UNDERBITE TREATMENT – QUEENS, NY

What Is an Underbite?

An underbite, clinically referred to as a Class III malocclusion, occurs when the lower teeth protrude in front of the upper teeth when the mouth is closed. In a normal bite, the upper front teeth sit slightly in front of and over the lower front teeth. In an underbite, this relationship is reversed: the lower jaw is positioned forward of the upper, causing the lower teeth to overlap the uppers.

The degree of underbite varies considerably. Mild cases involve just a few teeth out of position, with minimal jaw discrepancy. Moderate and severe underbites involve a more significant forward position of the lower jaw relative to the upper, affecting facial appearance, chewing function, and long-term joint health.

One important distinction: some patients appear to have an underbite because the upper jaw is underdeveloped or the upper teeth are tipped back — rather than because the lower jaw is truly too large or too far forward. This distinction matters significantly for treatment planning. An accurate diagnosis identifies which jaw (or combination of jaws) is actually contributing to the problem.

What Causes an Underbite?

Underbites develop from a combination of genetic and environmental factors, with genetics playing a particularly strong role:

• Genetics — The most common cause. Lower jaw size and the position of the jaws relative to each other are largely inherited. Underbites often run in families and can range from mild to severe depending on how the jaw genes express themselves.
• Lower jaw overgrowth — In some patients, the lower jaw (mandible) grows more than the upper jaw, causing it to protrude forward over time. This type of underbite tends to worsen during adolescent growth spurts, making early evaluation and monitoring especially important.
• Upper jaw underdevelopment — When the upper jaw (maxilla) doesn't grow forward enough, the lower jaw can appear to protrude — even if the lower jaw itself is a normal size. Treatment in these cases may focus on encouraging forward development of the upper jaw rather than restraining the lower.
• Dental factors — In some cases, the underbite is primarily dental rather than skeletal: individual teeth are tipped or positioned in a way that creates the appearance of an underbite without a true jaw discrepancy. These cases are often more straightforward to treat orthodontically.
• Premature loss of baby teeth — Losing upper baby teeth early can allow upper teeth to shift in ways that create a reversed bite position in specific areas.
• Habits and soft tissue pressure — Prolonged tongue thrusting or abnormal posture habits can contribute to tooth position changes that affect the bite relationship.

Why Underbites Worsen Over Time — Especially Without Treatment

Unlike some bite problems that remain relatively stable, underbites with a skeletal component tend to worsen during periods of active growth — particularly during the adolescent growth spurt, which typically occurs between ages 11–14 in girls and 13–16 in boys. During this period, the lower jaw often grows more than the upper, and an underbite that was mild in a younger child can become significantly more pronounced by the late teens.

This progression is one of the most important reasons underbites warrant early evaluation. The window to use growth-modifying appliances — which work with the developing jaw to correct the relationship before it sets — is limited. Once growth is complete, the jaw discrepancy is fixed and can only be addressed orthodontically (with some compromise) or surgically.

Why Underbites Shouldn't Be Left Untreated

Beyond aesthetics, an untreated underbite carries meaningful functional and health consequences:

• Chewing difficulty — A reversed bite makes it harder to bite and chew food efficiently. Patients often adapt by shifting the jaw to one side, which can create asymmetric wear patterns and muscle imbalances over time.
• Accelerated tooth wear — The front teeth bear bite forces they're not designed to handle when the bite is reversed. This causes premature enamel wear, particularly on the upper front teeth.
• Jaw pain and TMJ strain — The temporomandibular joint functions under abnormal stress when the bite is misaligned. Chronic jaw pain, clicking, limited opening, and headaches are more common in patients with significant underbites.
• Speech difficulties — The relationship between the upper and lower teeth affects how certain sounds are produced. Some patients with underbites develop lisps or difficulty with specific consonants.
• Facial appearance — A protruding lower jaw affects the lower third of the face, the chin profile, and lip posture in ways that become more pronounced as the underlying discrepancy grows.
• Progressive worsening — As described above, skeletal underbites tend to become more severe during growth — meaning that mild problems in young children can become moderate or significant problems in teenagers if not addressed.

