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When does an underbite need surgery? The short answer is: when Dr. Quas, Dr. Wiater and Dr. Kang 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. Quas, Dr. Wiater and Dr. Kang 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 Bend, Redmond, Prineville, La Pine or Sisters OR 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. Quas, Dr. Wiater and Dr. Kang 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. Quas, Dr. Wiater and Dr. Kang 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.

Well, of course you can chew gum and wear braces. But, should you chew gum and wear braces? That can be a sticky question.

For many years, the answer was a firm “No.” Not only did our favorite chewables literally gum up the (dental) works, but they were filled with loads of the sugar that cavity-causing bacteria love to feed on. The result? A much better chance of damage to your orthodontic work, and a higher risk of cavities near your brackets and wires.

But times, and gum recipes, change. Today’s sugar-free gum provides us with some new ideas to chew over.

• Sugarless gum is much less sticky than regular gum, so it is much less likely to stick to your appliance. If there is any chance that gum will damage your wires or brackets, we’ll let you know that it’s best to wait until your braces are off to indulge.
• Some orthodontic patients find that their jaws and ligaments are less sore if they chew gum for a few minutes after an adjustment.
• Most important, studies suggest that chewing sugarless gum might actually help prevent cavities from forming. How is that possible?

Because chewing gum increases our production of saliva! Okay, we don’t normally find saliva an exciting, exclamation-point-worthy topic, but let’s look at the dental benefits:

• Saliva washes away food particles and bacteria. And because braces can trap food when we eat, it’s great to have some help washing away any meal-time souvenirs.
• Saliva helps neutralize acids in the mouth. The acids found in foods and produced by oral bacteria lead to cavities, so diluting and neutralizing their effects provide important protection for our enamel.
• Saliva helps bathe the teeth in minerals that can actually rebuild weakened enamel. Acids in the mouth attack minerals in the enamel such as the calcium and phosphate that strengthen our teeth. Fortunately, saliva provides calcium, phosphate, and fluoride that can actually help rebuild weakened enamel.

So, should you chew gum and wear braces? The real question is, should you chew gum while you’re in braces? Dr. Quas, Dr. Wiater and Dr. Kang and our team are more than happy to provide the right answer for you! Talk to us at your next visit to our Bend, Redmond, Prineville, La Pine or Sisters OR office about the potential benefits and drawbacks of dentist-approved sugarless gum. Depending on the kind of gum you choose and the kind of orthodontic work you are having done, the answer just might surprise you.

If your child has just gotten braces, chances are it’s a good time to brush up on dental hygiene! Why now? What’s different? And how can you help? Let’s take a few minutes and explore these timely questions.

Brushing and Flossing Are Especially Important with Braces

There’s no getting around it, it’s harder to clean teeth with brackets and wires. But it’s essential to pay attention to dental hygiene. When bacteria and plaque start building up, your child is at risk for gum disease, cavities, and tooth discoloration.

• Gingivitis

This early stage of gum disease is the result of gum irritation caused by plaque. The gums become red, swollen, sore, and can bleed or start to recede. With proper brushing and flossing, gingivitis can be eliminated, along with the risk of developing more serious gum disease.

• Tooth Decay

One of the major reasons for cavities is the erosion of enamel caused by oral bacteria. These bacteria feed on sugars from our diet and produce acids that attack the tooth’s surface. Plaque, formed by a mass of these bacteria, sticks around brackets and the gum line, putting your child at risk for cavities near his orthodontic work—which might require removing wires and brackets to treat.

• Demineralization

When acids attack teeth, they remove the minerals from our enamel. This demineralization eventually leads to cavities, but in its early stages can cause white spots to appear where the mineral structure has been weakened. Braces wearers are at special risk for demineralization, especially around brackets and near the gums, where plaque can be missed while brushing.

Time for New Brushing and Flossing Techniques

Even if your child has always done a wonderful job of brushing and flossing, braces provide a new challenge for getting teeth their cleanest. Unfortunately, plaque buildup around the brackets and the gum line is all too common in orthodontic patients. Dr. Quas, Dr. Wiater and Dr. Kang can recommend some tools that make the cleaning process easier and more effective.

• Toothbrushes

Manual brushes are available with small, soft-bristled heads designed especially for braces wearers. If your child still has problems getting rid of plaque and food debris, an electric toothbrush might be helpful. And remember, encourage your child to be thorough but gentle for the sake of both braces and gums.

• Flossing with Braces

Flossing can be challenging for children at any time, but especially with braces. We’ll show you how floss threaders work, and how special flosses designed just for braces can fit under wires. This might also be a good time to invest in a water flosser. Your help demonstrating how to floss even with brackets and wires blocking the way will be appreciated by your child and your dentist!

• Products Just for Braces

Interproximal brushes are tiny cone-shaped brushes designed to fit around brackets and wires and between teeth. We can also suggest special toothpastes and rinses to help fight plaque and prevent cavities from developing. Ask us about what to shop for to make both of your lives easier.

