What This Guide Covers
This guide explains what an orthodontist for underbite does, which treatment choices exist, and when a child or adult needs specialist care.
An underbite is one of the more visible bite problems. The lower front teeth close in front of the upper front teeth instead of behind them. This guide walks through how the problem forms, how an orthodontist confirms it, and what happens during treatment. You will also learn what affects cost and when to move from a general dentist to a specialist.
The right approach changes with age. A young child who is still growing has different orthodontic treatment options than an adult whose jaw growth has finished. We cover both so you can ask better questions at your first visit. You can also read more on the orthodontics page.
Understanding Underbites
An underbite, known clinically as a Class III malocclusion, occurs when the lower teeth and lower jaw extend past the upper teeth [2].
Malocclusion simply means the upper and lower teeth do not meet the way they should. With an underbite, the mismatch can come from the teeth, the jaws, or both. Some people have a small underbite that mainly shows when they smile. Others have a larger jaw size difference that changes the shape of the face and makes chewing harder. An orthodontist measures how much of the problem is dental and how much is skeletal, because that decision shapes the entire treatment plan.
What Causes an Underbite
Most underbites come from a mix of inherited jaw shape and habits during early childhood. Genetics set the size and position of the upper jaw and lower jaw. When the lower jaw grows longer than the upper jaw, the lower teeth slide forward.
Certain childhood habits can affect jaw growth and make a bite problem worse. Long-term thumb sucking, tongue thrusting, and chronic mouth breathing can each change how the jaws develop. Mouth breathing is often linked to blocked nasal airways, such as enlarged tonsils or allergies. When a child breathes through the mouth for years, the tongue rests low and forward, which can push growth in the wrong direction. Tongue thrusting, where the tongue presses against the front teeth during swallowing, adds steady pressure that can move the lower teeth ahead of the upper teeth.
How Orthodontists Diagnose an Underbite
An orthodontist diagnoses an underbite with a clinical exam, dental impressions or scans, and x-rays that show the jaw bones. Photographs of the face and teeth help record the starting point.
Newer tools are also being studied. Research on artificial intelligence systems has tested whether software can classify how the upper and lower teeth fit together using intraoral photographs, with accuracy compared against clinical diagnoses [2]. These tools support the orthodontist but do not replace the hands-on exam. The orthodontist still decides whether the underbite is mainly dental or skeletal, since that answer drives every later choice.
What to Know Before Treatment
Timing matters more with underbites than with many other bite problems, because jaw growth can only be guided while a child is still growing.
The American Association of Orthodontists suggests a first orthodontic check by about age 7 [9]. At this age, the orthodontist can spot a developing underbite while the jaw bones are still soft and responsive. Early intervention at this stage may guide growth and reduce the size of the problem later. For some children, early intervention lowers the chance of needing jaw surgery as an adult, though results vary by case.
An adult underbite is handled differently. Once growth has stopped, appliances can no longer move the jaw bones themselves. Treatment then focuses on moving teeth, on surgery to reposition the jaws, or on a mix of both. Knowing which category you fall into helps you understand why two patients with similar looking underbites can be offered very different plans.
What to Expect During Treatment
Treatment usually starts with records and a written plan, then moves through an active phase with appliances, and ends with retainers to hold the result.
At the first visit, the orthodontist reviews your dental and medical history, examines your bite, and takes scans and x-rays. You then receive a treatment plan that lists the recommended appliances, the expected timeline, and the goals. This is the right time to ask about each path and how it fits your daily life and oral health.
Growth-Guiding Treatment for Children
In growing children, two appliances are common. Palatal expanders widen a narrow upper jaw so the upper teeth have room to meet the lower teeth correctly. Palatal expanders are often paired with a facemask, a device that gently pulls the upper jaw forward over several months.
A systematic review of facemask therapy in children with skeletal Class III malocclusion looked at how stable the correction stayed after treatment ended [3]. The review reported that corrections were generally maintained, although some relapse can occur as growth continues. This is why an orthodontist often monitors a child for years and may add a second phase of orthodontic treatment with braces during the teen years.
Treatment Options for Adults
Adults have three broad paths, and the choice depends on how large the jaw size difference is. Many patients ask whether braces fix underbites without surgery, and in mild to moderate cases the answer is often yes.
When the underbite is mostly dental, braces or clear aligners move the teeth into a better position. Clear aligners are removable, clear trays that are changed on a set schedule. To handle harder tooth movements, an orthodontist may add temporary bone anchor screws, sometimes called skeletal anchorage. Research describes how skeletal anchorage can be integrated into both fixed braces and clear aligner biomechanics to control tooth movement [5]. In some borderline cases, an orthodontist may also consider removing a lower front tooth to help the bite close; a systematic review describes mandibular incisor extraction as an uncommon but sometimes useful choice [7].
When the jaws themselves are badly mismatched, tooth movement alone is not enough. The orthodontist then works with an oral surgeon to plan orthognathic surgery, also called jaw surgery, which repositions the upper jaw, lower jaw, or both. Braces or aligners are usually worn before and after the operation. Some teams now use a surgery first approach, where the operation comes before most of the orthodontic treatment; a systematic review has examined how this sequence affects treatment [6]. Software is also used to predict how the face profile will change after double-jaw surgery in Class III patients, which helps patients see likely outcomes before they decide [8].
What Affects the Cost
Underbite treatment cost depends mostly on whether the plan involves only orthodontics or also jaw surgery, plus how long treatment lasts. Costs vary by location, provider, and case complexity.
A child treated with palatal expanders and braces over two phases costs differently than an adult treated with clear aligners alone. Surgical cases tend to cost the most, because they involve a hospital or surgical center, an oral surgeon, anesthesia, and orthodontic treatment on both sides of the operation. Longer cases with more visits also add to the total.
Dental insurance often covers part of orthodontic treatment, especially for children, and medical insurance may cover jaw surgery when an underbite causes functional dental problems with chewing or speech. Coverage rules differ by plan, so ask both the orthodontic office and your insurer for a written estimate before you start. General patient resources from the American Dental Association can help you prepare questions about coverage [10].
When to See an Orthodontist
See an orthodontist when the lower teeth sit in front of the upper teeth, when a child shows early signs of a Class III bite, or when an adult has jaw pain or trouble chewing.
A general dentist can spot an underbite and refer you, but an orthodontist has the training to measure the jaws and plan correction. Take a child for an evaluation by about age 7 if you notice the lower jaw jutting forward, ongoing mouth breathing, or a crossbite. Early review does not always mean early treatment; sometimes the orthodontist simply watches growth.
Adults should see a specialist if an underbite affects how they eat or speak, causes jaw pain, or is linked to gum recession or uneven tooth wear. One study examined the link between occlusal interferences, where teeth meet unevenly, and mid-buccal gum recession, which supports getting bite issues checked rather than ignored [4]. An orthodontist can confirm whether your underbite is dental, skeletal, or both, and then explain realistic options to fix underbites in your situation.
Find an Orthodontist Near You
If you or your child has an underbite, an orthodontist can confirm the diagnosis and walk you through every path before you commit. Browse the orthodontics page to learn more and connect with a specialist who treats underbites in children and adults.
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