Underbite, medically known as Class III malocclusion, is more than just a cosmetic concern. This dental and/or skeletal, where the lower teeth extend beyond the upper teeth, can significantly impact oral health, speech, and facial appearance. Understanding underbite, its causes, and treatment options is crucial for those affected and for promoting general oral health awareness.
Causes of Underbite
- Genetic Factors: Often, underbite is a hereditary condition. If parents or close family members have an underbite, their children will likely develop the same condition.
- Childhood Habits: Prolonged habits like thumb-sucking, excessive use of pacifiers, and bottle-feeding can lead to developmental issues in the jaw and teeth, resulting in an underbite.
- Jaw Misalignment: At times, underbite is due to misaligned jaw growth, where the lower jaw develops more rapidly or is positioned ahead of the upper jaw.
Is an Underbite Genetic?
Often, yes. Most underbites come from the way the jaws grow, and jaw size and growth pattern are largely inherited. When the lower jaw grows more than the upper jaw, or the upper jaw grows less than it should, the lower front teeth end up in front of the upper ones. This kind of underbite — a skeletal underbite — tends to run in families: if a parent, grandparent or sibling has one, a child is more likely to develop one too.
Not every underbite is inherited. Some are dental rather than skeletal: the jaws are in proportion, but the teeth are tipped or positioned so the lower front teeth close in front of the upper ones. Prolonged thumb-sucking or pacifier use, losing baby teeth early, and crowding can all contribute to this type.
The difference matters for treatment. A dental underbite can often be corrected with braces or aligners alone. A skeletal underbite depends on jaw growth, so timing matters: treatment that guides the upper jaw works best while a child is still growing, and an adult with a large skeletal underbite may need jaw surgery as part of the plan.
If underbites run in your family, there is no need to wait until one looks obvious. The American Association of Orthodontists recommends a first orthodontic check-up by age 7. At that visit, Dr. Karla Thompson can tell whether an underbite is dental, skeletal or both, and whether anything needs to happen now or can wait.
Effects of Untreated Underbite
Leaving an underbite untreated can lead to a host of problems:
- Dental Issues: An underbite can cause uneven wear on the teeth, leading to tooth decay and periodontal diseases.
- Speech Problems: It might affect speech, leading to difficulties in articulation and clarity.
- Facial Asymmetry: Over time, an untreated underbite can alter the shape of the face, resulting in asymmetry and potential self-esteem issues.
- Eating difficulties
- Chronic jaw or joint (TMJ) pain, as well as headaches and earaches
- Sleep apnea, snoring, and other nighttime breathing difficulties
- Low self-esteem
Orthodontic Treatment for Underbite at Every Age
The right orthodontic treatment for an underbite depends mostly on two things: the patient’s age, and whether the problem is in the teeth, the jaws, or both.
Children (about 7 to 10). While the jaws are still growing, treatment can guide the upper jaw forward and widen it so it fits around the lower jaw. A Reverse-Pull Face Mask is one option at this age, and it works best when worn many hours a day. Early treatment may reduce how much correction is needed later, but it does not always replace it, so growth is checked again as the child gets older.
Teens. Growth is slowing, so braces do most of the work. Self-ligating braces, such as the Pitts21 PRO System used at SmileHaus, can widen the upper arch with light, steady forces and bring the teeth into a bite where the upper front teeth close in front of the lower ones. Temporary anchorage devices (TADs) may be added to help move teeth where they need to go.
Adults. Jaw growth is finished, so braces or Spark™ Clear Aligners correct the position of the teeth, which is often enough for a mild or moderate underbite. When the difference between the jaws is large, orthodontic treatment is usually combined with orthognathic jaw surgery, and your orthodontist plans it together with an oral surgeon.
Every case is different, and the only way to know which of these applies is an exam with x-rays. SmileHaus offers a complimentary consultation that includes the exam, x-rays and photographs, so you can see your options before deciding anything.
Underbite Treatment Options
Braces: A Common Solution for Underbite Alignment
Braces are a prevalent method for correcting underbites, catering to various age groups. They come in different types, such as metal, clear, or 'hidden' braces, and are often considered the most cost-effective and efficient solution. Typically, braces need to be worn for two to three years, followed by a retainer to maintain the alignment.
Reverse-Pull Face Mask for Children
The Reverse-Pull Face Mask is specifically designed for children under 10 years, targeting the alignment of the upper jaw. It involves a mask-like device that wraps around the head. The mask is most effective when worn at least 12 hours/day to achieve an orthopedic effect.
Upper Expansion with Self-ligating Braces
Historically, an Upper Jaw Expander is a device fitted across the palate, usually for a duration of about a year. It involves nightly adjustments using a special key to gradually widen the upper jaw, ensuring the lower teeth do not close against the uppers. Today, in most cases, I can achieve the expansion needed with self-ligating braces, the natural pressure from the tongue, and special archwires.
Alternative Methods for Underbite Correction
Tooth Extraction: Addressing Overcrowding
In cases where overcrowding of the lower teeth leads to an underbite, tooth extraction might be a viable solution. This can be a standalone procedure or combined with other corrective methods.
Surgical Approaches to Severe Underbites
Orthognathic Jaw Surgery
This surgical method involves repositioning the lower jawbone to correct a protruding jaw. It requires a separation of the bone in the rear part of the jaw from the front, allowing the lower teeth to be repositioned. The recovery period can range from one to three weeks for returning to work or school, with complete healing taking 9 to 12 months.
Le Fort III Osteotomy
A more comprehensive surgical approach, Le Fort III Osteotomy, is used when the entire face appears recessed above the lower jaw. This procedure involves moving the entire face forward, significantly altering appearance and functionality.
