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Underbites – A Comprehensive Guide

Excerpt: An underbite is a class III orthodontic malocclusion (misalignment of teeth)...
Table of Contents

What is an underbite?

An underbite underbite is a class III orthodontic malocclusion (misalignment of teeth), when the teeth are in proper alignment, the front teeth should be slightly past the lower teeth. However, in an underbite, the bottom teeth are positioned in front of the upper teeth.

Types Of Underbites

There are two main types of underbites that are recognized by dentists.

Dental Underbites

These are caused by crossbites, which occur when the upper and lower teeth do not align correctly. When the bottom teeth are positioned outside of the upper teeth, a crossbite can occur. A dental underbite will be present when the crossbite occurs in the front of the mouth. The lower teeth are positioned slightly forward but the jaw does not protrude outwards.

Skeletal Underbite

If the condition is caused by the lower jawbone, then it is considered a skeletal underbite. This is generally caused by a genetic defect. 

What Causes An Underbite?

There are a few primary causes for underbites.
  • Genetics (primary cause)
  • Tongue thrusting
  • Thumb sucking during childhood
  • Sucking on a pacifier as a baby (more frequently and longer than normal)
  • Drinking from a bottle long-term (babies)
  • Facial and jaw injuries
  • Jawbone tumors

Overbite Vs. Underbite

If you have the insurance coverage or the budget to do so, you should always consider correcting a malocclusion as early as possible. If you have only a minor misalignment then it may not need to get corrected, but a significant overbite or underbite can cause complications later on if it is not corrected. 

Complications Of An Underbite

If you have a significant malocclusion, it can cause complications later on in life that can be fairly serious and they are definitely something you should consider avoiding:

Increased Risk For Dental Decay

Depending on how the teeth are aligned, it could cause damage to the enamel of the teeth. If the enamel is destroyed or damaged you are at risk of increasing your chances for tooth decay.

Breathing Issues

There are a few breathing issues that can happen as a result of your teeth being misaligned. Sleep apnea, mouth breathing, and snoring are all potential issues that can arise from an overbite or an underbite. These issues can cause lots of problems with getting quality sleep, and may even impact your athletic performance. If you fix the bite alignment earlier on, you may be able to avoid most, if not all of these ailments.

Temporomandibular Disorders (TMD)

Your temporomandibular joint (TMJ) connects your lower jaw to your skull. Over time this joint can be negatively impacted by a bite alignment issue. These issues can even make daily tasks like eating or talking difficult, and sometimes it can even be painful.
Some other complications can include:
  • Difficulties speaking
  • Difficulties eating
  • Increased risk of gum disease
  • Structural changes in the mouth
  • Irregular or crooked teeth
  • Bad Breath (halitosis) even with good oral care
  • Self-esteem issues
  • Increased need for jaw surgery

Can An Underbite Be Corrected?

If the underbite does not resolve on its own, there are a few different options for correction that you can take. The dentist will likely have a recommendation they think is the best solution for your situation.

When Is The Best Time To Correct An Malocclusion?

You will want to correct an underbite sooner than later to risk any further complications that may occur. If the dentist or pediatrician is able to diagnose a bite alignment during childhood, getting it corrected then would be best. However, sometimes an alignment issue may not be recognized until later on, in this case, it is best to get it corrected as soon as it is diagnosed.

Surgical Removal Of Baby Teeth

If an alignment issue is detected before the adult teeth grow in, the dentist or pediatrician may recommend the child has some of their teeth removed. This is a common treatment for bite issues at this stage of life, since they are just baby teeth, they are not nearly as important as adult teeth.


Braces are orthopedic device that was developed to correct bite alignment issues. They are incredibly reliable to use and are often preferred to be used as a treatment option early on in life. Braces may be expensive if you don’t have good insurance coverage, but they can save a significant number of issues later on in life.

Invisalign (Clear Aligners)

Invisalign is a product that’s similar to braces, but they are much less intrusive, they’re removable and less noticeable. The only drawback is they are generally only used to correct minor alignment issues. If you have severe issues or if the issue is caused by your jaw bone, then Invisalign will most likely not be an effective option for you.

Upper Jaw Extenders (UJE)

Upper jaw extenders are fitted in the upper jaw behind the teeth. They adjusted over time to slowly extend the upper jaw. The main goal with UJEs is to widen the upper jaw, expand your dental arch, and move the teeth within the bone. Usually, the average duration for these devices is between 3-6 months.

Jaw Surgery

If the situation cannot be fixed by an orthopedic device, a dentist may recommend jaw surgery. Jaw surgery will require the oral surgeon to x-ray, cut, reshape, and reposition the jaw bone into a more optimal placement. Jaw surgery is not a common solution, as most alignment issues can be fixed by one of the many devices and solutions listed above.
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