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Underbite: Causes And Treatment With Braces And Surgery

An underbite is a bite problem that occurs when the lower teeth rest further than the upper teeth. Underbite mostly occurs due to genetics, and it causes several other dental issues. Fixing your underbite helps you avoid these other dental problems later in life.

Both children and adults can have an underbite, and in both cases, the condition can be treated. The common treatment options are braces and surgery. However, there are other treatment options.

If you have an underbite and you are looking to treat it, here is all you should know about the condition and how it affects you.

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Table of contents

  1. What is an underbite?
  2. Do I have to correct my underbite?
  3. How do I fix an underbite?
  4. The link between underbite, cleft palate and lips
  5. Underbite correction on the NHS
  6. Takeaway
  7. What Is An Underbite?

    An underbite is a type of malocclusion resulting from the lower teeth sitting further than the upper teeth. It means that the lower teeth stick out when your upper and lower teeth meet. In some people, the underbite is mild. Hence people do not notice the lower teeth sticking out. In more severe cases of the condition, there is a noticeable gap between the upper and lower teeth. Irrespective of the severity of the malocclusion, dentists recommend that you correct your underbite.

    What are the causes of an underbite?

    In most cases, you inherit an underbite from either or both parents. The condition is usually associated with cleft lips and palates, then some childhood behaviours such as

    • Sucking the thumb
    • Thrusting the tongue
    • Excessive use of a dummy
    • Prolonged bottle-feeding

    Some underbites results from the upper jaw being too short and underdeveloped or the lower jaw protruding too far. Sometimes, the problems may be a combination of both situations.

    Do I have to correct my underbite?

    The significant difference between underbite and overbitesis thatunderbites are not natural, but some overbite can occur naturally. Underbite causes a lot of problems, and the longer you put off treatment, the harder it becomes to treat.

    If a child has an underbite, it is advisable to start the treatment early when the bones are still easy to move. If the underbite is left untreated, it could cause the child the following problems.

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    • Difficulty in biting and chewing food properly
    • Speech difficulties such as lisping and slurring
    • Facial pain resulting from abnormal jaw strain or pressure
    • Cracking or wearing down of the tooth enamel
    • Risk of tooth decay
    • Sleep apnoea
    • Breathing through the mouth
    • Low self-esteem
    • Abnormally shaped face

    How do I fix an underbite?

    Different treatments options are available that dentists have used in the past to fix underbites successfully. Before you get treatment for your underbite, your dentist will examine your condition and recommend the best treatment option for you.

    Most times, the dentist may recommend two or more of these treatment options to make the treatment effective and long-lasting to give you a beautiful smile. The following treatments are suitable for fixing underbite.

    Upper jaw expander

    Most types of underbitesare due to an underdeveloped upper jaw, and your dentist may recommend a jaw expander to help the upper jaw develop the correct shape if this is your case. The jaw expander gradually pushes out the teeth and expands the palate.

    The jaw expander may be a removable one like a retainer or fixed like some orthodontic treatments. It is one of the least noticeable treatments for underbite as no one can see it except you yawn or laugh.

    Some previous upper jaw expander users claim that the treatment is painful, although, any treatment that requires moving the jaw may come with some level of pain. The jawbones do not fuse until the age of 12 – 13, so it is more comfortable and less painful to correct underbite at a young age.

    Treatment with an upper jaw expander may last for about a year depending on the amount of movement needed. After treatment, you may need to wear a retainer for a while until the new bone grows to make the correction permanent.

    Reverse pull headgear

    A reverse-pull headgear helps to pull the lower jaw back to correct an underbite. The thought of using a reverse headgear may be scary, but it is a common underbite treatment.

    The dentist places the headgear to rest on the forehead and chin, then attaches it to braces or a retainer with elastic bands that slowly pull the upper teeth into position.

    Reports have shown that reverse headgear treatment for underbite is up to 75% effective, especially for treatments before the age of ten. For the treatment to be effective, you may use the headgear alongside a chin cap or cup. The device will fit over the head from the crown to the chin. It helps to reduce the growth of the lower jaw, and this allows the upper and lower jaw to align quickly.

    If you decide to use this treatment, wear the headgear as often as you can and every night for it to be effective. Most people, especially children, may not mind wearing it indoors to carry out activities but wearing it for any activity outdoor may be a problem. Endeavour to follow your dentist’s advice to get the most of the treatment because it could help you avoid surgery.

