Crooked Teeth: Causes, When It Matters, and Treatment Options

There is rarely a single cause. These are the ones orthodontists most often point to.

• Jaw size and tooth size that do not match. A small jaw with average or large teeth leaves too little room, and teeth crowd. This is the most common pattern and tends to run in families. Our guide to crowded teeth covers it in more detail.
• Jaws that do not line up with each other. If the upper and lower jaws differ in size or position, the teeth meet in an overbite, underbite, or crossbite, and individual teeth often tip to compensate.
• Baby teeth lost early or late. Baby teeth hold space for the adult teeth beneath them. When one is lost early to decay or injury, neighboring teeth can drift into the space.
• Extra, missing, or unusually shaped teeth.
• Childhood habits. Thumb or finger sucking and pacifier use that continue for years can push front teeth forward or open the bite.
• Injury to the teeth or jaw.
• Tooth loss in adults. Teeth next to a gap tend to tilt into it over time.
• Gum disease. When the bone supporting teeth is lost, teeth can drift, flare, or open spaces.
• Age. Lower front teeth in particular tend to crowd gradually through adulthood, including in people who had braces and stopped wearing retainers.

Wisdom teeth are often blamed for late crowding. The link is debated, and crowding also happens in people who have no wisdom teeth. Whether yours matter is a question for a dentist with an x-ray in front of them.

Mild crookedness, such as a slightly rotated tooth, a small overlap, or a little unevenness in the lower front teeth, often causes no health problem. If every surface can be cleaned, the gums are healthy, the teeth meet comfortably, and nothing is wearing down, a dentist may say that treatment would be for appearance only.

That is still a legitimate reason to want treatment. It simply means the decision rests on preference, cost, and time.

Straight teeth are also not the same as healthy teeth. Straight teeth can have decay and gum disease, and somewhat crooked teeth can stay healthy for a lifetime. What dentists care about most is whether teeth can be kept clean and whether the bite works.

Position starts to matter for health when it gets in the way of cleaning or function. Things dentists and orthodontists look for:

• Places a brush and floss cannot reach. Tightly overlapped teeth trap plaque. Over time that can contribute to cavities between teeth and to inflamed, bleeding gums in those spots.
• Uneven wear. Teeth that meet edge to edge or hit in the wrong place can chip or wear flat faster than their neighbors.
• A bite that does not fit together. Examples are trouble biting through food with the front teeth, or lower teeth that hit the gum behind the upper teeth.
• Teeth that stick out. Upper front teeth that sit well forward are more exposed to knocks, which matters for children who play sports.
• Jaw discomfort. The bite is one of several things that may be checked when someone has sore jaw muscles, though many jaw complaints have other causes.

Having one of these does not mean you need braces, and having none is not a clean bill of health. They are reasons to have the question looked at properly. The bite type guide lets you pick what your bite looks like and shows what orthodontists typically check and what to ask. It is a way to prepare for an appointment, not a diagnosis.

Children's teeth often look crooked while the adult teeth are coming in. New teeth can come in at odd angles, and gaps open and close as baby teeth are lost. Some of this sorts itself out as the jaws grow. Some of it does not.

Because growth can be used to guide the jaws while a child is young, many orthodontists like to see children for a first check at around age 7, when the first adult molars and front teeth are usually in. A first check does not usually lead to braces at that age. Most children are simply watched. Some are offered early steps, such as a palatal expander for a narrow upper jaw.

A child's dentist will usually say when it is time for that visit, and you can ask sooner if something worries you. Our teeth by age tool shows which teeth typically come in when, which helps make sense of what you are seeing.

Adults can have their teeth straightened. Teeth move through bone in response to steady, gentle pressure at any age, provided the gums and bone are healthy.

A few things are different for adults:

• Gum and bone health come first. An orthodontist will want gum disease and decay treated before teeth are moved.
• Growth is finished. Jaw size differences that could have been guided in a child may, in an adult, be managed by moving teeth alone or, in more marked cases, with jaw surgery.
• Existing dental work matters. Crowns, bridges, implants, and missing teeth all shape the plan. An implant, for example, does not move.
• Teeth that have recently changed position need an explanation first. New gaps, flaring front teeth, or a tooth that has become loose in adulthood can be a sign of gum disease and are a reason to see a dentist soon.

Many adults ask about less visible options such as ceramic braces or clear aligners. Our guide to braces cost for adults looks at the money side.

What is suitable depends on what is causing the crookedness, which only an exam can establish. In general terms, these are the tools:

• Braces. Brackets and wires can move teeth in all directions. Metal braces are often quoted at roughly $3,000 to $7,000 for a full case, ceramic braces at roughly $4,000 to $8,000, and lingual braces, which sit behind the teeth, at roughly $8,000 to $10,000 and sometimes more.
• Clear aligners. A series of removable clear trays, generally worn 20 to 22 hours a day. From a dentist or orthodontist they are often quoted at roughly $3,000 to $8,000, and short or limited cases can be less. They suit many cases but not all of them.
• Making room. Crowding is relieved by creating space: widening the arch, slimming the sides of some teeth very slightly, or in some cases removing teeth. These are done by the orthodontist or dentist as part of a plan.
• Jaw surgery combined with braces, for adults whose jaws themselves are significantly mismatched.
• Retainers afterward. Every option ends with retainers, because teeth tend to drift back.

All of these fees vary widely by region, provider, and case. They are ranges, not quotes. Braces often take about 18 to 24 months with a wide range either side, and aligner cases often 6 to 18 months, but no one can promise a finish date.

Dentists can also change how teeth look without moving them, using bonding, veneers, or contouring. These alter the shape of teeth and do not correct crowding or the bite. Our overview of teeth straightening options compares the routes.

Moving teeth works by remodeling the bone around each root, and it can go wrong when force is applied in the wrong direction or too fast. Roots can shorten, gums can recede, and teeth can loosen or be lost.

For that reason:

• Do not put rubber bands, "gap bands", or string around teeth. Bands can slide under the gum and damage the attachment of the tooth.
• Do not wear decorative or homemade braces. Our article on fake braces explains the risks.
• Do not file teeth to even them out. Enamel does not grow back.
• Do not push on teeth with fingers or objects to shift them.
• Be cautious with any treatment that involves no in-person exam and no x-rays. Problems under the gumline cannot be seen in a photo or an impression.

If cost is what is holding you back, say so at a consultation. Many orthodontic offices offer payment plans, and dental school clinics provide care at lower fees in many areas.

A first visit is usually a look, some records, and a conversation. The orthodontist examines the teeth, gums, and jaw joints, watches how you bite, and often takes photographs, x-rays, and a digital scan or impressions. From that they can say what is causing the crookedness, whether treatment is advisable for health or optional, what the choices are, and what each would cost.

Questions worth asking:

• What is causing my teeth to be crooked?
• Is this cosmetic, or is it affecting my bite, gums, or tooth wear?
• What is likely to happen if I do nothing?
• Which options would work for me, which would not, and why?
• What is the total fee, and are retainers included?

The visit notes tool can help you put your questions and history in one place before you go. It is also reasonable to get a second opinion, since orthodontists can differ in the approach they prefer.

Crooked teeth by themselves are not urgent. Some things that can come with them are:

• A tooth that has moved, tipped, or become loose over weeks or months
• New gaps opening between teeth in adulthood
• Gums that bleed, are swollen, or have pulled back around crowded teeth
• Toothache, or pain when biting

These call for a dental appointment in the near future, and pain or swelling for one sooner than that. Trouble breathing or swallowing, swelling spreading toward the eye or neck, fever with facial swelling, or bleeding that will not stop means calling 911 or going to the emergency room.