When most people think about orthodontic treatment, they imagine straighter, more attractive teeth. Whilst aesthetics are certainly important, many orthodontic patients have a more fundamental problem that goes beyond appearance: their bite doesn’t work properly. Overbites, underbites, and crossbites aren’t just cosmetic concerns—they’re functional problems that can cause pain, premature tooth wear, jaw joint dysfunction, and long-term oral health complications.
At The London Smile Clinic in London’s West End, Dr Pratik Sharma—a GDC-registered Specialist in Orthodontics and Consultant at the Royal London Hospital—treats these complex bite problems regularly. His specialist training, hospital experience with severe skeletal discrepancies, and role collaborating with oral and maxillofacial surgeons provide the advanced diagnostic and treatment skills these challenging cases demand.
In this comprehensive guide, we’ll explore the three main types of bite problems, their causes and health implications, and how specialist orthodontic expertise makes the critical difference in achieving functional, stable, long-term correction.
Understanding Malocclusion: What Is a “Bite” and Why Does It Matter?
Before exploring specific bite problems, it’s important to understand what orthodontists mean by your “bite” and why it’s so crucial for both health and function.
What is occlusion?
Occlusion refers to how your upper and lower teeth come together when you close your mouth. In an ideal bite:
- Upper teeth sit slightly in front of and overlap the lower teeth
- The pointed cusps of your upper teeth fit into the grooves of your lower teeth
- Your bite distributes chewing forces evenly across all teeth
- Your jaw joints (temporomandibular joints or TMJs) function smoothly without strain
What is malocclusion?
Malocclusion means “bad bite”—when teeth don’t fit together properly. This can involve:
- Incorrect positioning of upper teeth relative to lower teeth (overbite, underbite)
- Side-to-side misalignment (crossbite)
- Gaps or crowding that prevent proper tooth contact
- Jaw size discrepancies that create skeletal imbalance
Why does malocclusion matter?
Beyond aesthetics, bite problems cause genuine functional and health issues:
- Uneven tooth wear: Certain teeth bear excessive force, leading to premature wear, chipping, or fractures
- TMJ dysfunction: Improper bite relationships strain jaw joints, causing pain, clicking, headaches, and restricted movement
- Difficulty chewing: Severe bite problems affect your ability to chew food efficiently, potentially impacting nutrition
- Speech problems: Some malocclusions affect tongue positioning and articulation
- Increased decay and gum disease risk: Bite problems often coincide with crowding or spacing that makes cleaning difficult
Dr Pratik Sharma’s specialist training includes comprehensive study of craniofacial growth, development, and function. This enables him to assess not just where your teeth are positioned, but whether your bite relationship is functionally healthy for long-term oral health.
Overbite (Class II Malocclusion): When Upper Teeth Protrude
An overbite—clinically termed a Class II malocclusion—occurs when the upper front teeth significantly overlap or protrude beyond the lower front teeth. This is one of the most common bite problems.
What causes an overbite?
- Genetic jaw size discrepancy: Upper jaw is proportionally larger or positioned further forward, or lower jaw is smaller or positioned further back
- Childhood habits: Prolonged thumb sucking or dummy use can push upper teeth forward
- Tongue thrust: Habit of pushing tongue against front teeth during swallowing
- Missing lower teeth: Loss of lower back teeth allows remaining teeth to drift, affecting bite relationship
Types of overbites:
Dental overbite: Teeth are tilted or positioned incorrectly, but jaw sizes and positions are normal. This can typically be corrected with orthodontics alone.
Skeletal overbite: The upper jaw is genuinely positioned too far forward relative to the lower jaw (or the lower jaw is too far back). This requires more sophisticated treatment planning.
Health problems caused by overbites:
- Upper front teeth may bite into the gum tissue behind lower teeth, causing damage
- Lower teeth may wear excessively on their biting edges
- Lips may not close comfortably, leading to dry mouth
- TMJ strain from the lower jaw being positioned too far back
- Increased risk of upper front teeth being damaged in trauma (they protrude and are vulnerable)
How Dr Sharma corrects overbites:
Treatment depends on whether the overbite is primarily dental or skeletal, and the patient’s age.
