Short answer: Whether facial asymmetry can be corrected with orthodontics depends on its source. Asymmetries caused by shifted teeth, or by a jaw shift related to a crossbite, can in most cases be improved with orthodontic treatment. For marked asymmetries caused by different development of the jawbone, orthodontics and jaw surgery can be planned together. The source and the suitable path are determined by the dentist through the exam and records.
You may have noticed in the mirror or in photos that the two halves of your face look different, that your jaw has shifted to one side or that your smile sits at a slant. Facial asymmetry is one of the topics frequently asked about at orthodontic exams, and it often comes with this question: will this get better? The answer depends on the source of the asymmetry. In this article, we explain the types of facial and jaw asymmetry, in which situations orthodontics can help and in which situations different approaches may be needed.
What is facial asymmetry and how normal is it?
Facial asymmetry is when the right and left halves of the face differ in size, shape or position, and to a mild degree it is present in almost everyone. The human face is not an exact mirror image; one eyebrow sitting a little higher, one cheek looking fuller or the nose turning slightly to one side is quite common. These small differences are generally not noticed by others and do not create any functional problem.
What matters from an orthodontic point of view are asymmetries that are clearly visible to the eye or that affect chewing and the bite. A jaw that is visibly shifted to one side, teeth forming a slanted line when you laugh, or the lower jaw changing direction as the mouth closes are evaluated in this group. The dentist's first task is to tell whether the observed asymmetry comes from the teeth, the jawbones or the soft tissues.
What is the difference between dental and skeletal asymmetry?
In dental asymmetry, the jawbones are balanced but the teeth have shifted to one side; in skeletal asymmetry, the jawbone itself has developed differently on the two sides. This distinction is the most important step of the exam, because it directly determines the treatment options.
Three groups are generally defined according to the source of the asymmetry:
- Dental asymmetry: This comes from the position of the teeth on the jawbone. A prematurely lost tooth, a lack of space or the drifting of teeth in one direction can lead to this. In most cases it can be improved with orthodontic treatment.
- Functional asymmetry: Even though the jawbones are balanced, the lower jaw slides to one side as it closes because of an early contact point between the teeth. If the face looks more symmetrical with the mouth open but the jaw goes to the side when the mouth is closed, this may be considered.
- Skeletal asymmetry: This arises from the lower or upper jawbone growing differently on the two sides. In mild cases the appearance can be balanced with dental arrangement; in marked cases, surgical options along with orthodontics may come into question.
Telling these groups apart cannot be done by looking at outward appearance alone. It is done with an exam, an intraoral examination, bite analysis and, if deemed necessary, X-ray records. Which group the asymmetry falls into is determined by the dentist's exam.
Midline deviation and crossbite
Behind a significant share of the complaints described as a jaw shift or a crooked jaw are midline deviation and crossbite. The midline is the imaginary line passing through the middle of the upper and lower front teeth. Normally, these lines are expected to be aligned with each other and with the middle of the face. When the upper and lower midlines deviate from each other, the smile can look slanted and give the impression that the jaw has shifted to one side.
The causes of midline deviation are varied: a missing tooth on one side, a lack of space, the drifting of teeth in one direction or a deviation in the position of the jaw are among them. For detailed information, you can take a look at our page on midline deviation.
A crossbite, on the other hand, is when the upper teeth close inside the lower teeth rather than outside them. In a one-sided crossbite, the lower jaw often slides toward that side as it closes. When this slide continues for a long time, especially during the growth years, it can contribute to jaw development proceeding asymmetrically as well. We described in which situations a crossbite can be managed with clear aligners on our page on treating crossbite with clear aligners.
Why is early intervention important in childhood?
Early intervention is important for asymmetries noticed in childhood, because while growth continues it is possible to guide the development of the jaws. For example, when a functional shift related to a one-sided crossbite is corrected during the baby tooth or mixed dentition period, it can contribute to balanced development of the jaw.
