What is an underbite? Causes, Treatments, and FAQs

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Condition

Underbite

A type of bite misalignment (malocclusion) when the bottom teeth and lower jaw extend out beyond the upper teeth when the mouth is closed

Prevalance: Common (5-10% of global population)

Ages Affected: All

    • Visible protrusion of the lower jaw beyond the upper front teeth
    • Mouth breathing
    • Sleep disruption
    • Speech difficulties
    • Jaw/mouth pain
    • Problems with digestion
    • Bruxism (teeth grinding)
    • TMJ/TMD
    • Braces/Invisalign
    • Tooth extraction
    • Tooth reshaping
    • Surgery
    • “Facelift” Dentistry

An underbite can cause major problems if left untreated. This bite problem can affect everything from self esteem to sleep quality.

So, what causes an underbite, how do we spot it in children and adults, and what can be done to treat it?

What is an underbite?

An underbite is a type of bite misalignment, also referred to as mandibular prognathism or a Class III malocclusion.

This diagnosis refers to when the bottom teeth and lower jaw extend out beyond the upper teeth when the mouth is closed.

In moderate to severe cases of prognathism, the face can take on a bulldog-like look due to the protrusion of the bottom jaw bone.

Beyond appearances, this is one of “the most severe” conditions that can occur in the jaw, teeth, and face. The protruding jaw is not just a cosmetic concern, but a potential threat to the patient’s dental health. In fact, it can cause many serious issues if left untreated.

Due to the myriad of possible complications, underbite correction is crucial.

Causes of Underbite

An underbite can be caused by a number of factors, including genetic makeup, environmental factors, or other illnesses:

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Underbite Complications and Symptoms

Thankfully, an underbite is typically not a difficult condition to spot. Both its conditions and symptoms are usually clear and easy for a dentist to spot, even in younger children.

If you or your little one are experiencing any of the following, let your dental care provider know.

The symptoms of an underbite are, in part, determined by the severity of the malocclusion.

Perhaps the most commonly noticed is a visible protrusion of the lower jaw beyond the upper front teeth. Noticing overcrowding in the teeth and an aching jaw is also very common.

The mouth breathing mentioned above, and even low quality sleep, can also be indicators that something is amiss.

There are many difficulties that can come with an underbite, many ranging beyond the mouth. Here are some of the most common effects:

How to Treat an Underbite (5 Procedures + Costs)

If you or your loved one suffers from an underbite, you have several factors in your treatment options.

Your insurance will want to know if this is cosmetic dentistry or a necessary procedure for your oral health, which may determine how much they pay.

Pricing for dental work also depends on your location and the dentist you choose.

The severity of your underbite can also affect what sort of treatment you need—more severe cases may require more invasive methods.

If your child has a “pseudo” class III underbite, meaning lower teeth are ahead of the upper but jaw sizes are appropriate, braces/Invisalign and extractions may be an option. However, if an underbite is caused by skeletal issues, surgery will be the only choice.

1. Braces/Invisalign

Once an underbite is detected, you will need a treatment plan to realign your jaw and align your teeth. In milder cases, your underbite may be correctable with orthodontic treatment alone.

I am a fan of Invisalign (or other clear retainers) when it’s an option, as it creates less calcifications and uses safe ingredients that are free of BPAs and carcinogens.

Usually, this option won’t work for children. I’ve successfully used Invisalign on class III underbites, but it required tooth extractions. Metal braces are generally the go-to method for kids.

Before or in place of braces, your orthodontist may recommend specialized headgear. A reverse-pull face mask uses metal bands attached to the upper back teeth and wraps around the head to pull the jaw into place.

An upper jaw expander involves fixing a plastic and wire device to the roof of the mouth, expanded by turning a key daily. Over the course of roughly a year, the palate expands to correct the bite.

Typically, medically necessary braces can be partially covered by dental insurance.

Between x-rays, appointments, and the gear needed, braces can run between $2,000-$7,000, with dental insurance caps generally covering around $1,500.

For more information, check out my comprehensive guide to braces.

