a bit longer so that new bone can form in the middle to stabilize the expansion. 

Dr. Chan removes the expander and then after a resting period where the remainder of the baby teeth fall out, the patient starts phase 2 orthodontic treatment, typically around age 12 or 13. During phase 2, we use braces or Invisalign Teen to straighten the teeth and ensure the bite is coming together properly.

Is Crossbite Correction Effective in Adults?

We can treat an anterior crossbite or a crossbite that is due to the position of the teeth at any age. For a posterior crossbite that’s skeletal in nature, while it’s never too late to have it fixed, getting treatment during childhood or the early teen years will help you achieve the best results more quickly and less invasively. This is because, before jaw growth is complete, we’re still able to widen the upper jaw. 

In the past, treating a severe posterior crossbite in an adult would have required corrective jaw surgery, or orthognathic surgery, along with orthodontic treatment. However, thanks to advances in technology and treatments, we can fix a crossbite in an adult without surgery in more cases than ever before.

How to Fix a Crossbite


Can Invisalign fix a crossbite? Yes, Invisalign can fix a crossbite in certain cases. If you have an anterior crossbite or a single-tooth crossbite, Invisalign or Invisalign Teen will be super effective. For some patients with a posterior crossbite, braces are the better option. 

If clear aligners are used, we may need to pair your aligners with Invisalign attachments. These tooth-colored buttons are bonded to your teeth and act almost like a handlebar for your aligners to push off in order to achieve more complex tooth movements. Invisalign rubber bands could be needed too. Rubber bands provide the connective force necessary to improve your bite, or the way your upper and lower teeth meet.


We can fix a crossbite with metal braces or clear braces. In fact, certain types of crossbite respond better to braces, usually along with rubber bands, than Invisalign. Whether we use braces alone or in combination with other treatments and appliances will depend on the severity of your crossbite and whether it’s skeletal or related to the position of your teeth.

Auxiliaries and Orthodontic Appliances

When treating a posterior crossbite with braces or Invisalign, we may need some help from auxiliaries like rubber bands and/or Invisalign attachments. In preteen and teenage patients who are still growing, we sometimes pair braces or Invisalign Teen with an orthodontic appliance to expand the jaw at the same time that we straighten the teeth. 

Other patients may respond well to using innovations like temporary anchorage devices (TADs) with their braces. TADs are an alternative to headgear and give Dr. Chan a fixed anchor point from which to achieve complicated tooth movements, including asymmetrical tooth movements, more efficiently and comfortably.

How Much Does Crossbite Treatment Cost?

The cost of crossbite correction is determined by how severe the problem is and your treatment plan. Once you come in for a free consultation at our practice and Dr. Chan develops a diagnosis and treatment recommendations, we’ll be able to provide you with the cost. 

At Richard Chan Orthodontics, we pride ourselves on offering high quality care for an affordable price. We accept most insurance plans, will help you determine your coverage and even file claims on your behalf. We also offer flexible, in-office financing, including braces and Invisalign for as low as $129 per month.

Crossbite Correction in Mill Creek, Bothell and Monroe, WA and Juneau, AK

If you think your child has a crossbite, or you have one yourself, schedule a complimentary consultation at Richard Chan Orthodontics in Mill Creek, Bothell and Monroe, WA or Juneau, AK. At your consultation, Dr. Chan will evaluate your diagnostic records and perform an exam to determine an accurate diagnosis. He can then create a personalized treatment plan to fix the crossbite and help you or your child achieve optimal oral health and function.

Brush Your Teeth Before Breakfast

10 Habits That Could be Harming Your Teeth

By Dental Care, Orthodontics No Comments

At Richard Chan Orthodontics, we always teach our patients how to keep their teeth healthy so they can make the most out of their treatment. After all, no one wants to invest in braces or Invisalign® and then do something to harm their smile.

Of course, there are obvious things like not brushing or flossing your teeth that will have a negative impact on your oral health. But, there are also a number of common habits and practices that you might not think twice about that can damage teeth too. In this post, Dr. Richard Chan will be sharing what these habits are and how they can affect your smile.

1. Grinding Teeth

Teeth grinding and clenching, called bruxism, can have a significant effect on your teeth. While a mild, daytime teeth grinding habit might not be a huge concern, chronic bruxism, especially if you grind your teeth at night, will cause complications if not addressed.

Teeth grinding often results in excessive wear of the enamel, chipped or fractured teeth, damaged restorations, headaches, pain, temporomandibular joint (TMJ) dysfunction, earaches, loose teeth and more.

Wearing a night guard will help prevent complications by providing cushioning against the grinding forces. Depending on the cause of bruxism, additional treatment could be needed to help stop the habit and minimize or correct teeth grinding damage.

2. Chewing on Ice, Pencils or Other Objects

What does chewing on ice do to your teeth? First, it can wear away your enamel, which protects your teeth from cavity-causing acids. As enamel erodes, teeth are more susceptible to decay, they become sensitive to hot and cold and, if the underlying dentin is exposed, they can even look yellow. Chewing on ice is also a culprit behind cracked and chipped teeth and worn-down bite edges.

Chewing on pens, pencils, fingernails and other hard objects will probably have the same outcome. Hard plastics like pens or anything with sharp edges can lead to hairline cracks in the enamel and injure the soft tissues of the mouth. Plus, any time you put objects in your mouth, you’re also introducing germs.

3. Eating Lots of Starchy Foods Like Potato Chips and Crackers

There’s always a lot of talk about sugar and teeth. But, the bacteria in the mouth feed on carbohydrates, meaning both sugars and starches. When they do, they release acids that leach minerals from the tooth enamel. Frequent acid attacks cause tooth decay. As tooth decay progresses, a hole forms in the tooth, which is what we call a cavity.

