Dear Dr. Supan,

My son 15 y.o. has malocclusion with underbite on 1 side and overbite on the other side.  His lower jaw is moving to the underbite side.  I would like to know if malocclusion is the reason for his jaw deviated to the side or he was born with this trait that just developed later in his life. If malocclusion is the reason, are braces able to bring his lower jaw back?  
I upload the pictures of his teeth, please help me.  Thank you very much.

Best Regards,
Chi Phan



Dear Chi,

What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on your son 15 y.o. who has a malocclusion with underbite on 1 side and overbite on the other.

First of all Chi I want to thank you for sending the photos. They obviously were very helpful. The problem with  certain " crossbites. overbites, and underbites" is that they can be due to crooked teeth(malocclusion, mismatches in the size of the upper and lower jaws (skeletal discrepancies), or a combination of these two. Pictures of the bite are helpful, but do not allow the skeletal aspect of such a condition to be diagnosed. A cephalometric ( lateral ) radiograph, along with a panoramic radiograph are often the minimal records needed. In 2014 cone beam imaging as well as MRI technology are also employed.

Ok, given that at this point all I have is the photos to work with, I will offer the following limited comments for your consideration. You son it would appear has a crossbite that likely is largely skeletal in nature. The unilateral crossbite may be due in part to dental meshing of the teeth, but my impression is that your son has an overly large lower jaw relative to his upper jaw. This means that the lower jaw in larger both in the transverse (LEFT TO RIGHT). In addition, the lower jaw in the photos appears to be excessively large in an anterior/posterior manner as well. That is to say, from front to back, and therefore the reported front "underbite" as you termed it is developing.

For a 15 year old, there is still somewhat of an adolescent growth window remaining, and therefore these skeletal changes may yet continue. My recommendations as far as treatment would be to see an orthodontist and ask what your treatment options are, both with and with out surgery. Ideal outcomes may likely require surgery, but that is not to say that somewhat lesser, but nevertheless quite acceptable outcomes, could not be achieved non-surgically.

As you asked "  If malocclusion is the reason, are braces able to bring his lower jaw back?  
I upload the pictures of his teeth, please help me. ". Well in his case I believe there are significant skeletal as well as dental malocclusion factors. I do believe braces can help, and whether orthognathic surgery is absolutely needed or not is open for discussion, and will require more detailed diagnostic information.  As I said, this is a complex case, and I would recommend that you consult with an Orthodontist. Be prepared to undergo additional diagnostic procedures before a diagnosis can be made and treatment options presented.

Chi,I wish you the best for your son. Please scan through some of the older questions I have had on this very subject. I have covered it before regarding skeletal architecture imbalances of the upper vs lower jaw. And finally, thank you again for submitting the photos.  


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Paul Supan, DDS, MA, MPH


First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.


Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Available upon Request.

BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

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