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When does an underbite need surgery? The short answer is: when Dr. Elizabeth Hite, DMD, MS 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. Elizabeth Hite, DMD, MS 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 Edwardsville 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. Elizabeth Hite, DMD, MS 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. Elizabeth Hite, DMD, MS 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 are many great reasons to see an orthodontist. For a healthier bite. For straighter teeth. For a more confident smile. So why are you hesitating? If the visibility of traditional braces is what’s holding you back, ask Dr. Elizabeth Hite, DMD, MS about lingual braces.

With regular braces, brackets are bonded to the front of each tooth with a special adhesive. Ligatures around each bracket or bracket clips grip an archwire, which does the work of moving the teeth. The gentle pressure from the wire guides the teeth into alignment in gradual stages. Every adjustment moves the teeth to their perfect positions. These braces are quite effective—and they are usually quite visible.

Lingual braces, on the other hand, are virtually invisible. Lingual means “toward the tongue,” and this placement is the difference between lingual braces and more traditional types of orthodontic braces.

Lingual braces are custom designed to be applied to the inside of your teeth. Specially designed brackets are attached to the backs of the teeth. Individually crafted archwires are used to guide your teeth to their best alignment.

Lingual braces can be the solution to many orthodontic concerns:

• If you need or want invisible braces for personal or professional reasons, lingual braces are a great option. Because they are behind your teeth, they are even less noticeable than clear aligners—and you don’t need to keep track of your hours wearing them.
• Lingual braces keep the front of your teeth braces-free for playing a brass or reed instrument, or for participating in sports. (Just remember, a mouthguard is always a good idea for athletic activities, and especially when you wear braces.)
• Both brackets and wires can be customized to fit your teeth perfectly, and new lingual brackets and wires are more comfortable than ever.

You might be a good candidate for lingual braces if:

• You have a large enough tooth surface to place a bracket. Adults with small teeth—or children—might not be have enough room on the back of each tooth to hold a bracket.
• You don’t have a major malocclusion (bite problem) which would make lingual braces impractical. A deep overbite, for example, could cause the wires and brackets behind the upper teeth to come loose or detach as they come in contact with lower teeth.
• You are dedicated to keeping up with your oral hygiene. Because wires and brackets are behind the teeth, it can be harder to keep them free from food particles and plaque.

Finally, even if lingual braces aren’t the perfect match for your orthodontic needs, there are other options that can work for you. Smaller metal brackets, ceramic brackets that blend in with your enamel, and clear aligners mean today’s orthodontic work is more subtle and discreet than ever before.

For a healthier bite, for straighter teeth, for a more confident smile—don’t hesitate. Contact our Edwardsville office to discuss the many great options you have available to give you the smile you’ve always wanted—front and center.

Healthy teeth make you happy to share your smile with the world. But there’s more to your smile than its beauty! There’s a lot of hard work going on, too. 

Teeth Are Designed for Efficient Eating

Because humans are omnivores, we can eat both meat and plants. That’s why our teeth have different shapes—they’re meant to help us process different types of food. 

• Incisors, our front teeth, have sharpish edges to help cut through meats and other firm foods when we bite.
• Canines, the pointed teeth, help tear food into bite-size portions.
• Premolars are flat topped teeth with two cusps, raised points which help us grind food.
• Molars are the flat-topped teeth in the rear of the mouth. They have four cusps to grind and crush food into a paste-like consistency. 

So: Incisors and canines bite and tear food into smaller pieces, which molars and premolars then crush and grind into a paste. Bite, tear, crush, grind—why all this food aggression? Because that’s the key to healthy digestion. 

Successful digestion begins with chewing. Chewing:

• Starts the process of breaking food down into digestible particles.
• Increases saliva production. Saliva binds food particles so that we can swallow easily.
• Expands the surface area of food particles, which allows the digestive system to extract nutrients more efficiently. 

When biting causes you pain, it can be hard to chew food. Swallowing becomes difficult when food particles are too large, and digestion becomes uncomfortable.

