Dental Midline Definition
A non-medical definition of the dental midline is a vertical dividing line between one side of the face and the other. Running from the top of the head, this line should pass through the eyes, over the nose, and down to the chin. Ideally, the line falls directly between the two upper center teeth and the two lower center teeth. In addition, the upper and lower jaws should ideally align with the middle of the face.
When the dental midline is off center, it is called a dental midline shift. Other common terms for this misalignment are dental midline deviation, dental midline discrepancy, deviated midline, teeth midline shift, or dental midline asymmetry.
Tom Cruise is perhaps one of the most well-known people with a deviated dental midline. When he was 40, Cruise had the issue corrected with ceramic braces.
Dental Midline Problems
A slight asymmetry of the dental midline is usually not serious and may be unnoticeable to the layperson. However, the more prominent the dental midline shift is, the more evident it can be. Large midline discrepancies also often require a more involved orthodontic treatment plan to correct.
How to Check Dental Midline
To check the dental midline, orthodontists look at the patient from the frontal view. They also take diagnostic photos of the patient’ face from this same direction. By drawing a straight vertical line down the middle of the face on the photograph, the midline can be illustrated relative to the center of the face. If the line does not fall between the two center front teeth and two lower front teeth, then there is a dental midline shift. As mentioned previously, the shift may be very minor or could be pronounced.
Causes of Dental Midline Shift
A dental midline deviation may have a variety of causes. Dental midline shift causes include:
- Bite issues (malocclusions) such as posterior crossbites
- Missing teeth (caused by genetics, early loss of baby teeth, or dental trauma)
- Oversized teeth
- Undersized teeth
- Extra teeth
- Teeth crowding
- Jaw misalignment
- Previous trauma to the jaws or teeth
- Developmental disturbances
- Oral habits such as prolonged thumb sucking
Dental Midline Shift Correction
Fortunately, dental midline correction can be treated in a variety of ways. The recommended treatment will depend on the specific orthodontic issues of each patient. Our orthodontists, Dr. Ryan Redford and Dr. Michael Burke will conduct a thorough exam (including X-rays) and identify all orthodontic issues that will influence the treatment plan. Depending on the specifics of the case, treatment recommendations may include braces, Invisalign, or devices like palatal expanders.
Correcting Dental Midline Deviation with Braces
Braces can be very effective at correcting dental midline alignment issues.
Our orthodontist offices in Temecula and Lake Elsinore offer a variety of braces to give patients options that fit their preferences and lifestyle. Some of the different braces types used by orthodontists include:
- Metal braces—including self-ligating braces, traditional braces, or lingual braces
- Ceramic braces—ideal for patients who want to minimize the appearance of their braces, also known as “clear braces”
- Damon braces—a self-ligating braces system that does not use elastic or metal ties
- Lingual braces—braces that are bonded to the back surface of the teeth (also called “invisible braces”)
Correcting Dental Midline Deviation with Invisalign
Invisalign was one of the first clear removable aligner systems, and in the right circumstances and when used in the right hands can be used to address midline and bite issues. Invisalign offers some advantages over braces in that they are removable for eating and brushing and are less noticeable. In cases where Invisalign is ruled out as an option, but a discreet material is desired, ceramic braces are an alternative.
Invisalign uses a series of clear aligners (trays) to slowly shift teeth into their ideal positions. Invisalign for teens can be used instead of braces for teenagers in some cases. There are three factors that are crucial for successful outcomes with clear aligners:
- A proper treatment plan. Aligners (and braces) are simply a tool in the orthodontist’s hands. Clear aligners are very effective at some tooth movements, and less effective at others. Being able to assess the effectiveness and limitations of the materials being used for tooth movement before starting treatment is critical. Choose your orthodontist wisely.
- Proper attachment design. Tooth colored (white) attachments are placed on patients’ teeth as part of the Invisalign process. These attachments help the trays to “grip” the teeth for effective tooth movement. Orthodontists have the training and understanding of tooth biomechanics necessary to engineer the placement and orientation of these attachments on the teeth. The results achieved during treatment are more closely related to the treating orthodontist than the type of aligners or braces used.
- Excellent cooperation. Invisalign must be worn 22 hours a day to be effective. If a parent anticipates their teenager may be forgetful or non-compliant with aligner wear, then braces may be a better option.
Correcting Dental Midline Deviation with Palatal Expanders
A palatal expander is an orthodontic device that increases the width of the upper jaw by widening a growth plate with slow and gentle pressure. Expansion happens by activating the device with a “key” as instructed by the treating orthodontist.
This device helps to address jaw size mismatch issues that may be cause the lower jaw to shift to one side when biting down, resulting in a dental midline shift. The device achieves great results in younger children because the jaw is still developing and because the growth plate to be widened has not yet fused closed.
Correcting Dental Midline Deviation with Tooth Extraction
Tooth extraction before braces is another way to help correct a dental midline deviation but is only used when absolutely necessary. Extraction(s) can be useful to create extra room when severe crowding is present or to shift bites favorably when upper and lower teeth/jaws do not align ideally.
Dr. Redford and Dr. Burke view tooth extraction as a last resort effort. Our orthodontists will consider all alternatives before recommending this procedure. However, in some cases, tooth extraction will be necessary and critical to achieving orthodontic goals.
Burke and Redford Orthodontists is known as the top child orthodontist in Temecula and Lake Elsinore. We have been treating patients in Riverside County since 1991 and have hundreds of 5-star reviews attesting to the care, professionalism, and results of our orthodontic treatment.