Underbite Treatment Options at SimpliBraces

The right treatment for an underbite depends on the patient's age, the severity of the bite discrepancy, and whether the underlying cause is dental, skeletal, or both. Dr. Yelizar evaluates all of these factors before making any recommendation.

Facemask (Reverse Pull Headgear) — for Young Children

The facemask is the most effective early intervention for underbites caused by an underdeveloped upper jaw in growing children, typically between ages 7–10. It applies gentle forward traction to the upper jaw using a frame that rests against the forehead and chin, pulling the upper jaw forward while allowing the lower jaw to remain in its natural position. Research consistently shows this approach is significantly more effective in younger children — before the sutures of the upper jaw begin to fuse — than in older patients. It is worn at home for a prescribed number of hours per day, typically 12–14 hours.

Palate Expansion

In patients where the upper jaw is narrow in addition to being underdeveloped, palate expansion is often used alongside or before facemask therapy. Widening the upper arch creates more room for the upper teeth and can improve the bite relationship as part of an overall growth modification approach.

Functional Appliances — for Growing Tweens and Teens

For older growing patients — typically ages 10–14 — functional appliances can be used to influence jaw growth and improve the bite relationship before the growth window closes. The specific appliance depends on the nature of the underbite, and Dr. Yelizar will recommend the approach most appropriate for the patient's growth stage and the severity of the discrepancy.

Braces and Clear Aligners — for Dental Underbites and Post-Growth Correction

For underbites that are primarily dental — where individual teeth are tipped or positioned in a way that creates the reversed bite without a true jaw discrepancy — braces or clear aligners can reposition the teeth to correct the bite relationship. This approach is effective for dental underbites at any age. For patients who have completed growth and have a skeletal component to their underbite, orthodontic treatment alone can improve the bite and appearance significantly, though the jaw relationship itself cannot be changed without surgery. Learn more about braces. Learn more about clear aligners.

Orthognathic Surgery — for Severe Skeletal Cases in Adults

When an adult has a significant skeletal underbite — a true jaw size or position discrepancy — orthodontic treatment alone can improve the bite but cannot fully correct the underlying jaw relationship. In these cases, orthognathic (jaw) surgery performed by an oral and maxillofacial surgeon, coordinated with orthodontic treatment, can achieve what braces or aligners cannot. Dr. Yelizar will be direct about when surgery may be the only path to a fully corrected bite, and when orthodontic treatment alone can produce a result the patient will be satisfied with.

The Case for Early Evaluation

Of all the bite problems treated in orthodontics, underbites are among the most time-sensitive. The earlier a skeletal underbite is identified, the more options are available — and the simpler and less invasive the treatment tends to be. A facemask used at age 8 can sometimes achieve a correction that would require surgery at age 22.

This is why the American Association of Orthodontists recommends a first evaluation by age 7. It doesn't mean treatment starts then — it means that if an underbite is developing, there's still time to do something about it that works with the body's natural growth rather than against it.

Why Choose SimpliBraces for Underbite Treatment in Queens?

Underbites require more nuanced diagnosis and treatment planning than most bite problems. The cause — dental versus skeletal, upper jaw versus lower jaw — determines the treatment, and getting that assessment wrong leads to approaches that don't address the real issue.

Dr. Yelizar evaluates every underbite with a full clinical picture: digital scans, bite analysis, jaw relationship assessment, and a frank conversation about what's driving the problem and what can realistically be achieved. He doesn't recommend surgery unless it's genuinely necessary, and he doesn't recommend early treatment unless there's a clear growth window to take advantage of. What he does do is give you an honest picture — so you can make informed decisions without pressure.

Our office is located at 63-109 Saunders St #BA2, Rego Park, NY 11374, and we serve patients from Rego Park, Forest Hills, Kew Gardens, Elmhurst, Corona, and across Queens.

Schedule Your Underbite Consultation

Whether you're a parent concerned about your child's bite or an adult who has lived with an underbite and wants to explore your options, contact SimpliBraces to schedule a consultation. Dr. Yelizar will evaluate your bite thoroughly, tell you exactly what he sees, and walk you through what treatment can achieve for your specific case.