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When does an underbite need surgery? The short answer is: when Dr. Paul Gates 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. Paul Gates 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 Round Rock, TX 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. Paul Gates 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. Paul Gates 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.

There's something special about customizing the elastics on your braces to fit your unique personality. Once you embrace your braces (no pun intended) you'll realize how many color options and combinations there are to choose from. Although you'll have a fantastic smile afterward, you won't have this level of customizability once your braces come off, that's for sure!

Adding flair to your braces isn't what all patients are looking to do (like those opting for clear aligners or ceramic braces), but it's part of the fun of traditional metal braces! Many of our patients ask Dr. Paul Gates to have their elastics match the colors of their favorite sports teams or their school, but how about changing your elastics to match holiday colors?

Here are some options to consider:

• Valentine’s Day – Red and pink
• Easter – Pink, blue, and violet
• Halloween – Orange and black
• Christmas – Red, green, and white
• Saint Patrick’s Day – Green and white

There are a few colors that some people choose to avoid. But if you’re trying to make your teeth stand out in a crowd, the following suggestions need not apply!

• Brown or Green – can be mistaken for food being stuck in your teeth
• Black – might look like a rotten tooth if someone isn't looking hard enough
• White – Some patients think it will make their teeth look whiter, but in fact it can make your teeth appear yellower than they actually are. White elastics can also stain easily.
• Yellow – accentuates the yellowness of your enamel

Since changing the color of your elastics has no effect on the actual orthodontic treatment process, the idea is to have fun and add a personal touch. So, next time you get your elastics changed at our Round Rock, TX office, why not wear your braces boldly and opt for something festive?

A clean mouth is a happy mouth. And when Dr. Paul Gates and our staff see you have a clean mouth, we are happy too. Of course, all of this should make you happy because you’re the one preventing sneaky little food bits from getting trapped under the wires of your braces.

Still, you need to be thorough with your brushing. When you have braces, you’re playing a game of hide-and-go-seek with everything you eat. Here are five tips to keep your mouth (and us) happy.

1. How is brushing with braces like geometry? It’s all about the angles. Brush the tops of your teeth and braces with your brush angled down. Brush the bottom of your teeth with the brush angled up. Pointy brushes, aka interproximal brushes, are good for reaching the tiny spots around braces.
2. Brush after every meal. If those sneaky little food bits hide in your mouth for very long, they’ll turn into plaque. And plaque is a sign of a very unhappy mouth.
3. Brush one tooth at a time for at least ten seconds, and pay close attention to the spots where your braces touch your teeth.
4. Fluoride is your new BFF. Make sure your toothpaste and mouthwash contain this cavity-fighting ingredient.
5. Braces are no excuse not to floss. In fact, saying you can’t floss because you have braces is like saying the dog ate your homework. Dr. Paul Gates and our staff, like your geometry teacher, aren’t going to buy it. Be sure to floss after every meal.

Imagine that you’re only going to brush your teeth once tomorrow. Don’t worry, we know you would never skimp on your dental hygiene like that, but let’s just pretend for a moment. When would be the best time to brush? When you wake up? During the day? Or perhaps before you go to bed?

Actually, whenever you choose to brush, you’ll receive important overall dental benefits as well as specific benefits tied to the time of day. Let’s explore your daily schedule to see why.

Brushing in the Morning

Brushing when you first jump out of bed produces several positive results.

• Cleaning plaque from your teeth

Plaque is a sticky film made up of oral bacteria, food particles, and saliva. As you sleep, these oral bacteria multiply and produce acids which attack the minerals in your enamel, leaving weak spots which, over time, can become cavities. Brushing removes these bacteria and acids from your enamel before they cause serious harm.

Moreover, plaque hardens if it’s left undisturbed, turning into tartar in a relatively short time. And once plaque becomes tartar, it must be removed by a dental professional. Brushing first thing in the morning removes this plaque buildup and helps prevent tartar from forming.