You Can Help!

• Teamwork—Works!

When your child first gets braces, practice brushing and flossing together. Our Bend, Redmond, Prineville, La Pine or Sisters OR team will be happy to show you both the very best techniques for keeping teeth their cleanest and healthiest. Especially for young children, your help will make sure those techniques are learned and used.

• Make Time for Cleaning

Your child’s before-braces routine might have meant brushing two minutes each morning and two minutes at night. But thorough cleaning around brackets and wires might take a bit longer. (And, with braces, it’s best to brush after every meal rather than the common twice-a-day routine). Be available, at least at first, for a quick check to make sure braces and teeth are their cleanest. And you may have to help with removing and replacing bands until your child gets the hang of it.

• Be Prepared!

Whether it’s a day at school or an overnighter with friends, be sure your child has a kit filled with cleaning supplies ready to take along. A toothbrush, floss, an interproximal brush, toothpaste, a mirror—with these necessities, your child can keep on top of any cleaning emergencies.

For younger children especially, learning how to keep teeth and braces their cleanest can take some time. Be patient, be prepared, and be willing to help, and you and your child will have a new routine mastered—in no time at all!

Modern orthodontic technology has changed the way you wear braces. Brackets are smaller and come in a variety of shapes and colors. Wires are more efficient. Clear aligners can eliminate the need for brackets and wires altogether. And your high-tech advantages don’t stop there—today’s digital X-rays make creating your treatment plan even more convenient and efficient.

Why Are X-rays Necessary?

Beautifully aligned teeth and a healthy bite are the visible result of your orthodontic work, but there’s a lot going on above and below the surface that needs to be discovered and taken into account before your treatment even begins. X-rays help Dr. Quas, Dr. Wiater and Dr. Kang evaluate:

• The size, shape, and position of your teeth, including impacted teeth and wisdom teeth
• The size, position, and health of your roots throughout treatment
• The size and shape of your jaw bones, and how they affect your teeth alignment and bite
• Your progress during different phases of treatment
• The most effective type of retainer for protecting your beautiful smile after treatment.

How Do X-rays Work?

Traditional X-rays, or radiographs, make use of film just like traditional cameras. When you have an intraoral X-ray, for example, the film is sealed in a moisture- and light-proof packet, and placed inside the mouth to capture images of specific teeth and the bone around them.

The X-ray machine is aligned precisely with the film and an exposure is taken. The image at this point is latent, and won’t show on the film, because, just like photo film, traditional radiographs need to be chemically processed before they produce a visible image.

Digital technology, on the other hand, uses an electronic sensor instead of film. For an intraoral digital X-ray, a small sensor is positioned in the mouth just like a film. When the X-ray is taken, a digital image capture device produces an image which is formed by a matrix of pixels instead of a photo-like film exposure. This format allows the image to be sent directly to a computer for immediate display without requiring processing.

Even though these methods seem very similar, digital X-rays offer some significant advantages over traditional films. Let’s look at how they compare, more or less.

• More Diagnostic Advantages

A traditional X-ray is a fixed image. It cannot be modified or enhanced. Here the digital X-ray offers a clear advantage in evaluating your teeth and the bone structure surrounding them.

Just as you can enlarge certain types of images on your computer without blurring or losing detail, a digital X-ray uses computer software to magnify images while keeping their details sharp. They can also be enhanced through brightness and contrast applications to make details stand out even more.

There is even digital subtraction radiography software available that can be used to compare recent images to older ones, removing (“subtracting”) all the similarities in the two images to display only the changes in the two—even small changes—that have taken place over time.

• Less Exposure to Radiation

Modern technology means traditional X-rays expose patients to less radiation than ever before, but digital X-rays have significant advantages here as well. Radiation exposure can be reduced by an additional 10%, 20%, or more with a digital radiograph.

And while all types of dental X-rays expose you to very little radiation, it’s always best to reduce exposure whenever possible.

• More Convenient for Sharing and Transmitting

If you need to share your X-rays with another dentist or physician, digital technology allows you to simply have them e-mailed to another office or multiple offices. You no longer need to worry about preserving physical copies, either.

• Less Waste

Unlike traditional X-rays, digital X-rays don’t need to be processed, so you save time in the office. And while the processing time is not significant (usually several minutes), if you need to repeat some X-rays for a clearer picture, or require different images for several teeth, this time can add up.

Digital X-rays are also more eco-friendly.  The fact that they don’t need to be developed means that the chemicals used to process traditional films are no longer necessary—which also means that there is no need to dispose of chemical waste products afterward.

Our goal is to provide you with the safest, most efficient, and most effective treatment possible. Digital X-rays are an important tool for orthodontists, helping us to provide you with the best treatment plan possible. If you have any questions about digital X-ray technology, contact our Bend, Redmond, Prineville, La Pine or Sisters OR office. We’re happy to explain the science—and the benefits—behind this high-tech diagnostic tool.