For dental overbites or mild skeletal overbites:
- Strategic use of elastics (rubber bands) between upper and lower braces to guide teeth into proper relationship
- Functional appliances that encourage lower jaw growth in growing children and teenagers
- Careful tooth positioning and bite mechanics with Invisalign, lingual braces, or fixed braces
- Sometimes strategic extractions to allow upper teeth to move back
For severe skeletal overbites in adults:
- Orthodontics alone may still achieve significant improvement through tooth positioning compensation
- Some severe cases require combined orthodontic-surgical treatment (orthognathic surgery) where an oral surgeon repositions the jaw bones
Dr Sharma’s dual role as a specialist practitioner and hospital consultant means he regularly treats the full spectrum—from straightforward dental overbites to complex skeletal cases requiring surgical collaboration. His experience enables accurate diagnosis of whether your case can be treated with orthodontics alone or requires surgical intervention.
Underbite (Class III Malocclusion): When Lower Teeth Protrude
An underbite—clinically termed a Class III malocclusion—occurs when the lower front teeth sit in front of the upper front teeth when you bite together. This creates a characteristic “bulldog” facial profile and represents one of the most challenging orthodontic problems to treat.
What causes an underbite?
- Genetic jaw size discrepancy: Lower jaw is proportionally larger or positioned further forward, or upper jaw is smaller or positioned further back
- Hereditary component: Underbites often run in families and are more common in certain ethnic groups
- Childhood development: Sometimes results from abnormal jaw growth patterns during development
Types of underbites:
Dental underbite (pseudo Class III): Lower teeth are tilted forward or upper teeth tilted back, but jaw sizes are normal. Can usually be corrected orthodontically.
Skeletal underbite (true Class III): The lower jaw is genuinely too large or positioned too far forward relative to the upper jaw. More complex to treat.
Health problems caused by underbites:
- Difficulty biting and chewing food properly
- Speech difficulties, particularly with certain sounds
- Excessive wear on front teeth due to abnormal contact
- TMJ problems from abnormal jaw relationship
- Self-consciousness about facial profile and appearance
- Strain on front teeth which aren’t designed to bear heavy chewing forces
How Dr Sharma corrects underbites:
Underbites are among the most challenging bite problems, and treatment success depends heavily on early, accurate diagnosis and specialist expertise.
For dental underbites or mild skeletal underbites:
- Orthodontic mechanics to tip teeth into improved positions
- Strategic use of elastics to guide bite relationship
- Sometimes reverse-pull headgear in growing children to encourage forward upper jaw growth
- Careful treatment planning to achieve stable results
For moderate to severe skeletal underbites:
- In growing children and teenagers, functional appliances combined with braces can sometimes influence jaw growth
- In adults with significant skeletal discrepancy, combined orthodontic-surgical treatment is often necessary
- Pre-surgical orthodontics positions teeth optimally, then oral surgeon repositions jaw bones, then post-surgical orthodontics refines the result
Dr Sharma’s hospital consultant role at the Royal London Hospital involves close collaboration with oral and maxillofacial surgeons on precisely these complex cases. He’s experienced in both non-surgical orthodontic approaches and the coordinated care required for combined orthodontic-surgical treatment.
His research background—including awards from the American Journal of Orthodontics and the British Orthodontic Society—reflects his engagement with the cutting edge of knowledge about treating challenging Class III cases.
Crossbite: When Teeth Meet Incorrectly Side-to-Side
A crossbite occurs when one or more upper teeth bite on the inside of the lower teeth rather than the outside. This can affect the front teeth, back teeth, or both, and can involve one side or both sides of the mouth.
What causes crossbites?
- Narrow upper jaw: The most common cause—upper jaw is too narrow relative to lower jaw
- Dental tipping: Individual teeth tipped into incorrect positions
- Delayed tooth eruption: Upper teeth erupting late, allowing lower teeth to erupt into their space
- Childhood habits: Prolonged thumb sucking can affect jaw width
- Genetics: Jaw size discrepancies often have hereditary components
Types of crossbites:
Anterior crossbite: One or more upper front teeth bite behind lower front teeth (like a localized underbite)
Posterior crossbite: Upper back teeth bite inside lower back teeth, often affecting one side more than the other
Unilateral vs bilateral: Crossbite affecting one side only (unilateral) often causes the jaw to shift to one side, creating functional asymmetry
Health problems caused by crossbites:
- Asymmetrical jaw growth in children—if jaw shifts to one side repeatedly, that side can overdevelop
- Excessive, uneven tooth wear
- Gum recession on affected teeth due to abnormal forces
- TMJ problems from chronic jaw shifting or asymmetry
- Difficulty chewing efficiently
- Increased risk of tooth fracture from abnormal force directions
How Dr Sharma corrects crossbites:
Crossbites often benefit from early intervention, but can be successfully treated at any age.
