Our Blog

When does an underbite need surgery? The short answer is: when Dr. Joseph Brogan 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. Joseph Brogan 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 Philadelphia, PA 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. Joseph Brogan 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. Joseph Brogan 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.

“Yes,” you’re thinking, “I shouldn’t be chewing sugary, sticky gum while I’m wearing my braces.” Or perhaps, “I should check with my orthodontist to see if this sugar-free gum is safe for my braces.” And these are both great thoughts—but today, we’re thinking about gums of a different sort!

While you’ve been taking care of your teeth with regular brushing and flossing, you’ve also been taking care of your gums. And now that you’re wearing braces, your gums need a bit of special attention to keep them their healthiest.

We tend to think of gum disease as an adult problem. In fact, periodontitis, or serious gum disease, is one of the most common chronic infections in the adult population. But young gums need care, too! Gingivitis, a milder form of gum disease, is unfortunately a common problem for both children and adults.

Gingivitis is an inflammation of the gums caused by the build-up of plaque and tartar. When plaque builds up, it irritates delicate gum tissue. And while gingivitis is not as serious as periodontitis, the symptoms caused by this disease are nothing to smile about:

• Redness
• Tenderness and soreness
• Swelling
• Bleeding
• Bad Breath

If you’re already feeling a little tender or swollen after an adjustment, the added discomfort caused by gingivitis is the last thing you want. But even worse, neglected gingivitis can lead to more serious infections of gum and even bone tissue. Luckily, gingivitis is both preventable and treatable with proper dental care.

So, how to protect your gums? We have some suggestions.

• Brushing Better with Braces

It can be hard to brush around your brackets and wires, but keeping these areas free of food particles and plaque makes for healthy gums—and fewer cavities! There are specially designed manual toothbrushes made for braces wearers, and tiny interproximal brushes that can reach tight spaces. Or, perhaps an electric toothbrush will do a better job for you. Just be sure to brush after each meal for the most complete removal of bacteria and plaque.

• Learn New Flossing Techniques

You might wonder how on earth you’ll get in between your teeth with your wires and brackets in the way. We have the answers! We know the best techniques for flossing your specific braces, and we’ll recommend specially designed flossing tools to make the job easier. Water flossers can also be a great help for cleaning in tight spots. Be sure to make flossing part of your daily routine—you’ll be able to remove plaque from places brushing just can’t reach.

• Rinsing? Recommended.

Talk to Dr. Joseph Brogan about the best dental rinses for reducing plaque and tartar, or how gargling can help prevent irritation. And drink water! Water helps wash away plaque and bacteria, and is a great way to rinse teeth and braces if you absolutely can’t brush after eating.

• Keep up with Professional Cleanings

Be sure to keep up with your regular dental exams and cleanings. Your dentist or hygienist will be able to remove any plaque or tartar build up that home brushing can’t handle.

We want your time in braces to be as healthy—and comfortable—as possible. If you have any gum discomfort, swelling, or sensitivity, give our Philadelphia, PA office a call. With prompt action, gingivitis can be treated, and with careful attention to your cleaning routine, gingivitis can be prevented altogether. Something to think about!

Whew! It’s a hot one! And whenever the temperature soars, you need to stay hydrated, especially when you’re outside or exercising. But all cold drinks aren’t equal when it comes to healthy hydration. Which beverages shouldn’t have a prime spot in your cooler when you’re wearing braces or aligners?

• Soft Drinks

You’re probably not surprised to find soft drinks at the top of the list. After all, sugar is a) a big part of what makes soda so popular, and b) not a healthy choice for your teeth.

Sugar is a favorite food source for the oral bacteria that make up plaque. These bacteria convert sugar into acids, and these acids attack the surface of your tooth enamel. Over time, the minerals which keep enamel strong begin to erode, and weakened, eroded enamel is a lot more susceptible to cavities.

So, what about sugar-free drinks? Does this make soft drinks a better choice? Unfortunately, you can take the sugar out of many sodas, but you can’t take the acids out. Most soft drinks are very acidic, even without sugar, and will cause enamel erosion just like the acids created by bacteria will.

• Fruit Drinks

Fruit juice provides us with vitamins, which is great, but it’s also full of natural sugars and acids. And blended fruit drinks and fruit punches often contain added sugars and added citric acids. Best to choose 100% fruit content and check the labels before you buy. (And you can always get refreshing fruit flavor by adding a slice of fruit to a glass of water.)

• Sports Drinks

You might be surprised to see these on the list—after all, they promise healthy hydration while you’re working out. And hydration is healthy—but sugars and acids aren’t. Even when the label tells you there’s no added sugar, that same label will often reveal high amounts of citric acid. In fact, some sports drinks are more acidic than sodas.

We’ll make an exception, though, for thirsty people who participate in sports or activities that require a lot of physical exercise and produce a lot of sweat. When we sweat, we lose electrolytes, those ionized minerals which help regulate many vital bodily functions. Talk to Dr. Joseph Brogan about which sports drinks are best for you if you need to replenish your electrolytes when working out.

