Underbites are usually genetic, which means that your toddler or child is unlikely to outgrow the condition even when his or her permanent teeth erupt. Moreover, the underbite will become increasingly noticeable as the permanent teeth get bigger during the adolescence growth spurt. At this point, the profile will appear more concave since the jaw and chin will be projected forward quite a bit.
This can lead to not only aesthetic concerns, but also a myriad of oral issues that cannot be corrected naturally without appropriate intervention by a skilled orthodontist using the right orthodontic appliances, or even surgery.
Generally, it’s important that you seek orthodontic treatment for an underbite at the earliest point possible, since most appliances can be used be used with children from the age of 7 years. At this point, the adult teeth have begun to set in, yet the jaw bone is still developing, making it easier to coax it into alignment. Nevertheless, it’s never too late to begin treatment for correcting an underbite or overbite.
Underbite correction without surgery
There are several ways to correct an underbite without surgery, especially for mild cases, and the most appropriate one will depend on the patient’s age and severity of their specific case. They include:
How to fix an underbite in a child
If the cause of your child’s underbite is the misalignment of their upper or lower front teeth, then your orthodontist may recommend the use of limited braces or a removable retainer to correct it. However, if the underbite is caused by excessive growth of the lower jaw, treatment is best achieved using a combination of a protraction facemask (reverse-pull head gear) and a rapid palatal expander.
As your child is still growing, these appliances make use of their natural growth potential to correct the underbite without the need for surgery in the future.
1. Reverse-pull head gear (facemask)
A “reverse-pull” face mask is a device that wraps around the child’s head and has metal bands attached to the upper back teeth. This appliance applies pressure to the upper jaw and pulls it outwards into position, and is typically used by patients who are less than 10-years of age. This device only needs to be worn when your child is at home, including when going to bed, so he/she doesn’t have to go to school with it. The exact amount of time that it should be worn will be discussed with your orthodontist.
The duration of treatment for underbite correction varies from six months to a year, depending on your child’s growth potential, the severity of the underbite, and how consistently they wear the head gear.
Younger patients have less mature bones, making it easier to grow the upper jaw. If the underbite is severe, it may take longer to correct. However, the most important factor for successful treatment is your child’s compliance, meaning their willingness to wear the appliance for at least 12-14 hours a day.
2. Upper jaw expander
An upper jaw expander is a wire-frame device that is fitted across the patient’s palate. It is widened every night by a small amount using a special key, causing the upper jaw to widen enough to meet the lower teeth. The expander is usually worn for one year and then replaced with a retainer.
3. The Franklle
The Franklle is a removable device that patients can easily use on their own, but recent studies have found that it does not help grow the upper jaw despite claims to the contrary. Rather, it corrects the underbite by moving the teeth, which is not the ideal method for treating a problem caused by inadequate jaw growth. It is important to use appliances that specifically address growth issues and not just mask the problem.
4. The chin cap
The chin cap appliance was once commonly used in the past, but it is now rarely used because recent studies have shown that it is not very effective in its claimed function of preventing further growth and protrusion of the lower jaw. Although it is not possible to stop the growth of the lower jaw, it is possible to encourage the upper jaw to move or grow to compensate for excessive lower jaw growth by using a facemask.
How to fix an underbite in teens and adults
If a patient is nearing puberty, using a head gear for treatment may not be very effective. Therefore, the orthodontist will closely monitor their development and choose the best course of action based on the growth pattern observed from year to year.
If the underbite is mild and stable, non-surgical treatment such as braces, Invisalign, or lingual braces may be suitable. However, moderate to severe underbites with significant lower jaw protrusion often require surgical treatment to achieve the desired outcome.
5. Traditional underbite braces
Traditional braces are an effective method for correcting underbites as they can be used in conjunction with elastics and headgear to realign the jaw. The downside of braces is their visibility, which may be a concern for some teens and adults. However, they work quickly and efficiently compared to other methods. Keep in mind that tooth extraction may be used in conjunction with braces for overcrowded teeth.
