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Updated on February 2, 2023
7 min read

Underbite Correction for Children, Teens & Adults

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What is an Underbite?

An underbite, also called a class III malocclusion, occurs when the lower front teeth overlap the upper teeth. It can be a cosmetic issue or a cause of various health problems.

Underbites can range from mild to severe and generally involve mandibular prognathism, where the lower jaw is pushed forward.

Orthodontic treatment is required to correct an underbite. This can include a wide range of options depending on the severity of the underbite and the patient's age.

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Early intervention is recommended for correcting the problem without surgery. Once a person’s bones and adult teeth have fully formed, shifting their positions is more difficult, and surgery may become necessary.

Clear aligners can save you thousands of dollars compared to braces. Learn about clear aligners.

Underbite Correction Options

There are several methods for correcting an underbite, and effective treatment may include more than one method. These range from jaw surgery to using orthodontic treatments and devices.

If treatment is performed while a person is young and still growing, an orthodontic appliance can often resolve the problem. These appliances are less effective for adults, who may need surgery to align their jaws correctly.

Both children and adults can benefit from braces or clear aligners such as Invisalign. These correct the dental aspects of the underbite, while appliances and surgical procedures handle the underlying issue with jaw alignment.

Underbite Correction for Children

The American Dental Association (ADA) and American Association of Orthodontists (AAO) state that children should first see an orthodontist when they are 7 years old.13 The earlier underbite treatment starts, the simpler and less expensive it will be.

Invisalign

Invisalign uses advanced technology to help fix an underbite. Patients wear customized clear aligners for two weeks at a time for a minimum of 22 hours a day.

They are only taken out to eat, drink, brush, and floss. With time, the jaw and teeth gradually move into a straighter position.

However, correcting underbites with Invisalign can be difficult. Clear aligners do not always have the same capabilities to move teeth like traditional braces. Traditional orthodontics is more likely to have a successful outcome in cases of moderate underbites.

Braces

Braces are the most common way to correct an underbite. Traditional braces are made up of several components. Metal brackets that cement directly onto tooth surfaces are known as conventional (buccal) braces. 

Lingual braces have the same components as conventional braces, but they’re fixed to the back of the teeth. Lingual braces are more esthetic than conventional braces. 

Metal brackets hold the wires that shift the teeth into the correct position. Braces can also include separators or spacers that create room between the teeth.

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Rubber ties hold wires to the metal brackets, and rubber bands attach to the upper and lower brackets to apply pressure. This helps create a perfect bite.

Children can opt for colorful rubber bands on their metal braces. Ceramic braces (which are usually clear or tooth-colored) are also available.

Reverse-Pull Headgear

The reverse-pull facemask wraps around a child’s head. It slows down the growth of the lower jaw in an attempt to allow the upper jaw to “catch up.” It’s especially likely to be used for underbites caused by an underdeveloped upper jaw (and not just an overdeveloped lower jaw).

The headgear consists of a metal frame with pads that fit comfortably against the forehead and chin. This frame is connected to attachments on the top front and back teeth using elastic bands.

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The force exerted by the pads against the attachments allows the upper jaw to come forward to match the lower jaw. 

Reverse-pull headgear is usually worn for at least 12 hours a day. It’s most effective when worn between the ages of 5 and 7 because the child’s jaws still have plenty of time and room to grow.

Chin Caps

A chin cap, also called a chin cup, is another form of orthodontic headgear that restricts the growth of the lower jaw. It works similarly to reverse-pull headgear.

The main difference is that chin caps attach completely outside the mouth rather than to the teeth. They’re kept in place on the chin with elastic bands that go over the top of the head.

Upper Jaw Expanders

A palatal expander is a wire-frame appliance that orthodontists fit across someone’s palate (the roof of the mouth). At prescribed intervals, a key is used to widen the expander by a small amount. The upper jaw expands gradually until the lower teeth no longer sit outside the upper teeth.

People usually wear the upper jaw expander for a year. It’s often replaced with a retainer afterward.

Baby Tooth Extractions

Baby tooth extractions are a standard underbite treatment for children. With early tooth extractions, there is room for permanent teeth to grow straight.

Orthodontists try to avoid extracting a child’s permanent teeth. However, in severe underbite cases, permanent tooth removal may be needed to allow for the movement of the other teeth.

Underbite Correction for Late Teens & Adults

Adults with an underbite require different orthodontic treatment than a child with the same condition.

