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Teen Orthodontics


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.

A Guide to Preparing Your Child for Braces or Invisalign® Teen

A Guide to Preparing Your Child for Braces or Invisalign® Teen

By Orthodontics, Teen Orthodontics No Comments

When your child first finds out they’ll be getting braces or Invisalign Teen, they’re likely going to have a lot of questions. They might be nervous about the treatment being painful or embarrassed to be the only person in class with braces (fact: they won’t be!). They might be frustrated about the rules of what they can and can’t eat, and how to brush and floss their teeth. We get these questions all the time at Richard Chan Orthodontics, both from our teen patients and their parents. In most cases, kids are simply afraid of the unknown. As parents, you can play a big role in helping them understand what to expect and prepare them as best as possible.

As your child gets ready to start his or her orthodontic treatment, there are many things you can do to ease their concerns and even get them excited (yes, really!). And if you ever have questions, just call your Monroe, Mill Creek, Bothell and Juneau orthodontist. Dr. Richard Chan  and our team are always here to help.

1. Learn All About Braces and Invisalign Together

Beginning any orthodontic treatment can feel a little overwhelming, not only for kids and teens but for their parents too. The first step in preparing for braces or Invisalign is to learn as much as possible about treatment before it actually starts. Research what your child will need to know from the foods they can eat to how to brush and floss. Better yet, get educated together so the whole family knows what to expect. When you’ve done thorough research and discussed all of your child’s treatment options, everyone will feel better equipped to take on life with braces.

2. Let Them Know They’re Not Alone

Many kids don’t want braces or Invisalign, because they think they’ll be the only one they know going through it. But did you know an estimated 80% of teens will have some sort of orthodontic treatment? Chances are your child already has a few friends or classmates with braces or Invisalign. Maybe you even had braces yourself way back when. Reminding your kids that they’re not alone (and that treatment can be a positive experience) can help them get more comfortable with the idea of getting braces.

There are also many celebrities who had braces, even when they were already in the public eye. Drew Barrymore, Kendall Jenner and Dakota Fanning are just a few of Hollywood’s biggest names who straightened their teeth. Once your kids see how common braces are for everyone, they’ll feel better about their own treatment. And seeing the results of braces on the big screen is also an added benefit!

3. Stock the Fridge with Soft Foods

Adapting to life with braces is about more than getting used to seeing a new smile in the mirror. Your kids will also have to adjust their eating habits to make sure they get the most out of their treatment. There are a number of foods to avoid when you have braces, including sticky, chewy, hard, or crunchy foods, or anything you have to bite into (such as apples, corn on the cob or whole raw carrots). 

As a parent, you can make their lives easier by stocking up on and preparing braces-friendly foods. Soft things like yogurt, fruit, soups, smoothies, steamed veggies or ice cream are perfect foods for people with braces, because they’re easy to chew and won’t get caught in your child’s appliance. The best part is that braces-safe foods are usually super healthy, so the whole family can benefit from a braces-friendly diet!

4. Plan Ahead for Discomfort

On top of learning what they can and cannot eat, your child will also have to get used to the feel of braces or Invisalign. With any orthodontic treatment, there can be mild discomfort as the teeth shift and move to their desired position. Braces can cause additional irritation to your child’s lips or the inside of their mouth. Parents can help their kids cope by having orthodontic wax and mild, over-the-counter pain relievers on hand. 

Have your kids take a child-safe medication like Advil before getting their braces tightened or when they’re switching to a new set of Invisalign Teen aligners. If their brackets are causing sores, place orthodontic wax over the uncomfortable part of the braces to reduce irritation. Being proactive about managing discomfort will ensure your kids have a much more positive experience with braces or Invisalign.