For narrow upper jaw (skeletal crossbite):
- In growing children/teenagers: Palatal expansion using appliances that gradually widen the upper jaw by stimulating growth at the mid-palatal suture
- In adults: More limited expansion possible orthodontically; some severe cases require surgical expansion
For dental crossbites:
- Strategic tooth movement using braces or aligners
- Careful bite mechanics to ensure teeth move into stable positions
- Sometimes selective tooth reshaping to optimize tooth contact
For unilateral crossbites with jaw shift:
- Correction of the crossbite often eliminates the jaw shift, allowing symmetric function
- Earlier treatment is beneficial to prevent asymmetric jaw growth
Dr Sharma’s specialist training includes understanding the critical difference between dental and skeletal crossbites, and the growth implications of untreated crossbites in children. His comprehensive diagnostic approach—including detailed clinical examination and cephalometric analysis—ensures accurate identification of the underlying cause and appropriate treatment planning.
Dental vs Skeletal Bite Problems: Why Accurate Diagnosis Matters
One of the most important distinctions in treating bite problems is determining whether they’re primarily dental (tooth position problems) or skeletal (jaw size or position problems). This distinction fundamentally changes the treatment approach and achievable outcomes.
Dental bite problems:
- Teeth are tipped, rotated, or positioned incorrectly
- Underlying jaw sizes and positions are normal
- Can typically be corrected with orthodontics alone
- Treatment is relatively straightforward with predictable outcomes
Skeletal bite problems:
- Jaw sizes are disproportionate (one jaw too large or small relative to the other)
- Jaw positions are abnormal (one jaw too far forward or back)
- More complex to treat—may require orthodontic compensation or combined orthodontic-surgical treatment
- Treatment planning requires sophisticated understanding of facial growth and biomechanics
Why specialist expertise matters for this distinction:
General dentists with limited orthodontic training may struggle to accurately diagnose whether a bite problem is dental or skeletal. This can lead to:
- Inappropriate treatment that addresses symptoms but not the underlying problem
- Unstable results that relapse because the root cause wasn’t corrected
- Missed opportunities for growth modification in younger patients
- Delays in referring for surgical consultation when it’s genuinely necessary
Dr Pratik Sharma’s three years of full-time specialist training included extensive study of craniofacial growth, skeletal analysis, and treatment planning for complex cases. His Master’s degree research contributes to the academic evidence base on these precise diagnostic and treatment questions.
How Dr Sharma Diagnoses Bite Issues
Accurate diagnosis is the foundation of successful bite correction. Dr Sharma’s comprehensive diagnostic approach ensures nothing is missed.
The diagnostic process includes:
Clinical examination:
- Assessment of how your teeth come together in all directions
- Evaluation of jaw joint function and any clicking, pain, or restricted movement
- Observation of facial proportions and symmetry
- Analysis of tooth wear patterns that indicate abnormal forces
Photographic records:
- Detailed photographs from multiple angles document your bite relationship and facial profile
- Before treatment photos enable monitoring of progress and comparison to final results
Radiographic analysis:
- Cephalometric X-rays: Side-view X-rays of your skull enable precise measurement of jaw positions, angles, and proportions
- Panoramic X-rays: Show all teeth and jaw structures, revealing any hidden problems
- 3D CBCT scans: For complex cases, three-dimensional imaging provides detailed anatomical information
Study models or digital scans:
- Precise reproduction of your teeth and bite allows detailed analysis and treatment planning
Cephalometric analysis:
This sophisticated diagnostic tool involves tracing a lateral skull X-ray and measuring specific angles and distances to determine:
- Whether your jaw sizes are proportionate
- How your upper and lower jaws are positioned relative to your skull base
- The inclination of your teeth
- Your facial profile characteristics
Dr Sharma’s specialist training includes advanced cephalometric analysis skills that enable him to quantify precisely whether your bite problem is dental, skeletal, or a combination, and to predict how treatment will affect your facial profile.
This diagnostic rigour, characteristic of specialist-level care, ensures treatment addresses the underlying cause rather than merely camouflaging symptoms.
Treatment Approaches: Orthodontics Alone vs Combined Orthodontic-Surgical Treatment
One of the most important treatment planning decisions for bite problems is determining whether orthodontics alone can achieve an acceptable result, or whether combined treatment with oral surgery is necessary.
