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When does an underbite need surgery? The short answer is: when Dr. Pack and our team recommend surgery as the best way to give you a healthy, functional bite. But let’s take a longer look, and see just why your doctors might come to that conclusion.

• First, what exactly is an underbite?

In a perfect bite, the upper and lower jaws align, well, perfectly. Upper teeth overlap lower teeth very slightly, upper and lower teeth meet comfortably, and jawbones and joints function smoothly. When the alignment is off, it causes a malocclusion, or “bad bite.”

When we talk about an underbite, or Class 3 malocclusion, it means that the lower jaw protrudes further than the upper jaw. This protrusion causes the bottom teeth and jaw to overlap the upper teeth and jaw.

• What causes an underbite?

Sometimes an underbite is caused by childhood behaviors while the teeth and jaw are developing, including tongue thrusting or prolonged thumb-sucking and pacifier use. (Working to stop these behaviors before they affect tooth and jaw formation is one of the many good reasons children should have regular visits with their dentists and pediatricians.)

Most underbites are genetic, however, and tend to run in families. It’s estimated that from five to ten percent of the population has some form of underbite. The lower jawbone (mandible) might be overdeveloped, the upper jawbone (maxilla) might be underdeveloped, both bones could be affected, or, sometimes, tooth size and placement might cause an underbite. These irregularities in jaw shape and size and/or tooth crowding are not something that can be prevented, and require professional treatment.

• Why? What’s the problem with an underbite?

Even a minor underbite can cause difficulties with biting and chewing. A more severe underbite can lead to speech problems, decay and loss of enamel where the teeth overlap, mouth breathing and sleep apnea, persistent jaw and temporomandibular joint pain, and self-confidence issues.

• Can’t my dentist treat my underbite?

Most probably not. A very mild underbite can be camouflaged cosmetically with veneers, but this does not address the cause of the underbite, and will not work for moderate or severe underbites.

• Can my orthodontist treat my underbite?

Dr. Pack will create an underbite treatment plan after a detailed study of each patient’s individual dental and skeletal structure. Treatment options will vary depending on the cause of the underbite, its severity, and even the patient’s age.

Early intervention is especially important for children who show signs of an underbite. That’s why we recommend that children visit our Murfreesboro, TN office by the age of seven.

If an underbite is caused by tooth misalignment or crowding, braces can reposition the lower teeth. Sometimes extractions are necessary to make room for proper alignment.

If the cause is due to jaw structure, children’s bones are still forming, so treatment can actually help correct bone development. Palatal expanders, headgear, and other appliances are various methods of encouraging and guiding bone development.

But braces and appliances aren’t effective for every patient with an underbite, and especially in patients (usually those in their late teens and older) when the jawbones are already fully formed. In this case, we might suggest coordinating treatment with an oral and maxillofacial surgeon.

• What does an oral and maxillofacial surgeon do?

An oral surgeon has the training, experience, and skill to help correct an underbite by surgically reshaping and repositioning the jawbone. This corrective jaw surgery is called orthognathic surgery.

• What will happen during orthognathic surgery?

Your treatment will be tailored to your specific needs. Two of the common surgical procedures for treating an underbite involve repositioning the upper jaw to lengthen it and/or reshaping the lower jaw to shorten it.

Bone is sometimes removed or added, small bone plates or screws are sometimes used to stabilize the bone after surgery—your surgeon will let you know exactly which procedures will give you a healthy, functional bite. The surgery itself is most often performed under general anesthesia and requires a brief stay in the hospital.

• How will my orthodontist and oral surgeon coordinate my treatment?

Correcting a Class 3 malocclusion can take time. Your oral surgeon will work together with Dr. Pack to analyze the interrelationship of teeth, bones, and joints to determine dental and skeletal problems, and will develop the best treatment plan possible to create a healthy alignment.

• So, when does an underbite need surgery?

Sometimes, a minor underbite can be corrected with braces and appliances alone. A serious underbite, however, will often require the specialized skills of both Dr. Pack and an oral surgeon.

And, while it’s not the primary purpose of surgery, corrective jaw surgery and orthodontics can also make you happier with your appearance and boost your self-confidence. Achieving a lifetime of beautiful, comfortable, and healthy smiles—that’s the answer to your question.

Most kids love candy; actually, most people in general love candy. So when it comes time for you to get braces there can often be a natural conflict between candy consumption and maintaining the integrity of your braces. For that reason, Dr. Pack and our team know that it’s good to know which types of candy are not good for your braces. To better illustrate, here are some candies that you will want to avoid.

Caramel

Caramel is a sweet and often exceedingly sticky and chewy type of candy that just does not mix well with braces. Caramel can cause a mess in regular teeth, but teeth with braces are a whole other story. The sticky candy can very easily get lodged and stuck between the teeth, gums, and braces, making for a difficult task of cleaning your mouth. And if your teeth don't get cleaned properly, cavities can easily form. If you get cavities while you have braces, that could mean additional appointments at our Murfreesboro, TN office and an extended treatment time.