Temporary Anchorage Devices (TADs)
TADs are like mini-implants that are placed in strategic areas. In most cases, the lower jaw is moved back to correct the position of the jaw. This can be a great alternative to orthognathic surgery.
Cosmetic Dentistry: A Non-Surgical Option
In milder cases, cosmetic dentistry may offer a solution by reshaping the lower teeth and fitting veneers to the upper teeth. While this doesn't correct the underbite structurally, it improves its visibility and enhances jaw functionality.
Seeking Professional Help
Consulting an orthodontist is vital for anyone with an underbite. They act as the quarterback in your case and work with other providers to achieve the best result in your case. Treatment plans are highly individualized, considering the severity of the underbite, patient age, and personal preferences. The study by McIlvaine et al. (2014) highlights the complexity of treatment choices, emphasizing the importance of professional guidance. The study assessed the feasibility of randomizing surgical versus non-surgical treatments for Class III malocclusion in cleft lip and palate patients. It found that most parents and patients were unwilling to accept random treatment assignments, with a significant portion likely to drop out if dissatisfied with the treatment. This highlights the challenges of conducting randomized trials in surgical settings and suggests the need for alternative research models.
Conclusion
Early diagnosis and appropriate treatment of underbite are imperative. A range of treatment options, from braces to surgery, can effectively manage each case. Consulting with us at SmileHaus Orthodontics ensures a treatment plan tailored to individual needs, promoting better oral health and overall well-being.
Frequently Asked Questions
At what age should my child be evaluated for an underbite?
All children should be seen by an orthodontist by age 7. If an underbite is present, treatment can begin at that time — especially approaches like the Reverse-Pull Face Mask, which are most effective during active growth phases and are designed for children under 10.
Can braces correct an underbite without surgery?
It depends on the severity and the underlying cause. Braces are a standard solution for underbites and can be effective on their own, particularly for less severe cases. In many situations, Dr. Thompson may be able to achieve the necessary expansion with self-ligating braces, the natural pressure from the tongue, and special archwires — without a separate expander appliance, though this depends on the individual case. Surgical options are reserved for cases where the jaw discrepancy is too significant to correct with orthodontics alone.
Does SmileHaus offer clear aligners for underbite correction?
SmileHaus offers Spark™ Clear Aligners (by Ormco / TruGEN) for adults and mature teens with mild to moderate cases. Whether aligners are appropriate for an underbite depends on the specifics of each case — Dr. Thompson will assess that at your complimentary consultation.
What is the Pitts21 PRO System and can it treat underbites?
The Pitts21 PRO System is a self-ligating bracket system and SmileHaus’s flagship braces treatment. Self-ligating braces are among the tools Dr. Thompson uses to address underbites, including cases that previously would have required a separate palate expander.
What are the recovery times for underbite jaw surgery?
Recovery times vary by procedure. Orthognathic jaw surgery typically requires 1–3 weeks before returning to work or school, with complete healing taking 9–12 months. Le Fort III Osteotomy follows typical surgical healing timelines. Your care team will provide guidance specific to your situation.
What happens if an underbite is left untreated?
An untreated underbite can lead to uneven tooth wear, difficulty chewing, speech difficulties, facial asymmetry, and impacts on self-esteem. In some cases it may also contribute to jaw discomfort. A specialist can advise on any concerns beyond orthodontic scope.
How do I get started with underbite treatment at SmileHaus?
SmileHaus offers a complimentary consultation that includes a free exam, x-rays, and photographs — no commitment, no pressure, just clarity on what’s possible. You can reach the office at (626) 788-5911 or visit us at 1414 Fair Oaks Avenue, Unit 7, South Pasadena, CA 91030. SmileHaus also accepts most major PPO plans and verifies orthodontic benefits before treatment begins.
How common is an underbite?
Underbite (Class III malocclusion) is one of the less common bite problems — it occurs less frequently than overbite or crowding, but it is a recognized condition that affects both children and adults. Genetics play a significant role: if a parent or close family member has an underbite, their children are more likely to develop one as well.
Will Dr. Thompson recommend treatment right away if my child has an underbite?
Not necessarily. Dr. Thompson takes a conservative, growth-respecting approach and will not recommend treatment if it is not needed yet. Treatment plans are highly individualized, taking into account the severity of the underbite, the patient’s age, and personal preferences.
What treatments does SmileHaus offer for underbites?
SmileHaus offers the Pitts21 PRO System (self-ligating braces) and Spark™ Clear Aligners for eligible cases, in addition to early treatment approaches for children. Dr. Karla Thompson evaluates each case individually — the right path depends on the severity of the underbite, the patient’s age, and their specific clinical picture. A complimentary consultation includes a free exam, x-rays, and photographs, with no commitment and no pressure.
When is jaw surgery necessary for an underbite?
Surgery is considered for severe underbites that cannot be adequately corrected with orthodontic treatment alone. Orthognathic jaw surgery repositions the lower jawbone and involves a recovery period of one to three weeks before returning to work or school, with complete healing taking 9 to 12 months. Le Fort III Osteotomy is a more comprehensive procedure used when the entire face appears recessed above the lower jaw. Your orthodontist acts as the quarterback in your care and works with other providers to determine the most appropriate approach for your situation.
Does SmileHaus accept insurance for underbite treatment?
SmileHaus accepts most major PPO plans and verifies orthodontic benefits before treatment begins. Financing options include in-house financing plans (subject to credit approval and terms vary), CareCredit, and payment by cash, check, Visa, Mastercard, American Express, or Discover. Ask our team for details on current financing terms.