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Underbite: Causes, Symptoms and Treatment

An underbite is a jaw misalignment where the lower front teeth protrude in front of the upper front teeth. It can affect chewing, speech, and facial appearance.

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Things worth knowing about "Underbite"

An underbite is a jaw misalignment where the lower front teeth protrude in front of the upper front teeth. It can affect chewing, speech, and facial appearance.

What Is an Underbite?

An underbite (medically known as mandibular prognathism or Class III malocclusion) is a dental and skeletal condition in which the lower jaw (mandible) protrudes further forward than the upper jaw (maxilla). As a result, the lower front teeth sit in front of the upper front teeth when the mouth is closed. Underbites range from mild to severe and can affect children, teenagers, and adults alike.

Causes

An underbite can result from skeletal, dental, or habitual factors:

Genetics: A family history of jaw misalignment is one of the most common causes. An overly large lower jaw or an underdeveloped upper jaw can be inherited.
Skeletal causes: Excessive growth of the lower jaw (macrogenia) or insufficient growth of the upper jaw (maxillary hypoplasia) leads to a skeletal underbite.
Dental causes: Misaligned individual teeth without an underlying jaw discrepancy can create the appearance of an underbite.
Childhood habits: Prolonged thumb-sucking, pacifier use beyond age three, or chronic mouth breathing can interfere with normal jaw development.
Early tooth loss: Premature loss of baby teeth can alter the spacing and growth of the jaw.

Symptoms and Effects

The impact of an underbite varies depending on its severity:

Chewing difficulties: Proper breakdown of food can be impaired due to the misaligned bite.
Speech problems: Certain sounds may be difficult to pronounce, leading to unclear speech or a lisp.
Aesthetic concerns: The protruding lower jaw can significantly alter the facial profile and may affect self-confidence.
Jaw joint problems (TMD): Temporomandibular disorders including jaw pain, headaches, and muscle tension are common associated conditions.
Excessive tooth wear: Uneven bite forces can cause accelerated wearing down of the teeth.
Sleep-related breathing issues: In severe cases, an underbite may be associated with snoring or obstructive sleep apnea.

Diagnosis

An underbite is typically diagnosed during a dental or orthodontic examination:

Clinical examination: The dentist or orthodontist visually assesses the bite and jaw relationship.
Lateral cephalometric X-ray: A side-view skull X-ray allows precise measurement of jaw angles and positions through cephalometric analysis.
Dental impressions or 3D scans: Plaster models or digital scans of the teeth are used to plan treatment.
Panoramic X-ray (OPG): Provides an overview of all teeth, roots, and jaw bone structure.

Treatment

Treatment options depend on the patient's age, the severity of the underbite, and whether the cause is dental or skeletal:

Treatment in Children and Adolescents

Early intervention (around ages 6-10): Removable or fixed appliances such as a facemask (reverse pull headgear) or Frankel appliance can guide jaw growth during developmental years.
Fixed braces (brackets): Used to correct tooth positioning during the second phase of growth.
Palate expanders: Widen the upper jaw to improve the bite relationship.

Treatment in Adults

Orthodontic treatment: Traditional braces or clear aligners can address mild, dentally-caused underbites.
Orthognathic surgery: For pronounced skeletal underbites, surgical correction is required. This typically involves repositioning the lower jaw backward (mandibular osteotomy) and/or moving the upper jaw forward. Surgery is usually combined with orthodontic treatment before and after the procedure.
Dental restorations: In select cases, crowns or veneers may help improve the bite situation.

Prevention

Not all underbites can be prevented, especially those with a strong genetic basis. However, the following measures may help reduce risk:

Limiting pacifier use and thumb-sucking from an early age
Regular dental check-ups starting in infancy
Treating mouth breathing and ear, nose, and throat (ENT) issues promptly
Early orthodontic screenings during childhood

References

Proffit WR, Fields HW, Sarver DM: Contemporary Orthodontics. 6th edition. Elsevier, 2018.
World Health Organization (WHO): Oral Health. Fact Sheet. www.who.int/news-room/fact-sheets/detail/oral-health
American Association of Orthodontists (AAO): Underbite. www.aaoinfo.org

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