Invisalign 

Invisalign and other in-office clear aligners can also fix some adults’ underbites. However, severe underbites may require Invisalign treatment (or braces) and surgery. Speak with a dentist or oral surgeon to discuss possible treatment plans.

Braces

Dental braces are commonly used to treat underbites in people of all ages. This is because they exert the amount of pressure needed to perform complex tooth realignments.

Adults who do not want visible metal braces can opt for transparent ceramic braces, or lingual braces, which run behind the teeth. Both of these options may help boost confidence and make people less self-conscious.

As with clear aligners, braces treatment may realign the teeth, but surgery may still be required to bring a person’s jaw into the proper position.

Orthognathic (Jaw) Surgery

Most board-certified oral surgeons can successfully correct underbites using a procedure called mandibular osteotomy. This surgery shortens and reshapes the lower jaw:

  • First, bilateral controlled fractures are created, during which some of the jawbone is removed
  • The mandible is then repositioned to sit correctly in the best possible dental arch alignment for the face
  • Once properly aligned, the upper and lower jaws are held in place with wires, titanium plates, and screws. Patients must follow a liquid diet until the jaw heals.
Recovery and Risks

During recovery after underbite surgery, jaw pain and discomfort can develop. Patients may also need to wear braces for approximately a year to align their teeth.

Underbite surgery also comes with some risks, including general anesthesia reactions, infection, bleeding, and scarring.

However, for most adults, surgery is the only option for correcting a skeletal underbite.We recommend at-home clear aligners if you have mild teeth misalignment. View our top recommendations.

What Causes an Underbite?

If someone has an underbite, it’s generally present before they hit puberty. Underbites are often hereditary, especially if they involve a high degree of skeletal (jawbone) involvement.

Childhood habits are the other main factor in developing an underbite. Thumb sucking, poor chewing habits, and excessive pacifier use can all contribute to an underbite or other type of malocclusion.

Obstruction of the upper airway during childhood can lead to a habit of mouth breathing. This can also play a role in the formation of an underbite.

Underbite Complications

While some people live happily with mild underbites, severe cases can have complications that interfere with daily life. These include:

  • Trouble speaking
  • Difficulty eating and drinking
  • Mouth and face discomfort due to misalignment of the jaw
  • Obstructed breathing and sleep apnea
  • Poor lip closure (mentalis strain)
  • Tooth decay, gingivitis, and other oral health issues
  • Bad breath (halitosis)

These complications can become more severe as people get older, and harder to correct without surgery.Clear aligners can save you thousands of dollars compared to braces. Learn about clear align

Summary

An underbite, or class III malocclusion, involves lower teeth that sit in front of the upper teeth. It often results from an overdeveloped or misaligned lower jaw and/or an underdeveloped midface or upper jaw.

A variety of treatments are available for an underbite. Which treatment method (or combination of methods) works best will depend on the severity of the case and the person’s age.

For children, a combination of braces and orthodontic headgear may be used. Mildly misaligned teeth may be treatable with clear aligners. For fully developed adults, surgery will likely be necessary to correct an underbite.

What’s Next?

The most popular at-home clear aligner kits can be found right here:

Learn about the different brands and what they offer.

Last updated on February 2, 2023
13 Sources Cited
Last updated on February 2, 2023
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
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  6. Azamian, Zeinab, and Farinaz Shirban. “Treatment Options for Class III Malocclusion in Growing Patients with Emphasis on Maxillary Protraction.” Scientifica, 2016.
  7. Eslami, Sara, et al. "Treatment decision in adult patients with class III malocclusion: surgery versus orthodontics." Progress in Orthodontics, 2018.
  8. Park, Kitae E., at al. "Orthognathic Surgery to Improve Facial Profile: Assessment, 3-Dimensional Planning, and Technique." Aesthetic Surgery Journal Open Forum, 2021.
  9. Underbite.” Invisalign.
  10. Tran, Khai, and Lori Picheca. “Orthodontic Treatment for the Management of Pain or Impacted Teeth in Patients with Malocclusion: A Review of Clinical Effectiveness and Guidelines.” Canadian Agency for Drugs and Technologies in Health, 2017. 
  11. Dental braces and retainers.” Healthdirect Australia.
  12. Extractions (removal) of baby teeth.” Queensland Government.
  13. Consumer. “When Should Your Child See an Orthodontist?” American Association of Orthodontists, 2021.
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