When orthodontics alone is appropriate:
- Dental bite problems where tooth positions are the primary issue
- Mild to moderate skeletal discrepancies where tooth positioning can compensate adequately
- Patients who are still growing (children/teenagers) where growth modification may help
- Patients who decline surgery and accept the limitations of orthodontic compromise
When combined orthodontic-surgical treatment is recommended:
- Severe skeletal discrepancies where jaw sizes or positions are significantly abnormal
- Cases where orthodontic compensation alone would create unstable or compromised results
- Patients with functional problems (severe chewing difficulty, sleep apnoea related to jaw position) requiring skeletal correction
- Patients who desire optimal facial profile improvement in addition to bite correction
How combined treatment works:
Combined orthodontic-surgical treatment (orthognathic surgery) involves three phases:
- Pre-surgical orthodontics (12-18 months): Dr Sharma positions teeth to prepare for surgery, often making the bite look temporarily worse to enable surgical correction
- Surgery (performed by oral surgeon): Jaw bones are cut and repositioned to correct the skeletal discrepancy
- Post-surgical orthodontics (6-12 months): Dr Sharma refines tooth positions and bite relationship to perfect the result
Dr Sharma’s role as a hospital consultant at the Royal London Hospital involves regular collaboration with oral and maxillofacial surgeons on these complex cases. This experience is invaluable—he understands surgical capabilities and limitations, can explain the combined treatment process clearly, and coordinates care seamlessly.
His established relationships with leading oral surgeons in London ensure that when surgery is genuinely necessary, patients receive coordinated, expert care across both specialities.
Why Specialist Training Is Crucial for Bite Correction
Bite correction represents some of the most complex orthodontic treatment. Several factors make specialist training crucial for optimal outcomes:
Diagnostic sophistication: Accurately differentiating dental from skeletal problems requires advanced training in cephalometric analysis and facial growth patterns
Biomechanics expertise: Correcting bite relationships requires precise understanding of the forces and directions needed to move teeth into functional positions
Growth modification knowledge: In growing patients, specialists understand how to harness or modify jaw growth—opportunities that general dentists may miss
Stability considerations: Bite corrections must be stable long-term. Specialists understand which tooth positions will remain stable and which will relapse
Surgical coordination: For cases requiring surgery, specialists have the training and professional relationships to coordinate complex interdisciplinary care
Dr Pratik Sharma’s credentials—GDC-registered Specialist in Orthodontics, hospital consultant, university lecturer, award-winning researcher—represent the highest level of training and expertise in this field. When you’re addressing a functional bite problem that affects your oral health and quality of life, specialist expertise isn’t luxury—it’s necessity.
Long-Term Benefits of Proper Bite Correction
Correcting bite problems delivers benefits that extend far beyond aesthetics and last for decades:
Oral health benefits:
- Even distribution of chewing forces protects all teeth from excessive wear
- Improved ability to clean properly aligned teeth reduces decay and gum disease risk
- Reduced risk of tooth fracture from abnormal forces
- Protection of existing dental work (crowns, fillings) from premature failure
Functional benefits:
- Improved chewing efficiency supports better nutrition
- Reduced or eliminated TMJ pain and dysfunction
- Improved speech clarity in some cases
- Comfortable, strain-free jaw function
Quality of life benefits:
- Relief from chronic headaches or jaw pain related to bite problems
- Confidence in your smile and facial appearance
- Investment in your long-term oral health
The London Smile Clinic’s industry-exclusive 10-year guarantee on cosmetic dentistry reflects confidence in results—bite corrections achieved by Dr Sharma remain stable when proper retention protocols are followed.
Your Bite Deserves Specialist Expertise
Bite problems—overbites, underbites, and crossbites—are complex orthodontic issues that affect both function and health. These cases demand accurate diagnosis, sophisticated treatment planning, and specialist-level expertise to achieve optimal, stable, long-term correction.
At The London Smile Clinic, Dr Pratik Sharma’s credentials as a GDC-registered Specialist in Orthodontics, his hospital consultant experience treating severe skeletal cases, his collaborative relationships with oral surgeons, and his patient-centred approach provide the comprehensive expertise complex bite problems require.
Whether your bite issue is primarily dental or skeletal, whether it requires orthodontics alone or combined treatment with surgery, specialist consultation provides clarity, accurate diagnosis, and expert treatment planning.
Don’t ignore bite problems that could affect your long-term oral health and quality of life. Book a specialist consultation with Dr Pratik Sharma at The London Smile Clinic today. Call the West End practice or visit the website for expert diagnosis and treatment of complex bite issues. Your functional, healthy bite is too important to entrust to anyone less than a specialist.
