Causes and How to Fix It

When there’s a mismatch or misalignment between your upper jaw bone (or maxilla) and the lower one (mandible), you have an uneven or crooked jaw. This can arise due to temporomandibular joint (TMJ) disorder, as well as trauma or dental issues such as malocclusion.

The severity of a crooked jaw varies. Some people with more serious cases have symptoms like an asymmetrical face, pain in the temples, ear-popping, and problems chewing. Treatments include using orthodontics and surgery, as well as symptom management.

Causes

Broadly speaking, a crooked jaw is caused by anatomical differences present at birth (congenital), issues as the teeth and jaw develop (developmental), or trauma or accidents (acquired). Here’s a breakdown of the causes.

TMJ Disorders

The temporomandibular joint (TMJ) is the hinge that connects the maxilla and mandible. TMJ disorders (often simply called “TMJs” or “TMDs”) are a common cause of crooked jaw. They occur when there are problems either with the joint itself or the surrounding muscles or ligaments.

TMJ issues that lead to inflammation, pain, and other symptoms can be caused by:

Trauma

Crooked jaw can also arise due to falls or accidents. For instance, healing can be uneven following a fracture of the mandible or maxilla, undermining their alignment.

This type of uneven jaw can arise in those of any age, though people with osteoporosis or low bone density are more likely to experience lasting damage. This is why doctors employ extra monitoring and care as you recover from a broken bone or traumatic injury to the jaw.

Conditions Present at Birth

Many cases of an uneven jaw can be attributed to conditions present at birth affecting the symmetry of the face.

A congenital issue, termed “hemifacial microsomia,” most commonly affects the jawbones. It leads to irregularities on one side of the face (unilateral) or both sides (bilateral). Varying in severity, this can cause:

• Canted teeth (slanted when compared to the nose and mouth)
• Chin pointed off to one side
• Other asymmetries in the lower side of the face.

Severe cases, especially if they’re bilateral and untreated, can lead to obstructive sleep apnea (snoring and sleep disruption) and Pierre Robin syndrome (a severe underformation of the mandible at birth).

Many syndromes result in midface deficiencies, with small upper jaws that cause severe malocclusion. A crooked jaw is also associated with cleft palate and lip.

Teeth Misalignment

Malocclusion—the misalignment and mismatch between the upper and lower sets of teeth—can also be a cause of crooked jaw. Many factors can cause crooked teeth, including:

• Inherited tooth crookedness
• Thumb sucking, tongue thrusting, and pacifier use (after the age of 3)
• Tooth loss, extra teeth, tooth impaction, or malformed teeth
• Poor-fitting dental appliances, braces, filings, retainers, and fillings
• Misalignment of jawbones following trauma or accident
• Tumor development in the jaw

Uneven Jaw Symptoms

Depending on how severe it is, an uneven jaw can significantly impact the health of your gums, the muscles and ligaments of the TMJ, jaw bones, and teeth. The chief symptoms of a crooked jaw include:

• Pain in the temples
• Headaches and/or pain in the shoulders and back
• Clicking, grinding, or pain in the jaw
• Ringing, buzzing, or popping in the ears
• Tightness and pain in the jaw

Additionally, a crooked jaw can affect the appearance of your face, leading to:

• A gummy smile, in which the upper jaw is too low
• Long face, characterized by an open bite and a stretched appearance to the face
• Toothless smile, where the upper jaw is too small (severe underbite)

Lastly, a crooked jaw can cause a range of dental issues, including:

• Tooth loss
• Wearing or damage on tooth surfaces
• Gum recession (where the gums pull back from the teeth, exposing more of the tooth than is typical)
• Loose teeth
• Damage to gums or surrounding tissues

How Is a Crooked Jaw Diagnosed?

The first step in getting a diagnosis is typically being referred to an orthodontist. They will examine your teeth, mouth, and head, and check to see if your mouth opens and closes properly.

The orthodontist will usually take X-rays and make plaster models of the teeth.

Treatment will then be planned based on the teeth models and X-rays. In some cases, you may also be referred to an ear, nose, and throat (ENT) doctor for additional evaluation. 

Treating a Crooked Jaw

While minor misalignments of the jaw may not require special treatment, symptomatic and more severe cases do. The options range from surgery in the most severe cases, to the use of orthodontic appliances and working to manage pain and other symptoms.

Surgery

Generally reserved for more severe and advanced cases, surgery to correct an uneven jaw is called “orthognathic surgery.” This surgery aims to reshape the upper or lower jaw to properly line everything up. Several types of surgery are considered:

• Maxillary osteotomy: Osteotomy is the surgical removal of bone. In this case, the surgeon focuses on the upper jaw (maxilla). The goal is to correct an overbite or open bite by creating space and repositioning this bone to line up with the mandible (lower jaw).  
• Mandibular osteotomy: In cases of severe underbite, osteotomy may be performed on the mandible. Bilateral sagittal split osteotomy (BSSO) advancement moves the jaw forward in a class 2 case. BSSO setback moves the lower jaw backward in a class 3 (underbite) case.
• Genioplasty: If the chin is too small or out of position, this surgery reshapes the mandible to realign the jaw and correct any crookedness.  

