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When does an underbite need surgery? The short answer is: when Dr. Pope 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. Pope 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 Flossmoor and New Lenox, IL 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. Pope 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. Pope 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.

The Valentine shopping list is traditional and simple: Flowers. Candy. But if your Valentine is in braces this year, suddenly your choices become more complicated. No need to worry! Dr. Pope and our Flossmoor and New Lenox, IL team have some sweet suggestions that are both braces-friendly and Valentine-approved.

First, let’s look at some options where Cupid’s arrow has missed the mark.

• Caramels—these sticky treats are difficult to clean from orthodontic work, and sticky, chewy foods can even cause damage to wires and brackets.
• Chocolate covered nuts—hard foods such as nuts can break or bend wires and brackets.
• Assorted chocolates—a confectionary minefield! There are bound to be some caramels and nuts in there somewhere, hiding beneath an innocent coat of chocolate, just waiting to ruin your Valentine’s evening.
• Other candies such as taffy, licorice, hard candy? No, no, and no. Remember, anything sticky, chewy, or hard is on the “Loves Me Not” list.

So, which chocolate treats won’t break hearts or braces?

• Soft truffles—if it’s not Valentine’s Day without a be-ribboned box of chocolates, choose soft truffles to fill it.
• Chocolate mousse—the perfect end to a romantic dinner.
• Chocolate covered strawberries—it’s a special occasion treat that won’t mistreat braces.
• Rich chocolate cake—always a delightful indulgence, and even better if it’s in the shape of a heart.

If your Valentine is not a chocolate fan, there are other sweet treats that are delicious alternatives.

• Cheesecake can be topped with (pitted!) cherries to celebrate in holiday-appropriate color.
• Soft heart-shaped cookies will be even more romantic with decorative icing—add your initials for a personal touch.
• Select an array of frozen yogurt, ice cream, or gelato in different shades of pink.
• Macarons also come in a variety of pink and red shades—but make sure this confection is on your Valentine’s braces-friendly list!

Of course, you can celebrate the day without sugary tributes. A single flower, watching your favorite movie together or, best of all, a heartfelt card or letter are all wonderful ways to show you care. But if it’s just not the same holiday without a sweet treat, try some of our suggestions. Your Valentine will appreciate your thoughtfulness.

From the time you were small, you’ve been warned about the dangers of plaque. Why? Because:

• It’s an unpleasant film that sticks to your teeth
• It causes cavities
• It causes gum disease
• It can cause extra problems when you wear braces

And really, do we need to know much more than this to motivate us to brush? But if you’re in a curious mood, you might be wondering just how this soft, fuzzy film accomplishes all that damage. Let’s take a closer look at the sticky problem of plaque.

How does plaque form?

We live with hundreds of species of oral bacteria, most of which are harmless, and some of which are actually beneficial. But when our oral ecosystem gets out of balance, problems can occur. For example, without regular and thorough brushing and flossing, we start to build up plaque.

Plaque starts forming within hours of your last brushing. And even though plaque fits the very definition of “seems to appear overnight,” this biofilm is actually a complex microbial community with several different stages of development.

• It starts with saliva.

Saliva is vital to our oral health, because it keeps us hydrated, washes away food particles, neutralizes acids in the mouth, and provides minerals which keep our enamel strong. Saliva also contains proteins, which help form a healthy, protective film on the tooth surface. This film is called a pellicle.

• Bacteria attach to the pellicle.

There are species of oral bacteria that are able to attach themselves to the pellicle film within hours of its formation. As they become more firmly attached, they begin to grow and divide to form colonies, and are known as the early colonizers of the plaque biofilm.

• A complex biofilm forms.

If you’ve skipped brushing for a few days (please don’t!), you’ll notice a fuzzy, sometimes discolored film on your enamel—that’s a thriving plaque community, and it only takes a matter of days to go from invisible to unpleasant.

If you’re not removing plaque regularly, it can harden further and become tartar. And once you have tartar buildup, you’ll need the care of a dental professional to remove it.

• What happens if we ignore plaque and tartar?

We get cavities and gum disease.

How does plaque cause cavities?

• The bacteria in plaque, like all organisms, need nutrients.

Our normal oral environment and the food in our everyday diets provide the nutrients plaque needs. And, as we mentioned above, certain types of oral bacteria convert these nutrients into acids. Foods such as carbohydrates, starches, and sugars are most easily converted into acids, which is why we recommend that you enjoy them in moderation.

• The biofilm promotes acid production.

Within the plaque film, anaerobic bacteria (bacteria which don’t use oxygen) convert sugars and starches into acids. As the plaque film becomes denser, it blocks acid-neutralizing saliva and oxygen from reaching these bacteria close to the tooth’s surface, creating an ideal environment for the bacteria to produce their acid waste products.

• Acids attack enamel.

The sticky nature of plaque keeps these acids in contact with tooth enamel, where, over time, acids dissolve minerals in enamel, weakening the mineral structure of the tooth.

How does plaque cause gum disease?

