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When does an underbite need surgery? The short answer is: when Dr. Andrew Schwartz 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. Andrew Schwartz 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 Washington DC 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. Andrew Schwartz 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. Andrew Schwartz 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 devote a lot of energy to your orthodontic treatment. Appointments, rubber bands, adjustments, cleaning (so much cleaning)—and why? Because you know that your attractive, healthy smile will be well worth the effort.

But if you find that keeping your teeth and braces clean requires more time and energy than it should, and you’re still not getting the results you’d like, a water flosser might be just the tool you need to help make your cleaning routine easier and more effective.

Plaque and tartar can be a real problem when you wear braces. Cleaning around braces and wires can be a challenge, and it can be difficult to get floss between your teeth and close to your gums, even with special threaders or floss designed to slip behind your wires.

But ignoring bacteria and plaque build-up can lead to cavities, weakened or discolored enamel, and gum problems. Fortunately, a water flosser can help wash away food particles, bacteria, and plaque even in tight, hard-to-reach spaces, while providing gentle cleaning along sensitive gums.

Water flossers use a pulsing stream of water to remove food particles and plaque between and around teeth. You can adjust the water pressure to apply just the right amount of cleaning power, and then direct the flow to your gum line, between your teeth, around your brackets, or anywhere else you need. Some models even offer tapered heads with brushes designed specifically for cleaning braces.

You might consider investing in a water flosser if you have:

• Mobility issues. If you have joint or mobility issues, a water flosser will let you clean those hard-to-reach areas more easily.
• Lingual braces. Because lingual braces are on the inside of the teeth, they can be more difficult to clean effectively with regular brushing and flossing.
• Problems removing plaque. If you find that you are brushing and flossing regularly, but still have plaque build-up around your braces, give water flossing a try.

A beautiful smile is well worth all the time and effort you are devoting to it. If you think a water flosser might save you a bit of that time and effort, and provide better cleaning power, talk to Dr. Andrew Schwartz  about your options during your next visit to our Washington DC office. We’ll let you know if traditional flossing, a water flosser, or a combination of the two will give you your cleanest, healthiest smile.

Your dashboard lights up when your car needs an oil change. Your family smoke detector beeps when you need to switch out the batteries. But when it’s time to replace your toothbrush, you’re on your own. Luckily, there are several not-too-subtle clues that you should be shopping for a new model.

• Fraying

Is your toothbrush looking a bit scruffy? Do those once orderly bristles look like they have the toothbrush equivalent of bed head? Have some bristles vanished altogether? Time to retire that toothbrush. Once the bristles are frayed, you just can’t reach plaque as effectively, especially where it likes to hide between the teeth.

Are you prematurely fraying? You could be brushing too hard. Overbrushing can injure delicate gum tissue, cause wear and tear to tooth enamel, and even damage your braces. If you find your brush fraying after only a few weeks of use, you might be using too much force. Remember, plaque is a sticky film, but it’s a soft sticky film. Ask us for advice on just how hard you need—or don’t need—to brush.

• Odor

This one really goes without saying—no one wants an aromatic toothbrush! How to make sure your toothbrush is fresh and clean?

Always rinse carefully after you brush. This will get rid of any toothpaste, bits of food, or other particles left on your brush.

Let your toothbrush air dry. It might seem more hygienic to keep your brush covered in a bathroom setting, but a closed, moist container is a perfect breeding ground for germs. Don’t let them make a home in your bristles!

• Illness

A cold or a bacterial infection (like strep throat) is no fun. But now that you’re feeling better, it might be time to throw out your toothbrush. The chances of re-infection are very low, unless your immune system is compromised, but this is a perfect opportunity to replace your brush with a fresh, germ-free model.

And if you share your toothbrush, or if you store it right next to a family member’s (which you really shouldn’t do, for this very reason), germs get shared, too. Quarantine your brush while you’re ill, and replace it once you’re out and about.

• Discomfort

Bigger isn’t necessarily better. A brush with a head that’s too big won’t allow you to get into those small spaces in your mouth where plaque likes to collect. And when you are trying to clean around brackets and wires, a regular brush might be a problem. Ask Dr. Andrew Schwartz for suggestions for the best tools for clean and comfortable brushing.

