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Gum disease is one of our most common dental diseases, affecting both children and adults. If you are considering getting braces or aligners, make sure your gums are their healthiest before beginning orthodontic treatment.

• Gingivitis

For both younger and older patients, gingivitis (mild gum disease) can be the result of poor brushing and flossing habits. When plaque builds up around the teeth and gums, it irritates delicate gum tissue. The gums become inflamed, and symptoms such as redness, swelling, tenderness, bleeding, and bad breath can result. Usually, your dentist can treat early stages of gingivitis with tips on more efficient brushing and flossing, a professional cleaning, and suggestions for mouth rinses if needed.

Because brushing and flossing with braces can be more difficult, you need to devote special attention to your cleaning routine to prevent gingivitis from developing after you start treatment. Talk to us any time about how to brush and floss most effectively when you wear braces. Dr. Joseph Brogan can also recommend tools designed especially for braces wearers to get your teeth and gums as clean and plaque-free as possible. If you are a candidate for clear aligners, this option can make it easier to keep your teeth their cleanest. We’ll work with you to keep your gums healthy as your orthodontic work takes place.

• Periodontitis

For older patients, gingivitis, left untreated, can eventually lead to periodontitis (severe gum disease). This chronic infection can lead to the formation of pockets between your gums and teeth that become home to bacteria and infection. Over time, periodontitis can lead to the destruction of gum, ligament, and bone tissue. Left untreated, it can lead to loose teeth and even bone and tooth loss.

Making sure you schedule regular dental exams will allow your dentist or periodontist to detect and treat any signs of periodontitis as early as possible. If you have any of the symptoms of gum disease, it’s important to treat the cause of these symptoms as soon as possible to protect your gums, bone, and teeth. Deep cleaning procedures such as scaling and root planing, topical and oral antibiotics, and oral surgeries such as flap surgery or bone and tissue grafting can help reverse the effects of periodontitis.

Because orthodontic treatment involves moving the teeth and re-forming the ligament and bone tissue, which hold them in place, you need healthy periodontal ligaments and bones to begin treatment. If you have suffered shifting teeth or bone loss due to periodontitis, talk to us. We will let you know at your visit to our Philadelphia, PA office if you are a good candidate for orthodontic work, and which type of appliance is best for your periodontal health.

We are happy to talk to you about the best way to achieve an attractive smile and a healthy bite if gum disease has been a problem in the past. Most important, we want to make sure that your teeth and gums are their healthiest even before you begin orthodontic treatment. Preventing and treating gum disease will provide the foundation you need for a lifetime of beautiful smiles.

One of the many benefits of your clear aligners is that you can remove them to eat. You should brush after every meal, just like you would with traditional braces, but cleaning your teeth is much easier without having to work around and between brackets and wires.

But when you wear your aligners 22 hours a day, you might be tempted to leave them in when you’re just having a sip of something when you’re thirsty. Unless you’re drinking water, please don’t.

What’s the problem with a can of cola or a cup of coffee?

• Staining

The virtue of your clear aligners is that they are, well, clear! Probably one of the reasons you decided on this method of treatment was because you liked the idea of an inconspicuous appliance.  Unfortunately, dark beverages such as colas, coffee, tea, and red wine can stain your aligner, making it more visible.

• Warping

Very hot beverages might actually affect the shape of your aligners. Since they are formed using heat, it makes sense that heat can also de-form them. If hot teas and coffee drinks cause a change in the shape of your aligners, they will not move your teeth the way they were meant to.

• Affecting Tooth Health

Even though our enamel is very strong, sugary and acidic drinks can damage it. Acidic foods can erode enamel, and the sugars in our diet provide food for cavity-causing bacteria, which then produce acids that erode enamel.

Normally, saliva provides some protection from acids and sugars by diluting them and washing them away from the teeth. When you drink a cola or an orange juice with your aligners on, some of the liquid will get in them, and can stay in them until the aligners are removed. You will actually give these problem beverages the opportunity to bathe your teeth in sugar and acid over a longer period of time, without exposure to saliva to help offset potential harm. And after all your work to create a beautiful smile, you certainly don’t want new cavities!

How to protect your aligners and keep them their cleanest—and most invisible?

• Take your aligners out before drinking beverages that can stain them, or, if you can’t, try using a straw. Clean your aligners according to Dr. Joseph Brogan and our team’s instructions to keep them as clear as possible.
• Don’t drink very hot beverages with your aligners in place. Try icing your coffee and tea if you can’t remove your aligners. And if you think your aligners have changed shape, please give us a call.
• Drink water! Water hydrates you, doesn’t damage enamel, and keeps your aligners clean. Tap water is your best option, as even bottled waters can be acidic.

If your aligners should become stained, remember that you change them frequently, so the staining can be a temporary problem. If you do have a drink of something hot and your aligners feel “off,” give our Philadelphia, PA office a call. We’ll let you know if you need to replace them.

But prevention is always best! Avoid staining from the start by removing your aligners before you drink dark beverages. Don’t expose your aligners to heat. Think about replacing unhealthy drinks with water. And certainly brush right away, or rinse with water if that’s not possible, if you drink a sugary or acidic beverage. These simple precautions will help keep your aligners, and, most important, your teeth, looking their best.

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. Joseph Brogan and our Philadelphia, PA 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.

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.