Buck Teeth Treatment UK

What causes buck teeth?

Buck teeth are clinically described as an increased overjet — the horizontal distance between the tip of the upper front teeth and the front surface of the lower front teeth when the back teeth are together. A normal overjet is 2 to 3 mm. An overjet above 4 mm is considered increased; above 6 mm is significantly increased. There are two broad causes. A dental overjet occurs when the upper incisors are tipped forward (proclined) or the lower incisors are tipped back, but the jaw bases are in a normal relationship. A skeletal overjet — the more complex scenario — results from an underdeveloped lower jaw (mandible), an overdeveloped upper jaw (maxilla), or a combination of both. Habits such as prolonged thumb sucking or dummy use beyond age 4 can create or worsen a dental overjet. Genetics significantly influences jaw size and relationship, making skeletal Class II malocclusion a largely inherited condition.

Measuring overjet and assessing severity

Your orthodontist measures overjet in millimetres using a ruler against the upper incisor edge. In addition to overjet, they will assess: the overbite (how much the upper teeth vertically overlap the lower), the lip competence (can the lips meet at rest without strain), the skeletal pattern (jaw relationship as assessed on x-ray), and the IOTN (Index of Orthodontic Treatment Need) score. An increased overjet is also associated with a higher risk of dental trauma — upper front teeth that protrude significantly are more likely to be knocked in accidents. This is a clinical reason, not just cosmetic, to treat in children.

Treatment in growing children and teenagers

In growing patients, the timing of treatment offers options that are not available in adults. If a skeletal contribution is identified — the lower jaw is underdeveloped — growth modification using functional appliances can be very effective. The twin block appliance is the most widely used in the UK: it consists of upper and lower removable bite blocks that posture the lower jaw forward, encouraging the condyle (jaw joint) to grow in a more forward position and the lower jaw to catch up with the upper. Treatment typically takes 9 to 12 months with a functional appliance, followed by a phase of fixed braces to detail tooth positions. The Herbst appliance is a fixed alternative that works on the same principle and does not rely on patient compliance for wear. For purely dental overjets in children, fixed braces alone — sometimes with upper premolar extractions to allow the upper front teeth to be retracted — can be very effective. NHS treatment is available for children with an IOTN score of 3.6 (DHC) or aesthetic component score of 2 or more, and a large overjet often scores highly.

Treatment in adults without surgery

In adults who have finished growing, functional appliances are no longer effective because growth modification is no longer possible. Treatment for a dental overjet in an adult typically involves fixed braces or clear aligners, with or without upper premolar extractions depending on the degree of crowding and how much retraction is required. Clear aligners can manage mild to moderate dental overjets effectively, but their ability to bodily retract multiple teeth is more limited than fixed braces. For moderate cases, the combination of attachments, elastic use, and sequential aligner tracking can produce very good results. Fixed braces remain the gold standard for larger overjets requiring significant tooth movement. Realistic expectations are important: aligners work best for overjets under approximately 4 to 5 mm in adults; above this, fixed braces are more reliable for predictable overjet reduction.

Jaw surgery for skeletal cases

When the overjet has a significant skeletal component in an adult who has finished growing, orthodontics alone can only partially address the problem — a process called dental camouflage. The orthodontist retracts the upper teeth and/or proclines the lower teeth to reduce the overjet, but the underlying jaw discrepancy remains. For patients with a large skeletal overjet, combined orthodontic and orthognathic (jaw) surgery gives the best functional and aesthetic outcome. The surgical procedure typically involves advancing the lower jaw (bilateral sagittal split osteotomy, BSSO) and sometimes setting back the upper jaw (Le Fort I osteotomy). Pre-surgical orthodontics — usually 12 to 18 months of fixed braces — prepares the teeth and may temporarily make the bite look worse before surgery. Recovery after jaw surgery is typically 6 to 8 weeks before normal eating resumes, with full bone healing over several months. NHS funding for orthognathic surgery is available for patients meeting clinical criteria, usually assessed by a maxillofacial surgeon.

NHS eligibility and costs

NHS orthodontic treatment for buck teeth is available to children under 18 if the IOTN score meets the threshold. A large overjet typically scores highly on the Dental Health Component (DHC): an overjet greater than 6 mm scores DHC 4, and an overjet greater than 9 mm scores DHC 5, both of which qualify for NHS treatment. Adults generally do not qualify for NHS orthodontics unless they meet specific medical exception criteria. Private fixed braces in the UK cost between £2,500 and £5,500 depending on complexity and location. Clear aligners typically range from £1,500 to £5,500. Functional appliance treatment followed by fixed braces may cost £4,000 to £6,000 privately. Jaw surgery through the NHS is free for eligible patients; privately it can cost £15,000 to £25,000 including orthodontics.

Risk of trauma to protruding teeth

Research consistently shows that children with an overjet greater than 6 mm are approximately twice as likely to suffer dental trauma as those with a normal overjet. Upper front teeth that protrude are more exposed and have less protection from the lips in the event of a fall or collision. This is a clinical reason for early treatment, separate from cosmetic concerns, and is factored into IOTN scoring. Patients with very large overjets should be advised to wear a mouthguard during sports even before treatment commences.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.