• Fresh breath

That bacterial growth we mentioned? It’s also responsible for morning breath. If nothing else, brushing when you wake up means greeting a fresh day with fresh breath, and that’s reason enough to pick up your brush in the morning.

Brushing During the Day

Brushing after meals and snacks also has a lot to recommend it.

• “Leftovers” lead to cavities

Foods, especially foods rich in sugar and carbohydrates, are converted by oral bacteria into acids which weaken enamel and lead to cavities. When food particles remain in the mouth after a meal, bacteria have more time and more fuel to manufacture these acids.

• Acidic foods also affect your teeth

If you have eaten something acidic, such as citrus fruits, sodas, or pickled anything, the acids from these foods can temporarily weaken the mineral strength of your enamel. But brushing immediately after eating or drinking acidic foods can damage weakened enamel. Better to rinse well with water and brush after half an hour or so.

• When you wear braces

One of the first things you discover when you get your braces is that you might need to brush more often. In fact, it’s best to brush after every meal and even every snack while you’re in braces.

Why? First, because no one wants to smile with food particles sticking to brackets and wires. Even more important, though, the filmy plaque which sticks to your enamel can be harder to remove with those brackets and wires in the way. Since plaque causes weakened enamel and cavities, brushing thoroughly is more important than ever when you wear braces.

• When you wear aligners

Wearing clear aligners means you don’t need to worry about food trapped in brackets or cleaning around wires. After all, you take them out when you eat. But this doesn’t mean you are home free. Brushing after every meal is also a good idea when you wear aligners.

Our teeth have an organic way to help wash away food particles, acids, and bacteria between brushings—saliva! Your aligners, while covering your teeth, decrease their exposure to saliva. It’s really important, then, to make sure you brush after eating. Otherwise, food particles and acids which remain on your teeth after eating are trapped in your aligners, increasing the risk of enamel erosion and decay.

Whether you wear braces or aligners, you’re especially at risk for food particles sticking around your teeth and in your orthodontic appliances. Talk to Dr. Paul Gates about when to brush your teeth after eating and how to keep your braces or aligners clean throughout the day.

Brushing at Night

Growing up, you probably received regular reminders to brush before bedtime—for several really good reasons:

• Saliva production slows while you sleep

During the day, saliva helps to wash away food particles and neutralize acidity in our mouths. It also contains proteins and minerals which help keep tooth enamel strong. But as we sleep, saliva production slows dramatically, and our bodies can’t remove bacteria and acids as effectively.

• Food particles fuel bacterial growth

If you haven’t brushed since morning, you’ve accumulated a whole day’s worth of food particles from meals and snacks. Remember, oral bacteria use the sugars and carbs we eat as fuel to produce the acids which attack our tooth enamel throughout the night.

• Brushing helps prevent both of these problems

Brushing your teeth before bed not only cleans away the accumulated food particles of the day, but also eliminates the plaque and bacteria which would have a much easier time sticking to your teeth without that daytime saliva flow to wash them away.

So, When’s the Best Time to Brush?

In the morning, during the day, at night—there are solid advantages to brushing any time of day. The question isn’t so much when to brush as how often you should brush.

While many dental professionals consider brushing before bedtime as the most important brush of the day, brushing at least two full minutes, at least twice during a 24 hour period, is a necessity for basic dental hygiene, along with flossing at least once a day.

When you’ve been eating sugary snacks, when you’re showing signs of gingivitis or getting more than your share of cavities, when you want to reduce the chance of plaque and tartar buildup, or when you simply want to make sure you’re doing everything you can to maintain your overall dental health, brushing after meals is also highly recommended.

And when you wear braces or aligners, frequent brushing (and flossing) is the very best way to make sure your teeth stay clean and cavity-free.

Talk to Dr. Paul Gates about your brushing habits at your next appointment at our Round Rock, TX office. No need to use your imagination to plan your best brushing schedule. We have all the answers you need to help you brush your way to your best—and healthiest—smile!