Methods used in this period include upper jaw expansion appliances, adjusting the teeth that create early contact, and space maintainers. The method to be applied is chosen according to the child's age and the exam findings. Orthodontic associations recommend that the first orthodontic check-up be done around age 7; this check-up helps bite problems that could lead to asymmetry to be noticed early.
If you notice a tilt in your child's face or smile, it is better to schedule an orthodontic exam rather than assume it will correct itself with growth. If no intervention is needed after the exam, regular follow-up may be considered sufficient.
Orthodontic and surgical options in adults
Whether facial asymmetry can be corrected in adults depends on the source and degree of the asymmetry; because growth is complete, it is not possible to change the shape of the jawbones with orthodontic treatment. For this reason, it is important for expectations to be discussed realistically in adults.
In dental and functional asymmetries, orthodontic treatment can in most cases bring about a marked improvement. Correcting the midline, resolving the crossbite and aligning the teeth in a balanced arch contribute to the smile looking more level. In suitable cases, this arrangement can also be planned using clear aligner treatment with Invisalign; at our clinic, clear aligner treatment is provided only with Invisalign.
In mild skeletal asymmetries, orthodontic treatment can balance the difference in the bone to some extent by adjusting the position of the teeth. This is called "camouflage" treatment. This approach can improve the bite and the look of the smile, but it does not eliminate the difference in the facial bones.
In marked skeletal asymmetries, orthognathic surgery, in which orthodontic treatment and jaw surgery are planned together, may come into question. In this process the orthodontist prepares the teeth for surgery and, after surgery, makes the final arrangement of the bite. We described who this treatment is applied to in our article on what orthognathic surgery is. Which path is suitable for you is decided by the dentist and, if needed, a surgeon together, after the records are reviewed. With no method can it be promised that the face will become fully symmetrical; the aim is a balanced bite and a more harmonious appearance.
Evaluation with photographs and records
For a correct evaluation of asymmetry, photograph and X-ray records are used in addition to the intraoral exam. The records help show the amount and source of the asymmetry objectively. Orthodontic records generally include the following:
- Photographs of the face taken from the front, from the side and while smiling
- Intraoral photographs of the teeth
- Panoramic and, if deemed necessary, cephalometric X-rays
- A digital scan or impression of the teeth
If marked skeletal asymmetry is suspected, the dentist may request additional examinations such as three-dimensional imaging. Taking your own photographs before the exam and sharing the slant in your smile with your dentist can also be helpful; you can find how to take photos with the right angle and light in our guide on how to take a smile photo. Because the wide angle of a phone camera can create artificial asymmetry in the face, photographs alone are not sufficient for evaluation.
An evaluation in Ankara
If a jaw shift, a crooked smile or a marked difference in your face bothers you, the first step is to find out where this difference comes from. At our clinic at Park Oran Ofis next to Panora Mall in Çankaya, we can use the exam and records to evaluate whether the asymmetry is dental, functional or skeletal and talk through the options that may suit you in a measured and open way.
Frequently asked questions
Can facial asymmetry be corrected with braces?
If the asymmetry comes from the position of the teeth or from a jaw shift related to the bite, orthodontic treatment can in most cases bring about a marked improvement. Differences in the jawbone itself cannot be changed with braces in adults. Which situation applies is determined at the exam.
Does a jaw shift correct itself?
A functional jaw shift related to a crossbite generally does not correct itself and can affect jaw development during the growth years. For this reason, an orthodontic exam is recommended when it is noticed in children.
What causes an asymmetrical smile?
An asymmetrical smile can be seen because of causes such as midline deviation, a missing tooth on one side, teeth at different heights, a crossbite or the lip and facial muscles working differently. A clinical exam is needed to determine the cause.
Is jaw surgery always needed for facial asymmetry?
No. The surgical option comes into question only in marked asymmetries caused by the jawbone. In a significant share of dental and mild skeletal asymmetries, orthodontic treatment alone can be considered.
