An underbite affects more than the way your teeth look.
When the lower teeth or jaw sit in front of the upper, it can affect chewing, speech, and facial balance. In growing children, early treatment can redirect jaw development. In adults, specialist planning determines what correction is achievable.
What an underbite is and what causes it.
An underbite is a malocclusion where the lower front teeth sit in front of the upper front teeth when biting together. In orthodontic terms, this is classified as a Class III malocclusion. It can range from a mild dental discrepancy to a significant skeletal jaw imbalance.
The most common cause is a skeletal pattern where the lower jaw has grown proportionally larger or more forward than the upper jaw. This is largely genetic — underbites run strongly in families. Less commonly, an underbite can be dental in nature, where the teeth are angled in a way that creates the underbite appearance without a major jaw size difference.
Understanding whether an underbite is dental, skeletal, or a combination of both is essential because the treatment approach differs significantly. Dr Denize uses cephalometric X-rays and clinical analysis at the Claremont practice to make this distinction clearly.
Early treatment can change the trajectory of an underbite.
In children who are still growing, the jaw relationship is not yet fixed. This creates a window of opportunity to influence how the upper and lower jaws develop relative to each other.
Growth modification for underbites typically involves appliances that encourage the upper jaw to grow forward or restrain excessive lower jaw growth. A palatal expander may be used to widen a narrow upper jaw, and a reverse-pull headgear or protraction facemask can apply a gentle forward pull on the upper jaw during the growth years. This is specialist-level treatment that requires careful timing and monitoring.
Underbite correction when growth is complete.
Camouflage orthodontics
For mild to moderate underbites in adults, orthodontic camouflage involves moving the teeth to compensate for the underlying jaw discrepancy. The upper front teeth may be moved forward and the lower front teeth tilted back to achieve an acceptable bite relationship. This approach has limits — it works when the skeletal discrepancy is modest and the teeth can be moved enough to compensate.
Combined orthodontic and surgical correction
When the skeletal discrepancy is significant, orthodontics alone cannot achieve a stable or functional result. In these cases, Dr Denize works with oral and maxillofacial surgeons to plan a combined approach. Orthodontics aligns the teeth within each jaw, and orthognathic surgery repositions the jaws themselves. This is planned collaboratively from the outset and is where specialist orthodontic training is most important.
Honest assessment of what is achievable
Not every underbite can be fully corrected with orthodontics alone, and Dr Denize will explain this clearly at your consultation. Understanding the difference between what is possible with camouflage treatment versus what requires surgery is essential for informed decision-making. Patients from Dalkeith, Cottesloe, Swanbourne, and across Perth attend Claremont Orthodontics specifically because honest specialist assessment matters in complex cases.
Children with a noticeable underbite should see a specialist orthodontist early, while jaw growth can still be influenced.
Growth modification in children, camouflage orthodontics or surgical planning in adults — the approach depends on age and severity.
Specialist orthodontist, King's College London. Over 15 years managing underbites at Claremont Orthodontics.
Frequently asked questions about underbite treatment.
What causes an underbite?
An underbite is most commonly caused by a skeletal discrepancy — either the lower jaw has grown larger or more forward than the upper jaw, or the upper jaw is underdeveloped relative to the lower. Genetics plays a strong role, and underbites tend to run in families. In some cases, the underbite is dental rather than skeletal, meaning the teeth are angled in a way that creates the appearance of an underbite without a major jaw discrepancy. Dr Denize distinguishes between these at your Claremont consultation.
At what age should a child be assessed for an underbite?
Children with an underbite should be assessed by a specialist orthodontist by age seven, or earlier if the underbite is noticeable. Early assessment is particularly important for underbites because growth modification treatment works while the child is still growing — once growth is complete, the options narrow significantly. Families from Claremont, Nedlands, Subiaco, and across Perth's western suburbs bring their children for early assessment at our practice.
Can an underbite be fixed without surgery?
It depends on the severity. In growing children, growth modification appliances can often redirect jaw growth and reduce or resolve the underbite without surgery. In adults with a mild to moderate underbite, orthodontic camouflage — moving the teeth to compensate for the jaw discrepancy — may achieve an acceptable result. However, significant skeletal underbites in adults typically require combined orthodontic and surgical treatment for a stable correction. Dr Denize will explain what is realistic in your case.
How long does underbite treatment take?
Treatment duration varies considerably depending on the approach. Growth modification in children may involve 12 to 18 months of active appliance wear, sometimes followed by a later phase of braces. Comprehensive orthodontic treatment in teens or adults typically takes 18 to 30 months. Cases requiring surgical correction involve a longer overall timeline including pre-surgical orthodontics, the surgery itself, and post-surgical fine-tuning. Dr Denize provides a realistic timeline at your initial assessment.
What is a reverse-pull headgear?
A reverse-pull headgear, also called a protraction facemask, is an appliance used in growing children to encourage forward growth of the upper jaw. It attaches to the upper teeth or a palatal expander inside the mouth and applies a gentle forward pull via a frame that rests against the forehead and chin. It is typically worn in the evenings and overnight. While it requires consistent wear, it can be effective in reducing the severity of an underbite during the growth years.
Will my child need braces after growth modification treatment?
In many cases, yes. Growth modification treatment addresses the jaw relationship, but the individual tooth positions often need refining with braces or aligners once the permanent teeth have erupted. Think of it as two phases — the first manages the jaw, the second aligns the teeth. The advantage of early intervention is that the second phase is often simpler and shorter than it would have been without growth modification. Dr Denize plans both phases from the outset.
Worried about an underbite? Let's assess it properly.
Take our free 3-minute assessment or call our Claremont practice to arrange a consultation with Dr Denize. Underbites are always assessed by the specialist.