 5. Put Together An Invisalign or Braces Emergency Kit

Speaking of planning ahead, putting together an Invisalign or braces emergency kit is the key to being ready for any situation and keeping teeth clean while on the go. Store these items in a toiletry or cosmetic bag and have your child keep the kit on them when they’re at school or activities:
A Travel Toothbrush and Toothpaste

  • A Travel Toothbrush and Toothpaste
    Kids will want to brush their teeth after eating to get rid of any food debris that’s stuck in their hardware. Even those with Invisalign Teen should brush after eating, so their teeth are clean when they put their clear aligners back in.
  • Flossing Tools
    If your child or teen will be getting braces, don’t forget to add dental floss and a floss threader or special orthodontic flossers to their kit. Flossing can get rid of stubborn food that refuses to budge with a toothbrush. Interdental brushes, also called interproximal brushes, are a good addition too. These tiny brushes are able to clean around brackets and can be used to dislodge food.
  • Orthodontic Wax
    As mentioned above, braces wax is effective for stopping irritation and it can be used for minor braces emergencies like a poking wire or broken bracket.
  • Tissues
    Keeping tissues on hand ensures kids can quickly wipe away any spit when they take out their Invisalign aligners. Tissues can also be used to dry off areas of the braces that are causing irritation before applying wax.
  • Hand Sanitizer
    Encourage kids and teens to thoroughly wash their hands before removing or putting in their aligners or applying wax to their braces. If they’re not able to find soap and a sink, hand sanitizer will do the trick.
  • Lip Balm
    Include lip balm for braces and Invisalign wearers. When you have braces or are wearing aligners or a retainer, the lips stretch a bit to fit over the appliance, which can cause or worsen dryness and cracking. Sometimes, after braces adjustments, the lips can feel a bit dry too. Using lip balm will keep lips hydrated and help with any irritation. The best lip balm for braces or Invisalign is one that’s rich and soothing like Burt’s Bees 100% Natural Beeswax Lip Balm or Carmex.
  • Water
    While it might not fit in your child’s braces or Invisalign kit, be sure they bring their reusable water bottle with them when they leave the house. Kids can swish with water after meals and snacks if they forget their toothbrush or after having a sugary beverage. Staying hydrated by drinking water also stimulates the flow of saliva, which helps remineralize teeth and wash away food and plaque to keep cavities away.

6. Set Up A System of Small Rewards

As a parent, you know the real reward for keeping braces clean or wearing clear aligners or rubber bands for the prescribed amount of time is a healthy smile. However, kids and teens don’t always fully appreciate these long-term benefits. That’s why we recommend using a system of small rewards to help kids establish positive habits. Setting your expectations and figuring out a rewards system before kids start treatment will be helpful. 

Think about what motivates your child and then use it to temporarily reward them until the desired habit (i.e., diligently brushing and flossing with braces, wearing Invisalign Teen aligners or rubber bands for 22 hours per day, etc.) is firmly in place. 

For example, you could reward your kiddo with 15 minutes of extra screen time each day they brush their teeth for two full minutes after meals and snacks. Or, they could earn a ticket every time they wear their aligners for 22 hours. When they collect 10 tickets, they then get to go somewhere fun or order takeout from the restaurant of their choice. Get creative and find what works for your family! 

7. Focus on the End Goal

We all know that kids can be impatient and during orthodontic treatment is no different. Your kids will probably be counting down the days until their braces come off or when they can put away their aligners for good. Depending on their length of treatment, they’ll have many months to wait, which can make it hard for them to see how their oral hygiene habits today will impact results down the line. 

To keep them motivated, help them look ahead to the end of treatment when they’ll get to see their perfect smile. Focusing on the outcome will encourage them to stay on track and comply with their orthodontist’s instructions. And before they know it, they’ll be able to proudly show off their brand new smile.

Let’s Work Together to Give Your Child a Healthy, Beautiful Smile!

Still have questions about preparing your child for orthodontic treatment? Whether you want more details about oral hygiene or you’d like additional recommendations for things like the best toothpaste or lip balm for braces, contact us and we’ll be happy to help.

If you’re interested in finding out your child or teenager’s teeth-straightening options, schedule a complimentary consultation at Richard Chan Orthodontics in Bothell, Monroe or Mill Creek, WA or Juneau, AK today!