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When does an underbite need surgery? The short answer is: when Dr. Andrew Nalin 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. Andrew Nalin 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 Mount Vernon, WA 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. Andrew Nalin 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. Andrew Nalin 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.

One word no one likes to hear is “cavity!”

For those patients of ours wearing braces, hearing that word is especially problematic, considering that delaying any dental work may result in delaying treatment time.

We often blame candy as the culprit behind tooth decay, but other foods and drinks that kids consume can be just as harmful to their teeth, and can lead to cavities and tooth decay. Keeping your teeth or your child’s teeth from decay during treatment starts with a proper diet, and today, our team at Nalin Orthodontics will explain the negative effects that candy and other treats, including peanut butter, raisins, fruit juice, and chewy fruit snacks, have on your child’s teeth as he or she undergoes orthodontic treatment. Keep in mind that half of your child’s sugar intake may be coming from beverages that he or she drinks. A major offender is soda, but be mindful of fruit juices as well.

While sugar is known to sit in your child’s teeth and in between and under brackets and wires after consumption, it is important to know sugar is not the only cavity-causing culprit. Carbohydrates, starches, acids, and any food that is chewy or sticks break down into sugars, and can promote tooth decay.

So, what are the alternatives?

Candy such as dark chocolate, sugar-free gum, or anything that contains xylitol, a sugar substitute, is not as harmful for your teeth as hard, chewy, or sticky sweets. Sugar-free gum or gum that contains xylitol are known to reduce levels of bacteria on teeth.

And if you’re still looking for something to snack on, we recommend cutting up easy-to-eat fruits and vegetables. You would also be surprised how much eating a banana or sipping on a glass of water helps you curb snack cravings.

If you’re one of those folks who just can’t stay away from sweets, we encourage you to brush your teeth immediately afterward and swish water in your mouth.

Whatever you eat, Dr. Andrew Nalin and our team want you to remember to brush often, floss regularly, and visit your general dentist as your treatment progresses. If you have any questions about sugary foods or drinks, please give us a call or ask us during your next adjustment visit!

Parents usually have numerous questions about orthodontic treatment for their children. According to the American Association of Orthodontists, orthodontic treatment for children should start at around seven years of age. This allows Dr. Andrew Nalin to evaluate the child’s existing and incoming teeth to determine whether or not early treatment might be necessary.

What is early orthodontic treatment?

Early orthodontic treatment, known as Phase One, usually begins when the child is eight or nine years old. The goal is to correct bite problems such as an underbite as well as guide the jaw’s growth pattern. It also helps to make room in the mouth for the permanent teeth to be properly placed as they come in. This will greatly reduce the risk of the child needing extractions later in life due to his or her teeth getting crowded.

Does your child need early orthodontic treatment?

There are several ways that you can determine whether your child needs early treatment. If you observe any of these characteristics or behaviors, you should talk to Dr. Andrew Nalin.

• Early loss of baby teeth (before age five)
• Late loss of baby teeth (after age five or six)
• The child’s teeth do not meet properly or at all
• The child is a mouth breather
• Front teeth are crowded (you won’t see this until the child is about seven or eight)
• Protruding teeth, typically in the front
• Biting or chewing difficulties
• A speech impediment
• The child’s jaw shifts when he or she opens or closes the mouth
• The child is older than five years and still sucks a thumb

What are the benefits of seeking orthodontic treatment early?

Early orthodontic treatment is begun while the child’s jaw bones are still soft. They do not harden until the children reach their late teens. Because the bones are still pliable, corrective procedures such as braces work faster than they do for adults.

In short, early treatment at our Mount Vernon, WA office often allows your child to avoid lengthy procedures, extraction, and surgery in adulthood. Early treatment is an effective preventive measure that lays the foundation for a healthy, stable mouth in adulthood.

Let’s talk about mouthguards.

We could talk about how important wearing a mouthguard is when you lead an active life. If you play sports, ride bikes, skateboard, or participate in many other kinds of exercise, mouthguards protect your teeth, mouth tissue, and jaws from accidents. 

Or we could talk about how wearing a mouthguard while you’re wearing braces has extra benefits. Besides its normal protection, your guard helps protect your brackets and wires from damaging contact, and your delicate mouth tissue from impact with your braces.

But we’re not going to talk about any of these important topics today. Instead of looking at how your mouthguard protects you, today we’re going to look at how you can protect your mouthguard.

If you want your guard to last longer, work better, and stay (and smell!) cleaner, some basic tips make all the difference.

• Keep your guard clean.

This can’t be stressed enough. Without a good cleaning routine, your guard can become discolored, develop an unpleasant odor, and even cause illness. Not very appealing, right? Happily, keeping your mouthguard clean isn’t difficult.

When you wear your guard, the same plaque that is present in your mouth makes itself at home in your appliance. And when your guard is in its case, that dark, moist environment makes it a perfect breeding ground for all kinds of bacteria, viruses, and fungi.

As soon as you take your mouthguard out, rinse it off. Brush with a soft toothbrush to remove all the plaque, saliva, or food debris that might be lingering in your appliance. (If you are on the playing field, in the park, or at some other inconvenient location, rinse it and brush as soon as you can.) Toothpaste can help get your guard its cleanest, but can be too abrasive for some appliances.

Once you’ve cleaned it, let your guard air dry in a clean spot for about 30 minutes. Air drying helps prevent bacterial growth. After your guard has dried, return it to its case.

Once a week, you might need to give your mouthguard a good soak in a mouthwash or other dental cleaning solution.

Since cleaning instructions can be different depending on which type of mouthguard you have, be sure to follow our instructions if you have a custom guard, or clean as directed by the manufacturer if you have a store guard.

• Keep it safe.

When your mouthguard isn’t in your mouth, it should be in its case. Floating loose in your locker or tumbling around in your gym bag puts your guard at risk for breakage and bacteria.

And don’t forget to clean your case thoroughly every few days and air dry it as well. Bacteria, viruses, fungi, mold, and other unwelcome guests can collect in your case, too.

• Keep it only as long as it’s in good condition.

You can purchase mouthguards from sporting or drug stores, or Dr. Andrew Nalin can make you a mouthguard designed to fit your teeth and braces perfectly. These appliances are made to be strong and durable, but they’re not indestructible. Over time they can wear down or become damaged, especially if you treat them carelessly.

Bacteria can lurk in dents and cracks, and you can cut your mouth on rough, sharp, or broken edges. But if your mouthguard isn’t fitting properly, don’t resort to self-help! Trying to repair, reshape, or trim your appliance yourself is not a good idea, because it might affect its fit and protective ability.

Any sign that your guard isn’t fitting properly or shows signs of wear and tear could mean it’s time for a replacement. You can replace a store model, or see Dr. Andrew Nalin about replacing or repairing your custom guard. A mouthguard that doesn’t fit, doesn’t keep you safe.

Take care of your guard, and it will take care of you. The reward for the small amount of time and effort you put into caring for your mouthguard is braces that will last through your treatment at our Mount Vernon, WA office and a smile that will last you for a lifetime. Those are benefits we can talk about all day!