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When does an underbite need surgery? The short answer is: when Dr. Daniel Very 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. Daniel Very 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 Boardman or Niles 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. Daniel Very 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. Daniel Very 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 purpose of braces and other forms of orthodontic treatment at Very Orthodontics is to correct malocclusion, also known as crooked or crowded teeth, or “bad bites.” Past orthodontic practice dictated that wisdom teeth be removed, especially in cases of crowding.

The wisdom teeth are the last teeth to come in, and are officially known as the third molars. The teeth typically erupt, or break the surface of the skin, in young people between the ages of 13 and 20.

Sometimes, wisdom teeth are impacted. That means they cannot break through the gum tissue. This typically happens when the mouth or jaw is too small to accommodate the teeth. Impacted wisdom teeth can become infected, and some dentists and orthodontists may want to remove them as prophylaxis to prevent possible future infection.

Justification for removing wisdom teeth

Dr. Daniel Very will tell you that in some cases, wisdom teeth attempt to come in the wrong way, either tilting in the jaw, or sideways. If the mouth is too small to accommodate these additional teeth, they inevitably become impacted. Swelling or infection of the gum flap above an impacted wisdom tooth may cause pain. The greatest danger is pericoronitis, a potentially dangerous infection that can occur in the gum area around an impacted wisdom tooth, or around a wisdom tooth that has erupted.

Orthodontists base their decision to remove wisdom teeth on each patient's individual circumstances. To learn more about the impact wisdom teeth have on orthodontic treatment, or to schedule a visit with Dr. Daniel Very, please give us a call at our convenient Boardman or Niles office!

When you get braces as a child, you usually present the orthodontist with a blank canvas—newly erupted, perfect permanent teeth, just waiting to be aligned. But if you are a bit older, your canvas might already be a bit busy, with fillings, crowns, perhaps even a missing tooth. Can Dr. Daniel Very still work with that more complicated picture? Yes!

• Fillings

Many of us have acquired a filling or two. Normally, an old filling shouldn’t interfere with new braces. Large fillings, however, might call for spacers. These small rubber bands are inserted between two teeth as needed to create enough room for bands and brackets, and are generally put in place a week or two before you get your braces. They frequently fall out on their own as the space between the teeth gets a bit wider.

• Crowns

If you have had a root canal or any other dental treatment that left you with a crowned tooth, no need to be concerned. A special dental adhesive can be used to adhere brackets to crowns.

• Implants

If you have or would like to get an implant, this is a time to coordinate with your orthodontist and dentist or oral surgeon. Sometimes an implant can anchor your appliance, and sometimes it’s best to keep the spot open until your orthodontic work is completed. Once in place, an implant will not have the mobility of a tooth, so it’s always best to make sure your doctors can create a schedule that will work for both the installation of the implant and the positioning of your braces.

• Healthy Teeth and Gums

Before you begin orthodontic work, talk to your dentist. If you need a filling or crown, are considering a dental implant, have symptoms of gum disease, or are looking at any other dental concerns, you should work with your dentist first. Healthy teeth and gums are the very best foundation for orthodontic treatment at any age.

If you are wondering whether Dr. Daniel Very can help you achieve the smile you’ve always wanted, talk to us when you visit our Boardman or Niles office! Your past dental work will be just one of the many variables we take into consideration when we’re planning your future of picture-perfect smiles.

If this is your child’s first holiday season with braces, here are some tips on how to help children get the most enjoyment from these celebrations without compromising their braces or leaving them feeling left out of the festivities.

Halloween

When you think dental health, “Halloween” is not usually the first thing that comes to mind. Halloween can be tricky, but with some planning and intervention, you can make sure your child doesn’t miss out on the treats that make the holiday a favorite.

Braces present other challenges besides dealing with the scary amount of sugar in every trick-or-treat bag. Certain treats can be a challenge to clean from braces, and can even cause broken brackets and wires. How to avoid these frightful results?

• Go through your child’s treat bag when you get home after neighborhood trick-or-treating. Anything which can damage braces, such as regular gum, candy with nuts or caramel, or hard or chewy candies should be discarded. Perhaps you and your child can choose a selection of soft candy such as plain chocolate and peanut butter cups to trade for those tricky treats. Your child’s favorite soft fruits, cupcakes, and cookies could also be safe substitutes.
• Party time? Candy apples, bowls of candy corn, and popcorn balls are favorite treats at Halloween parties, but very bad for braces. Help your child recognize what should be avoided before attending, and suggest safe options like soft cupcakes.
• Finally, even safe treats will leave more sugar than normal in your child’s mouth and therefore more potential for plaque build-up. Brush and floss more often, if needed, and rinse regularly with water.

Talk candy guidelines over in advance with your child. If you’d like, Dr. Daniel Very can recommend safe alternatives. With your help, Halloween won’t be a fearsome experience for you or your trick-or-treater.

Thanksgiving

Now, this is a holiday to be thankful for! Almost all of your traditional favorites are perfect for family members with braces.

• Appetizers: Offer soft food options such as silky cheeses and deviled eggs instead of crunchy vegetables, chips, and nuts.
• Dinner: Turkey is a required dish on many tables, and no need to miss out! Just make sure pieces are bite-size and off the bone. Creamy mashed potatoes and gravy and jellied cranberry sauce are also braces-friendly traditions. Any cooked vegetable should be fine, but do cut the corn from the cob first. Dressing is a great side dish if your child avoids any crunchy tops and edges, as are soft, nut-free rolls and muffins.
• Dessert: Pumpkin pie, cheesecake, and apple pie with ice cream are all safe (and delicious) choices. Leave the pecan pie, caramel sauce, and anything nutty or chewy off your child’s menu. And remember to brush and floss carefully after the feast!

If you are concerned that following the usual food guidelines might be a little more difficult during this time of year, talk to us. Dr. Daniel Very and our team are happy to suggest ways to make your child’s first holidays with braces memorable for all the right reasons. The last thing you’ll want is an emergency visit to our Boardman or Niles office!