6. Invisalign or clear aligners
Invisalignis another treatment option for underbites, especially for adults. Invisalign uses clear, removable aligner trays to gradually move teeth into the desired position. An orthodontist creates a 3D image of the patient’s teeth to design the aligner trays. Treatment typically lasts about a year and may involve additional features like elastics to correct bite issues. Costs for Invisalign treatment vary significantly, ranging from $3,500-$8,000.
7. Tooth extraction
To address overcrowding that leads to an underbite, the extraction of lower premolars may be necessary. This procedure can alleviate pressure and assist the jaw in moving to its natural position. It’s usually a preliminary step before other treatments such as braces. Tooth extraction costs range from $75 to $300 per tooth.
8. Tooth reshaping
For mild cases of underbite where teeth do not fit properly in the mouth, your dentist might recommend tooth reshaping. It involves shaving and reshaping the bottom teeth and fitting veneers to the upper teeth. This procedure can realign how the jaw fits together. Tooth reshaping is a relatively painless treatment that only affects tooth enamel. It also reduces the risk of tooth decay.
Veneers can be used to improve the appearance of mild underbites, but they do not correct the actual bite or jaw alignment. They are thin porcelain shells that are attached to the front of teeth to change their size, shape, length, or color. The dentist can adjust the veneers to fit the patient’s smile. Veneers may be a good choice for those who are self-conscious about their underbite’s appearance. However, if the underbite causes dental or physical problems such as misalignment or discomfort, veneers are not a sufficient treatment option. More extensive treatments will be necessary in those cases.
10. Facelift dentistry
Facelift dentistry is a treatment method that focuses on correcting bite issues like underbite. It involves the use of JawTrac and VENLAY technology, which can help avoid the need for traditional orthodontic treatment and surgical procedures.
Facelift dentistry is intended for adult patients only and promises to correct underbite problems in just three weeks by utilizing electronic jaw tracking readings. These readings are based on the anticipated natural position of the jaw without any teeth misalignment. The cost of this treatment is usually $35,000 or more.
11. Underbite surgery options
Orthognathic jaw surgery is a treatment option for severe cases of underbite. The procedure involves realigning the upper and lower jaws to their optimal locations. The operation is known for its high predictability and low risk of complications. However, a referral from a specialized orthodontist is necessary for further treatment by a maxillofacial surgeon.
Early diagnosis of underbite by a knowledgeable orthodontist is crucial for successful and appropriate treatment. Oral surgeons with certification in the field can properly correct underbites.
One of the most common types of surgery performed for severe underbites is reshaping the jaw by extending the upper jaw or shortening the lower jaw. The correct contour of the jawbone can also be preserved through the use of wires, plates, or screws. Although surgery is effective, it does come with potential risks, including those associated with general anesthesia, the possibility of infection or bleeding complications, and the formation of scars.
Surgical correction options for severe underbites vary based on the form and alignment of the jaw. They include:
- Underbite surgery – It involves the extraction of some teeth to help alleviate the condition for those with an excessive number of teeth.
- Orthognathic jaw surgery – This is a procedure that involves separating the rear jaw from the front jaw and altering the front jaw for a better fit while moving the rear jaw into a better position. This procedure may be done as an outpatient or require a brief hospital stay, with full recovery taking up to a year.
- Le Fort III Osteotomy – This is a surgical procedure that requires a surgeon specializing in oral and maxillofacial reconstruction. The procedure involves bringing the entire face forward to correct the alignment of the jaw. The healing process typically takes the standard amount of time.
12. Corrective exercises for natural healing
Will your dental insurance cover underbite treatment?
Underbite treatment may be covered by dental insurance if it is deemed medically necessary by the insurance company. However, most dental insurance plans have a yearly coverage limit of $1,000 to $2,000, which may not be sufficient for extensive underbite treatment. If your underbite treatment is considered cosmetic, it is unlikely to be covered by insurance.
In rare cases, orthognathic surgery for underbite may be partially covered by medical insurance if it is causing airway issues like sleep apnea. However, most dental insurance plans do not cover facelift dentistry.
It is important to check with your dental office and insurance plan before undergoing any treatment to avoid unexpected costs. Every insurance plan and patient case is different, so make sure that you fully understand your coverage and potential out-of-pocket expenses.