2. Tooth Extraction

Overcrowding in the teeth can create an underbite, particularly in the upper or lower front teeth.

In some cases, a tooth extraction may be necessary to relieve the pressure this causes and aid the jaw in relaxing into its natural position. This may be all that’s required, but in other situations, this is a first step prior to braces or other treatment options.

The cost to extract one tooth can range from $75-$300, often partially covered by insurance.

3. Tooth Reshaping

In cases where the teeth do not fit in the mouth properly, tooth reshaping is a cosmetic dentistry option.

In this treatment, the bottom teeth will be shaved down and reshaped slightly, and veneers fitted to the upper teeth. This can realign how the jaw fits together, and is appropriate for some mild cases of underbite.

Some benefits of tooth reshaping are that it’s relatively painless, since it only alters tooth enamel, and lowers the incidence of tooth decay.

Tooth reshaping typically costs between $50-$300 per tooth.

4. Surgery

For severe underbite or older patients, jaw surgery (also referred to as orthognathic surgery) can be necessary. This typically is recommended in conjunction with orthodontic treatment.

Jaw surgery can realign the position of your upper and lower jaw, and create proper bite patterns in extreme cases of prognathism.

Each surgery is different and tailored to the patient, but the typical recovery time can range between ten and 12 weeks.

With no insurance, jaw surgery can range from $20,000-$40,000. However, with insurance, the cap of what you’ll pay often lands under $5,000.

Unlike many other types of dental treatments, this type of surgery is typically covered by medical insurance.

5. “Facelift” Dentistry

“Facelift” dentistry aims to correct bite problems using their specialized JawTrac and VENLAY technology—designed to prevent the need for braces and jaw surgery.

This dentistry, available only to adult patients, claims the ability to correct underbites in as little as three weeks by harnessing electronic jaw tracking readings. These are based on the projected natural position of the jaw without having been shifted by malocclusion.

Pricing for “Facelift” dentistry varies by patient, but starts around $35,000.

Since this is newer technology, the insurance coverage for this procedure varies by provider.

Differences Between Underbite and Overbite

In proper alignment, when the mouth is closed, the top front teeth extend very slightly over the lower teeth and jaw.

Extreme cases of this are another type of malocclusion, called an overbite. An underbite creates the opposite effect when the mouth closes, pushing the lower jaw and teeth to the front.

Both an underbite and an overbite can make patients self-conscious, causing issues with breathing, chewing, and speaking.

However, the difference is simple: an overbite looks like the upper jaw and teeth are too far forward, and an underbite presents as a protruding lower jaw and teeth.

Underbite Statistics

Estimates for underbite prevalence claim they occur in 5-10% of the population.

One global study took a closer look at the incidence in different nations. The U.S. has a 5% incidence, while China has a whopping 15% of the population with an underbite—perhaps due to genetics.

FAQs

Q:

What’s the best age to treat underbite?

A: The short answer is: as early as possible. As soon as you notice an underbite developing in your child, consult your dentist. This early intervention may prevent the need for orthodontics or surgery. I tell my patients that beginning treatment by the age of five can make all the difference!

Otherwise, traditional underbite treatment can be most effective between ages 5-10.

Q:

Can I get my underbite fixed even though I’m an adult?

A: It’s never too late to treat an underbite, and can reverse many of the painful and embarrassing complications even later in life. Treatment in adults has proven successful in many cases.
Q:

Does an underbite make me ugly?

A: While an underbite can be stigmatized due to its rarity, the only ugly thing is a judgmental attitude towards others’ appearances.

However, studies show that self-esteem can increase after treatment for prognathism, especially in women.

Q:

Should I get my underbite fixed even if I don’t think it’s causing problems?

A: My answer is a loud and enthusiastic yes!

All you need to do is look at the complications list above to see that an underbite often leads to major problems all throughout the body, from headaches to indigestion. This is more than a cosmetic procedure– your oral health affects your overall wellness and quality of life.

Q:

How will my appearance change after having an underbite corrected?