Bite pain can occur when there’s a deep cavity or an injured tooth, but it can also be caused when the teeth and jaws don’t fit together the way that they should. This misalignment is called a malocclusion, or bad bite. And while a malocclusion often makes eating more difficult, it can have further damaging effects as well.

Teeth Are Designed to Be Good Partners

While eating is probably the first thing that comes to mind when we think about dental duties, our teeth also work in coordination with other parts of our bodies. A malocclusion can interfere with these normally smooth interactions, affecting:

• Tooth and Jaw Health

Biting, chewing, and clenching put hundreds of pounds of pressure on our teeth and jaws. A misaligned bite misapplies this pressure, which can lead to damaged and unevenly worn teeth, tooth grinding, headaches, jaw pain, and other problems. 

• Speech

Our teeth work with our tongues and lips to form many of the phonetic sounds which make up speech. Try saying the word “teeth,” and see how your tongue and teeth work together! Misaligned teeth and jaws can affect speech development in children and pronunciation in children and adults.

• Face Shape

Our teeth and jaws help give shape to our faces. Alignment problems can affect facial symmetry and self-confidence.

You Can Help Your Teeth Work Their Best

Daily brushing and flossing, eating a healthy diet, and regular visits to your dentist for exams and cleanings help your teeth perform their many daily duties. But if bite problems are causing troubles with eating, tooth or jaw pain, difficulty speaking, or self-consciousness, it’s time to team up with your orthodontist. 

And just like your everyday dental care, orthodontic treatment works best with your active participation. 

• Make sure your teeth are their cleanest with careful brushing and flossing. You may need to brush and floss more often while you’re in treatment.
• If you wear braces, eat a braces-friendly diet. 
• Wear aligners, bands, or appliances for the hours recommended each day.
• Keep up with your orthodontic visits to keep your treatment on schedule.

Talk to your orthodontist to learn more about how to help your teeth work their best for you—and be ready to share that beautiful, hard-working smile!

Do you ever find yourself gnawing at your nails? Nail-biting is a very common and difficult to break habit which usually has its beginnings in childhood. It can leave your fingers and nail beds red and swollen. But if you think that your nails are the only ones getting roughed up by nail-biting you'd be mistaken—so are your teeth!

According to a study by the Academy of General Dentistry, those who bite their nails, clench their teeth, or chew on pencils are at much higher risk to develop bruxism (unintentional grinding of the teeth). Bruxism can lead to tooth sensitivity, tooth loss, receding gums, headaches, and general facial pain.

Those are some nasty sounding side effects from chewing on your nails. Most nail-biting is a sign of stress or anxiety and its something you should deal with. So what steps can you take if you have a nail-biting habit?

There are several things you can do to ease up on nail-biting:

• Trim your nails shorter and/or get regular manicures – Trimming your nails shorter is an effective remedy. In so doing, they'll be less tempting and more difficult to bite on. If you also get regular manicures, you’ll be less likely to ruin the investment you’ve made in your hands and fingernails!
• Find a different kind of stress reduction – Try meditation, deep breathing, practicing qigong or yoga, or doing something that will keep your hands occupied like squeezing a stress ball or playing with a yo-yo.
• Wear a bitter-tasting nail polish – When your nails taste awful, you won't bite them! Clear or colored, it doesn't matter. This is also a helpful technique for helping children get over the habit.
• Figure out what triggers your nail-biting – Sometimes it's triggered by stress or anxiety and other times it can be a physical stressor, like having hang nails. Knowing what situations cause you to bite your nails will help you to avoid them and break the habit.
• Wear gloves or bandages on your fingers – If you've tried the steps above and they aren't working, this technique can prove effective since your fingernails won't be accessible to bite.

If you're still having trouble with nail-biting after trying these self-help steps, it's best to consult your doctor, dermatologist, or Dr. Elizabeth Hite, DMD, MS. For some, it may also be the sign of a deeper psychological or emotional problem.

Whatever the cause, nail-biting is a habit you need to break for your physical and emotional well-being. If you have any questions about the effects it can have on your oral health, please don't hesitate to ask Dr. Elizabeth Hite, DMD, MS during your next visit to our Edwardsville office.