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When does an underbite need surgery? The short answer is: when Dr. Gill 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. Gill 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 Fargo, Wahpeton, ND 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. Gill 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. Gill 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.

You’re in the band and you’re getting braces. Now what? If you are a member of the string or percussion sections, you can go back to rehearsal. You’re good to go. When your talents have seated you in the reed or brass sections, though, a little adjustment might be necessary to keep your instrument and your braces working in harmony.

If you play a wind instrument, you know the term embouchure—the way you position and use your lips, tongue, facial muscles, and teeth to produce the sound you want. Depending on the instrument you play, you might be completely unaffected when you get your braces, or you might need to develop a more comfortable embouchure to accommodate them.

Wires and Woodwinds?

If you play a wind instrument such as the flute or piccolo, you might find that your normal lip positioning or blowing angle is affected by your braces, but usually the adjustment time is fairly short. Reed instruments such as the saxophone, clarinet, oboe, and bassoon are considered some of the easiest to adjust to when you have braces, but even though the single and double reed mouthpieces don’t require as much pressure as brass instruments, there can still be an adjustment period. One thing you should look out for is more condensation in your mouthpiece or instrument—be sure to keep your instrument clean to keep your sound pure.

Brackets and Brass?

Brass instruments require mouthpiece pressure. This leaves your lips pressed between the mouthpiece and your braces. For this reason, many brass players have a more challenging adjustment when wearing braces. Smaller mouthpieces (trumpet, French horn) usually require more pressure than larger ones (tuba, trombone). It’s important to learn how to use technique to avoid cuts, irritation, and other injuries caused by the pressure of your braces against your lips. Learning to play with less pressure on the lips and more air control and breath support will help you to recover your tone and range of notes while protecting your lips and mouth.

How Can We Help?

Let Dr. Gill know if you play, or plan to play, a wind instrument. We might be able to offer some suggestions. For regular metal and ceramic braces, some musicians find extra wax is helpful in preventing lip and cheek injuries. There are brace guards available that can be applied over the braces to protect your lips and mouth if wax doesn’t do the trick.

There are also alternatives to regular bracket-and-wire braces, depending on your orthodontic needs, cost factors, and length of treatment. Invisalign® devices fit smoothly over your teeth and can even be removed when it is time to practice or play, as long as you get the necessary hours of wear in per day. In some cases, lingual braces, where the brackets and wires are placed behind the teeth, might be the best choice for you.

Finally, don’t forget to talk to your music instructor. Don’t be dismayed if you find the quality of your playing has been affected. Your teacher might have valuable suggestions for adjusting your embouchure, playing with less pressure on the lips, and developing better air and breath support. You might need to shorten your practice time at first, and there might be another period of adjustment after your braces come off.

Above all, take care of yourself! If something is poking your lip or cheek, call our Fargo, Wahpeton, ND office immediately before it causes injury. It might be difficult at first, but finding an embouchure that works for your comfort and technique is worth it. And remember, these temporary fine-tunings will lead to a wonderful coda: skilled musicianship and a beautiful, healthy smile. Bravo!

If you participate in sports or other physical activities, it’s wise to consider getting a mouthguard. Also known as mouth protectors, mouthguards are a device worn over the teeth to lessen the impact of a blow to the face.

This reduces the chance that you might lose teeth or sustain other serious oral injuries. We recommend that all patients involved in a contact sport such as wrestling, football, or hockey wear a mouthguard because of the high risk of such injuries.

However, anyone involved in a physically demanding sport or activity should wear a mouthguard as well.

Can you imagine what it would be like to lose a few of your front teeth? The way you talk, eat, and smile would all change. Potential injuries when you don’t wear a mouthguard include chipped and broken teeth, fractured jaws, root damage, damage to crowns and bridgework, concussions, and/or injury to the lips, cheeks, or gums.

Types of Mouthguards

There are three different types of mouthguards — typically made of a soft plastic material or laminate. You can decide which works best for you in terms of budget, fit, and comfort.

• Stock mouthguards are prefabricated to a standard size. They offer adequate protection, but you need to make sure you find one that fits properly and comfortably. Stock mouthguards are readily available at department stores, sporting goods stores, and online.
• Boil-and-bite mouthguards are placed in boiling water to soften them, then into the mouth so they can conform to the shape of the teeth. Boil-and-bite mouthguards are more expensive, but offer a more customized fit than stock ones. You can find these in department stores, pharmacies, sporting goods stores, and online.
• Custom-made mouthguards are created just for you by Dr. Gill. These offer the best fit and comfort of all the options, but they are also the most expensive. Ask a member of our Fargo, Wahpeton, ND team for more information.

The American Dental Association says a good mouthguard should be easy to clean, fit properly, be comfortable, and resist tearing or damage. It shouldn’t restrict speech or breathing.

Still not sure if you need a mouthguard or which kind is right for you? Ask Dr. Gill or one of our staff members for more information.

All over the Internet you'll find videos and articles showing how you can close the gap between teeth or space them out. There is a plethora of DIY orthodontic techniques out there — you can even mail order your own impressions to get clear aligners, without even seeing a dentist or orthodontist. Following the instructions laid out in these videos and articles (by people who have zero training in orthodontics) is about the worst decision you can make for your overall oral health.

Performing DIY or at-home orthodontia can lead to or cause:

• Loss of teeth
• Infection
• Cavities or infections that are missed or undiagnosed
• Gum damage

Dr. Christina Carter, president of the Northeastern Society of Orthodontists, says that DIY orthodontics can have terrible consequences. She spoke to TODAY about closing gaps between teeth using rubber bands or elastics:

"The teeth are connected to the gums and the blood supply and there is a risk of infection, of tearing the gums which might not heal properly, and a risk of damaging the attachment between the tooth and gums so the tooth no longer gets the support it needs." She also noted, "A simple rubber band can actually slide up the tooth and cut all the attachments to it and you can actually lose a tooth."

One of the worst parts about DIY orthodontics is that you never consult with a trained orthodontist, so you're really operating on a dangerous lack of information. It's best not to risk damage to your teeth or infection. Let Dr. Gill know what you want to accomplish with your teeth and we will help you find the safest and most cost-effective way to achieve it.

Dr. Gill want you to be informed and practical about your oral health. Should you have any questions about orthodontic treatment options, please do not hesitate to give us a call at our convenient Fargo, Wahpeton, ND office.