Salt Water Taffy

Another sticky and chewy candy to avoid with braces is salt water taffy. For many of the same reasons as caramel, it is best to avoid taffy until you get your braces removed. It may be a long wait, but when it comes to the health of your teeth, and the purpose of your braces, it really is best to avoid taffy.

Popcorn

Popcorn of any kind is best to avoid when you have braces. The kernels can easily do damage to the braces as you chomp on them, and they can get stuck between your teeth and the braces causing discomfort and further complications. In this sense it does not matter which flavor of candy popcorn you eat, all popcorn is bad news until you get your braces off.

Generally speaking, any candy that is chewy, crunchy, or sticky is not a good idea to eat with braces in your mouth. These types of candy will make life wearing braces much more difficult than if you were to just wait until your braces come off. With a little patience you will be back to eating all your favorite candy again, and with straightened teeth at that.

October 31—Halloween. Fourth Thursday in November—Thanksgiving. And, in between these two favorite autumn holidays, we have November 1—National Brush Day!

Okay, okay. Maybe National Brush Day isn’t quite as well-known as Halloween or Thanksgiving, but we take any opportunity to celebrate your dental health. So, let’s celebrate brushing!

After all, brushing is vital for healthy teeth and gums.

• Brushing is your first line of defense against plaque. Plaque forms all day long. Plaque sticks to your teeth. Plaque is filled with bacteria which produce cavity-causing acids. Brushing regularly means plaque won’t stay on your teeth long enough to cause serious tooth decay.
• Brushing effectively is especially important while you wear braces. Plaque collects around brackets and can cause enamel discoloration if it’s allowed to build up.
• Brushing is also important for your gum health. Angling your brush to carefully clean plaque and bacteria away from your gum line helps prevent gum disease.

To make the most of the time you spend brushing, let’s take a moment to review some basics on National Brush Day.

Are You Brushing Correctly?

• Big, broad brushstrokes aren’t the answer. Instead, use short up-and-down or circular strokes over each tooth—outside, inside, and on the flat surfaces of your molars.
• Because plaque forms all day, you need to keep on top of it. Brushing at least twice a day for two minutes each time is a good general rule, but doesn’t always hold true during orthodontic treatment.
  • If you wear braces, Dr. Pack will probably recommend brushing after each meal or snack to make sure plaque and food particles don’t stick to your teeth and your braces.
  • Take advantage of the special orthodontic brushes that are available if your old brush isn’t cleaning your braces (and your teeth!) as well as you’d like. A brush with a smaller head or different shaped bristles might make all the difference.
  • If you have aligners, you take them out to eat. It’s always a good idea to brush before you replace them. Otherwise, food particles which would normally be brushed away or washed away by saliva are trapped next to your teeth.
• Brushes are meant to clean, not to scrub. You don’t need a heavy hand for cleaner teeth.
• Which also means, there’s almost never a good time to brush with a hard-bristled brush. Hard bristles, along with hard brushing, can actually damage your enamel. Stick to a soft-bristled brush for dental TLC.

Are You Taking Care of Your Brush?

• To clean away bacteria and viruses you might have picked up during the day, wash your hands before brushing and flossing.
• Shake your brush dry when you’re finished and then let it air-dry upright with the handle pointing down. Only use a case for travel, and make sure it has air holes for ventilation. (Bacteria thrive in a wet environment.)
• If your toothbrush lives in the bathroom, close the toilet seat before flushing to avoid airborne particles.
• No matter how close you are to your family members or roommates, don’t share your toothbrush. Sharing doesn’t mean caring in this case—it means sharing germs. Your brush should keep a healthy distance from other brushes as well.
• And no matter how fond you are of your brush, be prepared to replace it often! Most brushes last three to four months at best, because bristles start to fray and can’t clean effectively after several months of use.

It’s no coincidence that National Brush Day comes right after Halloween, the most sugar-filled holiday of them all. So, how can we mark the occasion?

Take a moment to review your brushing habits. Check out the brushes designed for orthodontic treatment. Treat yourself to a new toothbrush. Brushing your teeth properly is one of the easiest things you can do to protect your oral health. That’s something to celebrate!

Today, Dr. Pack and our team thought we would offer a few tips for our patients currently undergoing orthodontic treatment. For those of you wearing braces, it’s important to be even more dedicated to good oral hygiene than those not currently in treatment.

After getting your braces, it is important to know how to take care of your teeth in order to ensure that your braces stay intact and do their job so that your teeth are in top-notch condition after you complete your orthodontic treatment.

Braces are known to trap food, which contributes to plaque formation. If it is not carefully removed from the teeth and gums, plaque will develop into decay or gum disease, leading to costly delays during your treatment. It is important to practice good oral hygiene by following instructions from Dr. Pack during your treatment.

We are proud to offer supplies to help fight plaque, such as a proxabrush, dental floss, and floss threaders. The use of an electric toothbrush and or a water pick can also be helpful in combating cavities and decay. And, of course, our team at Pack Orthodontics suggests brushing at least twice a day.

We hope that helps! If you have any questions, please give us a call at our Murfreesboro, TN office or ask us during your next adjustment appointment!