Following surgery, or in the case of jaw fracture, you may temporarily require interarch elastics (rubberbands) to hold the jaw together but still allow some movements. Temporary jaw wiring, or the use of pins to support the structure and help correct the misalignment, is another option.

Dental Appliances

In cases where the uneven jaw is due to malocclusion, orthodontics and wearing dental appliances can help correct the issue. Orthodontic treatment generally follows after acute TMD symptoms have been managed.

Over time—typically 18 months to two years—the pressure put on the teeth and jaw promotes a healthier alignment. These approaches may include:

• Splints: Splints are instruments worn on the upper or lower sets of teeth. These appliances aren’t removable and encourage proper alignment of the teeth.
• Mouthguards: To help with TMJ and grinding—as well as to help reposition the jaw—you may need to wear a guard at night.
• Braces: A cornerstone of orthodontic care, braces are brackets that gradually push teeth into proper alignment. Bite correction requires additional hardware called orthodontic functional appliances. These appliances are used in growing children when the jaws are most malleable.
• Aligners: Sets of clear aligners (such as Invisalign) or other types may be used to correct tooth alignment or support the work of braces.
• Bridges: If missing teeth are at the root of the uneven jaw, dental bridges—false teeth attached to surrounding teeth—can be used to correct the issue.

Sometimes braces are used as an initial treatment to correct the upper or lower jaw and then surgery is done afterwards.

Pain Management

Taking on the pain and inflammation associated with crooked jaw, especially when there’s a TMJ disorder, can be another important aspect of treating the condition. A range of methods—everything from making lifestyle changes to alternative therapies—can help:

• Icing or heating: Applying an ice pack or warm towel to the temples or jaw for 10 minutes at a time can help with pain. This can be especially helpful when paired with jaw stretches shown to you by your provider. It can be done multiple times a day, as needed.
• Eating soft foods: Chewing can be difficult and cause pain. Soft foods, such as steamed or boiled vegetables, yogurt, fish, soups, and mashed potatoes, can be less painful to eat. Steer clear of crunchy or tough-to-chew foods.   
• Over-the-counter medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like Motrin and Advil (ibuprofen), Aleve (naproxen), and aspirin, take on inflammation and pain. These are all available over the counter.
• Prescription medications: Your provider may prescribe other drugs in more severe or hard-to-manage cases. Narcotic analgesics can be prescribed for pain, with muscle relaxers helpful to ease tension from teeth grinding. NSAIDs come in stronger, prescribed doses. Anti-anxiety drugs and low doses of certain anti-depressants can also help.
• Careful movement: Be careful when yawning and avoid chewing excessively. Correcting head and neck posture can help, as can keeping your upper and lower teeth slightly separated as much as you can. Stretches and exercises as directed by your provider can also help with tension.
• Relaxation methods: Meditation, mindfulness work, and other methods of promoting relaxation can help ease muscle pain and tension in the jaw. Breathing-oriented activities such as yoga can also help, as can activities like gardening or simply taking a bath.
• Acupuncture: An alternative health modality with origins in Traditional Chinese Medicine, acupuncture involves using specialized needles to stimulate specific points in the body. Research has shown that this can be effective in taking on chronic pain problems.

In difficult-to-manage and severe cases of TMJ pain, additional procedures to consider include:

• Transcutaneous electrical nerve stimulation (TENS): A device that delivers electrical impulses to nerve centers in the TMJ to scramble pain messaging.
• Ultrasound: Using specialized sound waves, affected areas in the jaw are heated up to relieve pain and tenderness.
• Trigger-point injection: Injections of pain medication or local anesthetic to specific points in the muscles surrounding the jaw (called “trigger points”) can also manage pain.
• Radio wave therapy: Directed radio waves cause electrical stimulation within the TMJ, which stimulates blood circulation, easing symptoms.
• Botox injections: Injections of botulinum toxin (Botox) into muscles around the jaw reduce inflammation and cause them to decrease in size, which can help.

Summary

Uneven jaw occurs when the upper jaw, or maxilla, does not properly line up with the lower jaw, or mandible. This can be due to a range of factors, including misalignment of the teeth, disorders of the temporomandibular joint (TMJ) connecting these bones, trauma, as well as birth defects.

Varying in severity, this condition causes pain in the temples and jaw, ear popping, and problems chewing or swallowing. It can also lead to tooth decay and loss and have a mental health impact.

Treatments for crooked jaw include wearing dental appliances, certain surgeries, as well as management of the associated inflammation and pain.