A: Facial structures vary a lot from person to person, but check out these incredible before-and-after pictures of corrected underbites.

View this post on Instagram

Transformation Tuesday! 🙌 #stunning Underbites can change the shape of the whole face. A severe case, like this one, can distort features and make the chin look like it is sticking out. Orthodontics is more than just straightening up the teeth! Bite abnormalities occur in almost all of our patients. Most are easily corrected without surgery. Putting teeth in their proper place for the best occlusion is what we do!! 😍 #orthodontics #braces #occlusion #healthybite #underbite #beforeandafter #newsmile #bracesoff #nicesmile #teenbraces #odonto #orthodontist #smilemakeover #dentalcase #underbitecorrection #loveyoursmile #transformation #transformationtuesday #smikesbyspokane

A post shared by Spokane Orthodontics (@spokane_orthodontics) on

Key Takeaways: Underbite

An underbite, when the lower jaw extends farther out than the upper, is a serious dental concern that should never be left untreated.

Causes of an underbite can range from environmental factors like thumb sucking to the individual’s genetic makeup. Common treatment options include braces/Invisalign, extraction, tooth reshaping, surgery, and “facelift” dentistry.

Though early intervention is better, there’s no wrong time to begin underbite treatment to regain your self-esteem and health.

Read Next: Underbite in Toddlers

14 References

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  2. Tang, E. L., & Wei, S. H. (1993). Recording and measuring malocclusion: a review of the literature. American Journal of Orthodontics and Dentofacial Orthopedics, 103(4), 344-351. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/8480700
  3. Fotek, Ilona (2018-02-05). “Prognathism: MedlinePlus Medical Encyclopedia”. Full text: https://medlineplus.gov/ency/article/003026.htm
  4. Chang, H. P., Tseng, Y. C., & Chang, H. F. (2006). Treatment of mandibular prognathism. Journal of the Formosan Medical Association, 105(10), 781-790. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/17000450
  5. Watkinson, S., Harrison, J. E., Furness, S., & Worthington, H. V. (2013). Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database of Systematic Reviews, (9). Full text: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003451.pub2/full
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  7. Molina, F., Ortiz, F. M., & Barrera, J. (1998). Maxillary distraction: aesthetic and functional benefits in cleft lip-palate and prognathic patients during mixed dentition. Plastic and reconstructive surgery, 101(4), 951-963. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/9514327
  8. da Silva Dalben, G., Costa, B., & Gomide, M. R. (2006). Prevalence of dental anomalies, ectopic eruption and associated oral malformations in subjects with Treacher Collins syndrome. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 101(5), 588-592. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/16632269
  9. Joshi, N., Hamdan, A. M., & Fakhouri, W. D. (2014). Skeletal malocclusion: a developmental disorder with a life-long morbidity. Journal of clinical medicine research, 6(6), 399. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4169080/
  10. Cooper, B. C., & Kleinberg, I. (2007). Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders. CRANIO®, 25(2), 114-126. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/17508632
  11. de Almeida Prado, D. G., Nary Filho, H., Berretin-Felix, G., & Brasolotto, A. G. (2015). Speech articulatory characteristics of individuals with dentofacial deformity. Journal of Craniofacial Surgery, 26(6), 1835-1839. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/26355970
  12. Zere, E., Chaudhari, P. K., Sharan, J., Dhingra, K., & Tiwari, N. (2018). Developing Class III malocclusions: challenges and solutions. Clinical, cosmetic and investigational dentistry, 10, 99. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016584/
  13. Marşan, G., Kuvat, S. V., Öztaş, E., Cura, N., Süsal, Z., & Emekli, U. (2009). Oropharyngeal airway changes following bimaxillary surgery in Class III female adults. Journal of Cranio-Maxillofacial Surgery, 37(2), 69-73. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/19117765
  14. Jung, M. H. (2010). Evaluation of the effects of malocclusion and orthodontic treatment on self-esteem in an adolescent population. American Journal of Orthodontics and Dentofacial Orthopedics, 138(2), 160-166. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/20691357

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