In addition to containing carbohydrates, whether or not a specific food is likely to cause cavities also depends on how long it will be in contact with the teeth and how fast the food is eaten.

Starchy foods like potato chips and pretzels are heavy on the carbs, tend to be snacked on at a leisurely pace and get stuck in the teeth. So, they check all of the cavity-causing boxes. In fact, if you’re in the mood for a treat, when it comes to harming your teeth, you’d be better off having a scoop of ice cream than you would a handful of crackers since ice cream is eaten quickly and rinses off the teeth easily.

4. Not Wearing a Mouthguard When Playing Sports

It’s important to wear a mouthguard during any sport or physical activity that could result in a blow to the mouth. Unfortunately, only a handful of sports require a mouthguard, though a large number of dental injuries occur during basketball and baseball where mouthguards aren’t typically worn.

Common orofacial injuries include cuts to the soft tissues of the mouth, chipped, fractured or knocked out teeth and/or a broken jaw. Wearing a mouthguard is a proven way to reduce these types of injury and keep your smile safe. If you have braces, wearing a mouthguard is especially crucial as an injury can damage your appliance and the brackets and wires can cause even more extensive trauma to your mouth.

5. Drinking Soft Drinks, Energy Drinks or Sports Drinks

While you can drink soda with braces, we always encourage moderation because soda is one of the worst drinks for your teeth. It contains a large amount of sugar, giving fuel to your oral bacteria and causing them to release acids. Soda also contains acids itself, including citric acid. Citric acid is bad for your teeth in large amounts because it causes enamel erosion. The one-two punch of sugar and acidity is a major contributor to tooth decay.

Is diet soda better for your teeth? Nope. While you skip the sugar, it still leads to acid erosion. Some diet drinks have more acidity because of the artificial sweeteners. In fact, a study on enamel dissolution from various beverages found no difference between regular and diet versions of the same brand.

Energy drinks, sports drinks, bottled iced tea and lemonade tend to be up there with soda too, as they’re all acidic and high in sugar. The same study on enamel dissolution found that canned iced tea actually caused more enamel erosion than most soda, with the exception of Mountain Dew and Sprite.

The effects of acid on enamel are cumulative, so the prolonged exposure inherent in sipping a carbonated drink makes you more likely to experience teeth damage. Your best bet is to drink plain water. If you do have a soft drink, enjoy a small glass as part of a larger meal and rinse your teeth with water when you finish.

6. Brushing Your Teeth Right After Having Something Acidic

Speaking of acidity, as part of a balanced diet things like tea and citrus fruits are fine and, in the case of fruit, even beneficial. But if you do have something acidic, when you brush your teeth matters. So, should you brush your teeth before or after coffee or your morning orange juice? The answer is, before!

That might sound counterintuitive, but the acidity weakens your enamel for about 30 minutes to an hour after eating or drinking. If you brush your teeth before the pH in your mouth returns to normal, you can inadvertently cause further damage to your enamel while it’s in its temporarily weakened state.

Instead, brush your teeth before breakfast and then rinse your mouth out with water afterwards. If you’re prone to coffee breath, you can chew a piece of sugarless gum to get rid of the odor and encourage saliva production. Or, if you’re not in a rush, wait an hour after having coffee, juice or acidic foods to brush.

7. Using Your Teeth as a Tool

It can be tempting to use your teeth to tear open a plastic package or rip a stubborn tag off, but the habit increases your risk of teeth damage. Using your teeth as a tool can weaken them and cause chips or cracks, leading to pain, infection and aesthetic concerns. Preserve your pearly whites by using scissors instead.

8. Constant Snacking or Sipping

How often you eat and drink is nearly as important as what you eat and drink. Again, every time you eat, plaque bacteria feed on the sugars and starches and release cavity-causing acids. It takes 30 minutes to an hour for your saliva to neutralize the acidity in your mouth. Every sip and bite starts the clock over again, exposing your teeth to more acids.

Snacking also produces less saliva than eating a full meal does. This means food bits aren’t as effectively rinsed away and they sit on the teeth for a longer period of time.

To prevent tooth decay and damage to your teeth, minimize snacking and sipping on anything aside from water. When you do snack, eat something that’s smile friendly and low in carbohydrates like nuts, cheese or carrot sticks. Have sugary or starchy foods and drinks with a meal, so your saliva production is in full gear in order to promote remineralization and whisk away debris.

9. Frequently Indulging in Chewy and Sticky Treats

Just as with the starchy things like chips or crackers, chewy and sticky foods stick in the teeth, making you more susceptible to cavities. Raisins and other dried fruits and gummy bears, Sour Patch Kids, Starburst and other candies are especially harmful because they also contain sugar.

10. Sucking on Hard Candies or Cough Drops With Sugar

As long as you don’t chew them, hard candies, lollipops and cough drops should be better for your teeth since they dissolve and won’t get stuck in the nooks and crannies, right? Unfortunately, no.

These types of foods are high in sugar and still expose your teeth to carbohydrates and acid attacks. Since you’re sucking on them and they dissolve slowly, exposure is prolonged. Steer clear of hard candy and lollipops or opt for sugarless varieties (bonus points if they contain xylitol, which helps fight cavities). If you’re sick and need cough drops, look for sugarless ones or at least rinse your mouth out with water after having one.

Are You Ready to Experience Amazing Oral Health?

Aside from avoiding these teeth damaging habits, you can also improve your oral health with orthodontic treatment. Straight teeth are easier to clean and an aligned bite keeps your jaw healthy and strong. To find out your options for braces or Invisalign in Bothell, Monroe or Mill Creek, WA or Juneau, AK, schedule a complimentary consultation at Richard Chan Orthodontics today!