Also, harder doesn’t mean more effective. A brush with hard bristles can cause damage to your gums and enamel. We almost always recommend soft-bristled brushes for this every reason.

There are so many styles of brush out there, you’re bound to find the perfect fit with a little trial and error. Or ask us for suggestions the next time you’re at our Washington DC office for an adjustment!

• You’ve Passed the “Best By” Date

Because of its durable construction, your toothbrush can last a long, long time. But no matter how comfortable and effective your toothbrush is right now, it was never meant to go through life with you. Bristles break down over a period of a few months, and just don’t clean as effectively. Your brush should be changed every three months, and this includes changing the head on your electric toothbrush. And because you wear braces, you’re brushing more often, so that three month lifespan might be stretching it.

Unfortunately, you don’t have a flashing light or annoying beep to remind you when it’s time to change brushes, so you’ll have to devise your own reminders. Reminder apps, calendar notes, the first day of a new season—use whatever works best for you. 

Don’t ignore the clues your toothbrush is leaving you. Replacing your brush whenever it’s necessary helps guarantee that the time you spend cleaning your teeth and gums will lead to confident, healthy smiles. Case closed!

Getting braces is a huge step in creating the beautiful smile you want. It’s easy to see how important your wires and brackets are. Week by week, you and your family and friends can see the progress you’re making as your teeth become straighter. That makes all the careful brushing, periodic adjustments at our Washington DC office, and annoying loose ligatures worthwhile.

And while straight, even teeth are the visible reward you get for your months in braces, there’s a benefit that’s every bit as important that might go unnoticed by your friends and family—a healthy, properly aligned bite.

Many people have some kind of malocclusion, or bad bite. There are several different bite problems we treat. Some of the most common are:

• Overjet (the upper front teeth protrude too far forward over the bottom teeth)
• Underbite (the bottom teeth overlap the top teeth)
• Crossbite (one or more teeth haven’t come in in the proper position, often with an upper tooth fitting inside a lower tooth)
• Open bite (the upper and lower front teeth don’t touch).

When the jaws and teeth don’t fit together properly, you might be looking at damaged teeth, headaches, and painful problems with the temporomandibular joint, or jaw joint, in your future. That’s why correcting your bite early is so important. Using rubber bands with your braces is one of the most popular and effective ways to help create a better bite.

Bands are used with your braces to gradually move your teeth into their best position. Specially designed brackets with tiny hooks are bonded to very specific teeth. Why so specific? Because the placement of the brackets depends on which type of malocclusion we are correcting. Rubber bands are then attached to the bracket hooks, usually from an upper tooth to a lower one. When they are in just the right position, those little bands provide just enough force to move your teeth more quickly and effectively than braces alone can.

If you need bands to help correct any kind of malocclusion, you will play a very important part in your orthodontic treatment. It will be your job to attach your bands every day. Don’t worry—while it can seem confusing at first, we’ll make sure you know exactly how and where to place them.

How long should they stay in? You’ll probably need to wear your bands 24 hours a day. It’s while you’re moving your mouth and jaw muscles that your bands are working their hardest. Talk to us about removing them for brushing and flossing, and whether you should wear them while you eat.

Can you use the same bands over several days? Not a good idea. Bands are selected for size and strength to move your teeth very precisely from visit to visit. When bands stay on too long, they become too stretched out to supply the proper pressure needed to move your teeth efficiently. Dr. Andrew Schwartz will let you know how long is too long for your specific bands.

Are two bands better than one? Absolutely not. Again, the bands you’re given at each visit are designed for your specific needs. Too much pressure can actually be harmful. Just keep to your recommended schedule of replacing bands, and your orthodontic treatment will stay right on track.

Attaching rubber bands? Keeping them on all during the day? Replacing them as needed? All of these responsibilities might seem a bit overwhelming at first, but we are here to give you all the information and support you need to succeed. Because straight, even teeth and a bite that is healthy and functional? That’s truly how you create your beautiful smile!