    Braces for underbite

    You can use braces alongside the other treatments above to correct your underbite. Braces correct other orthodontic treatments, including underbite by twisting, pushing and gradually moving the teeth to their perfect position.

    You can only get metal braces on the NHS to correct an underbite, but if you want other types of less noticeable braces like ceramic braces, you have to pay for them privately.

    After underbite treatment, you need to wear retainers for a while, mostly at night to maintain your progress and prevent the teeth from moving to their previous position.

    Invisalign for underbite

    Dentist recommends Invisalign for some underbites. Invisalign aligners are less noticeable, and this makes them a preferred option for those who are concerned about their appearance. You may use Invisalign or combine it with other treatments like surgery to correct your underbite.

    Everyone may not be suitable for Invisalign, so before your treatment, you can take an online Smile Assessment test or book an appointment with an Invisalign dentist to check if you are a right candidate for the treatment.

    Tooth extraction

    An underbite may result from having excess teeth in the lower jaw. In this case, the dentist will advise that you extract one or more teeth. You may also need the extraction to create space to fit brace.

    Carrying out tooth extraction needs a local anaesthetic, although the dentist may use a general anaesthetic for multiple or complicated extractions. Tooth extraction is usually a painless, quick and straightforward procedure. The dentist pushes or twists the tooth to loosen it from the socket, then takes out the tooth.

    Underbite jaw surgery

    If the underbite is severe, it may need surgery to correct the problem. Underbite surgery may involve different procedures depending on the cause of the problem.

    In some cases, the surgeon may need to push back or reposition the lower jaw, while in others, the surgeon may focus on repositioning the upper jaw. Both approaches will need your surgeon to use small screws and insert plates around the bone to ensure the bone does not move to their previous position.

    Before the surgery, the dental surgeon will tell you all you should expect before and after the surgery. The typical changes after an underbite jaw surgery include:

    • Differently shaped face
    • Better dental hygiene
    • Improved speech
    • Reduced risk of tooth decay and enamel eruption

    Underbite surgery may be a common procedure, and if your dentist recommends it, ensure you request for before and after photos of some previous patients, especially if you are concerned about the changes to expect.

    You would not have visible scars because the surgeon will make all the incisions inside your mouth and wire the jaws afterwards. Your surgeon may also place an internal frame in your mouth to ensure the bones heal correctly.

    Recovery from the surgery takes about 2 – 4 weeks, so you may need to take time off your regular activities after the surgery. You may also need braces before or after the surgery.

    Summary of underbite treatment

    The table contains a summary of the available treatments for underbite.

    Treatment option

    Removeable, long-term or permanent?

    Duration of treatment

    The age bracket for treatment

    Upper jaw expander

    Fixed or removable

    Teeth movement – one year

    Retention- one year

    Before the age of 13

    Reverse pull face mask


    About a year

    Before the age of 10

    Chin cap


    About a year

    Before the age of 10

    Underbite braces (including Invisalign)

    Long term

    1 – 3 years

    When all adult teeth have come through

    Teeth extraction


    One dental visit

    All adult teeth are out

    Underbite surgery


    Recovery lasts 2 – 4 weeks depending on the type of surgery

    About the age of 16 – 18

    The Link BetweenUnderbite, Cleft Palate And Lips

    Children born with either cleft palate or cleft lip are likely to have underbite because their upper teeth and jaw are underdeveloped. They may need underbite surgery to correct the problem. A general underbite surgery is quite similar to the surgery above. Sometimes, the surgeon may carry out both surgeries at the same time.

    Before the surgery, the NHS cleft team will explain everything you need to know about the procedure, and you can seek support from them at anytime.

    UnderbiteCorrection On The NHS

    An underbite surgery is free on the NHS for children below 18 years, while adults will pay a band three treatment charge of £269.30. The NHS covers the cost of dental surgery and any orthodontic treatment that is medically necessary for adults.

    After your consultation, your dentist will inform you if you are eligible for treatment under the NHS. If you qualify for treatment, the NHS will cover everything you need to treat the condition, including braces, before and after operations.


    All cases of underbite require treatment to improve oral health and self-esteem in most cases. Treating an underbite at a young age reduces the likelihood of using a more invasive treatment, and it also increases the success rate of the treatment.

    Different treatment options are available to correct underbite at London Braces, so you don’t have to settle for the noticeable metal braces. Contact us on 020 37457520 now to book an appointment for your underbite treatment.

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