• Bacteria cause inflammation and gingivitis.

The bacteria in plaque irritate the delicate tissue of the gums, which causes an inflammation response which can leave your gums swollen, red, bleeding, or tender. This early form of gum disease is gingivitis. Fortunately, good dental care and careful brushing and flossing can usually prevent and even eliminate gingivitis.

• Plaque and tartar can lead to periodontitis.

When plaque and tartar build up around and below the gumline, the gums pull away from the teeth, leaving pockets where bacteria collect, leading to infection as well as inflammation. Infections and constant inflammation not only harm gum tissue, they can destroy the bone supporting the teeth. This serious gum condition is periodontitis, and should be treated immediately to avoid further infection and even tooth loss.

How does plaque affect orthodontic patients?

• Plaque collects around your braces.

Braces provide plenty of spots for plaque to hide from your brush. If you aren’t extremely diligent with your brushing and flossing, plaque collects near brackets, wires, and bands—all those spots that a brush and floss find difficult to reach.

• Plaque promotes demineralization

The demineralization process we mentioned above can cause white spots on teeth (decalcification), where minerals have dissolved. Sometimes these spots can be treated, and sometimes they are permanent. They can become quite sensitive, and may lead to cavities.

Careful brushing and flossing around your braces will help eliminate the plaque that can cause demineralization near brackets. Ask Dr. Pope about the tools and the brushing and flossing techniques which will give you the best results.

How do we fight plaque?

From the time you were small, you’ve learned how to fight plaque:

• Brush at least twice a day for two minutes, and be sure to brush all of your tooth surfaces and around the gumline.
• Floss to remove plaque from between the teeth and near the gumline.
• See your dentist as recommended for a thorough professional cleaning.

Be proactive. If you have any questions, talk to us at our Flossmoor and New Lenox, IL office about the best way to keep plaque at bay. We can show you the most effective ways to brush and floss, recommend anti-plaque toothpastes and rinses, even suggest plaque-revealing tablets if you’re missing some trouble spots.

We’ve only brushed up on some plaque basics, because there is a lot more to discover about this complex biofilm. Happily, even with all there is to learn about plaque’s growth and development, it’s reassuring to know that getting rid of it is quite simple—with just a soft-bristled brush, some dental floss, and a few minutes of your time each day, you’re on the way to a healthy, happy, plaque-free smile.

If you’ve been following your dentist’s advice, you know that you should be devoting two minutes twice a day to gentle, thorough brushing, and floss carefully at least once a day. It’s automatic. It’s habit. You’re in the zone. Now that you have braces or aligners, though, it’s time to step up your game!

Removing Food Particles

No one wants to worry about food particles stuck in braces right after lunch—or, worse, noticed hours after lunch! Because food tends to stick around brackets and wires, Dr. Pope and our Flossmoor and New Lenox, IL team recommend brushing after a meal. Not only will you be confident in your smile, you’ll be improving your dental health.

But why?

Better Plaque Removal

Plaque is a sticky film containing acid-producing bacteria. These acids lead to weakened enamel and, eventually, cavities. Careful brushing with a fluoride toothpaste helps eliminate plaque. But as you may have discovered, it can be more difficult to clean around brackets and wires. Brushing after eating will help keep plaque from forming on your enamel, and using the right tools (floss made for braces and interproximal brushes) will help clean plaque more effectively.

But what about aligners?

If you wear clear aligners, you take them out when you eat. This avoids the problem of food particles trapped in brackets and difficulty brushing around wires. But this doesn’t mean you are home free. Brushing after every meal is also a good idea when you wear aligners.

Our teeth have an organic way to help remove food particles, acids, and bacteria between brushings—saliva! Your aligners, while covering your teeth, decrease their exposure to saliva. It’s really important, then, to make sure you brush after eating. Otherwise, food particles and acids can remain on your teeth after you replace your aligners, increasing the risk of enamel erosion and decay.

Brushing helps keep your aligners clear as well. If you notice aligner discoloration, this could be the result of food residue such as tomato sauce or coffee that remained on the teeth after a meal. Anything that stains your enamel can stain your aligners. And don’t forget about plaque. Plaque can stick not only to your enamel but to your aligners as well. If you notice that your aligners are cloudy, or have an unpleasant odor, talk to us about the best way to keep them their cleanest.

Make a Plan

So, what can you do to make brushing more convenient during a busy day? Be prepared! Keep a small kit with you containing a travel brush, a small tube of toothpaste, floss, and an interproximal brush for quick cleanings when you’re out and about, and you’ll never have to worry about your smile.

Of course, there are occasions when it’s just not possible to brush. At times like this, whether you have traditional braces or aligners, it’s a good idea to rinse well with water after meals or snacks, and brush as soon as you can.

Start your new dental routine now, and soon it will be automatic. An everyday habit. Your new comfort zone. After all, taking a few extra minutes from your day to brush after every meal will be well worth it when you end your orthodontic treatment with a smile that is as healthy as it is beautiful!