So, what’s your best hydration choice on a hot day? Water! It not only hydrates you, it cleans your teeth, it helps you produce saliva, and it often contains tooth-strengthening fluoride. But if you only have sports drinks in the cooler, or if you just want to enjoy a soft drink or a bottle of juice from time to time, no need to go thirsty. We have some ways to make sure your teeth are safer, even with this tricky trio:

• Rinse with water after you drink a sugary or acidic drink. And remember to brush when you get home.
• Be choosy. Check labels for added sugars and acids.
• Don’t sip your drinks all day long. Saliva actually helps neutralize acids in the mouth, but sipping acidic beverages throughout the day doesn’t give saliva a chance to work.
• Use a straw to avoid washing your enamel in sugars and acids.

While sugar and acids are never good for your teeth, it’s especially important to reduce your exposure while you’re in braces or aligners.

• Increased sugar means increased plaque and bacteria, which can collect around your brackets. When plaque isn’t cleaned away, bacterial acids cause mineral erosion, which shows up as white spots on your enamel. You don’t want to see a collection of white spots when those brackets come off!
• Filling a cavity might require the (temporary) removal of part of your braces.
• There’s a reason Dr. Joseph Brogan and our team recommend that you only drink water with your aligners on. If you wear them while you drink sugary and acidic beverages, the liquid collects in your aligner tray, literally bathing your teeth in sugar and acid—and speeding up the process of erosion and decay.

You need to keep hydrated when it’s hot. When you’re packing your cooler, choose drinks that are healthy for your entire body, including your teeth and gums. Ask our Philadelphia, PA team for the best choices in cold drinks to make sure you’re getting the hydration you need—without the sugar and acids you don’t!

Modern orthodontic technology has led to major changes in the world of braces. Brackets are smaller and come in both metal and ceramic materials. Wires are more efficient and more comfortable. Elastic bands come in a variety of vivid colors, or you can choose brackets which work without bands. You can even decide on clear aligners, with no brackets or wires at all.

And since modern software technology has given us a program for just about everything, it’s no surprise that you can install apps to help make your modern orthodontic treatment more convenient and more enjoyable. What can an orthodontic app do for you?

• Keep Track of Your Appointments

There are many apps out there that are designed to help you keep your treatment on track with appointment reminders. This sounds pretty basic, but when you have school, work, sports, and activities filling your days, it doesn’t hurt to get a timely reminder that our Philadelphia, PA office will be expecting you in the near future. And, since missed appointments delay your progress, you are making sure you achieve your beautiful, healthy smile in the shortest amount of time.

• Mapping Out Your Routine

You know how important it is to keep track of the hours you wear your aligners. Apps can help remove the guesswork with a timer to make sure you’ve got the hours you need to progress to the next phase of treatment. Apps can also remind you when you’re ready for a new aligner, and let you track your progress in one convenient place with selfies after each aligner transition. After all, it’s really exciting to see just how far you’ve come.

If you wear traditional braces, there are apps with very helpful reminders for you, too. For example, forgetting to wear your elastics can really delay your progress. An app can let you know when it’s time to wear your rubber bands and keep track of your hours. It can also remind you to replace your bands regularly, because elastics become less elastic through the day. And take advantage of the countdown feature some apps offer to see just when you can expect to be done with your treatment when you keep on top of your routine.

• Brushing and Flossing? Apply Yourself!

A big part of making your smile look its best after your orthodontic treatment is making sure you take care of your smile during your treatment. This means keeping up with daily brushing and flossing, and using proper technique. Two minutes brushing, twice each day, and flossing at least once a day are the basic recommendations for preventing cavities and gum disease. (During orthodontic treatment, you might need to increase your brushing and flossing—ask us how often is best for your needs.)

And to help you make sure you get a solid two minutes of brushing twice a day? Try an app that plays two minutes of your favorite music with a perfectly timed brushing playlist. Apps can also send you brushing and flossing reminders, let you know when it’s time to change your toothbrush (every three months, please!), and give you tips on better brushing and flossing techniques.

• Have Fun with Your Appearance

Not sure just how you’ll look in braces? Get a preview with an app that uses one of your selfies to model different types and styles of braces, brackets, bands, and aligners. Metal brackets? Ceramic? Elastic bands in your favorite colors? No bands at all? Hardly visible aligners? Find the look that works for you!

• When Problems Happen

Some apps will even guide you through common orthodontic problems, such as applying wax to an irritating bracket or relieving discomfort. Always remember, though, an app is not an orthodontist. If you have a serious problem or concern, call us immediately.

• Orthodontist Approved

If you’ve checked out the orthodontic apps available for your operating system, you know that there are a lot of options out there. If you’re looking for an app providing information about your treatment, tips for dealing with your braces, or a convenient way to track your progress or even be part of a community, you want the best information, tips, and conveniences possible—and hopefully all in one place.

To help you find the best orthodontic app for you, talk to Dr. Joseph Brogan! We might know just the app for your specific needs. Whether you choose aligners or brackets and wires, consider all the wireless options that can make your life easier, your dental care more complete, and—just maybe—your orthodontic experience a little more fun.