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When does an underbite need surgery? The short answer is: when Dr. Asbury 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. Asbury 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 San Diego 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. Asbury 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. Asbury 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.

We’ve probably all seen that unhappy kid or frazzled parent sifting through trash for a lost retainer. If we’re really unlucky, we might have been that unhappy kid or frazzled parent sifting through the unpleasant remains of third period lunch hour. But getting tossed isn’t the only risk these appliances face. Read on for ways to keep your retainer (and your parent!) happy.

• Keep Your Retainer With You

Always carry a retainer case. If you automatically put your retainer in its case when you’re eating, you are much more likely to remember it then if it has been wrapped up in a napkin on your lunch tray. And, if the worst happens, much more likely to recover it in one piece.

Choose the brightest colored case you can live with, so you will have an easier time locating it if need be, and discuss how to label the case to get it back safely to you--just in case.

• Keep Your Retainer Intact

You might think if you put your retainer in your backpack, or purse, or saxophone case, or athletic bag, it will be safe. It will not. Retainers are designed to be tough enough for everyday wear, but being tossed on the floor while inside a backpack is not everyday wear. Always put your retainer back in its (brightly colored) case before packing it away.

Retainers can warp if they are exposed to heat, so keep them away from potential heat sources like stoves, microwaves, and washers and dryers. Even your car dashboard can become hot enough to warp your retainer. And never use boiling water to clean them.

Finally, your dog might find your retainer to be the #bestchewtoyever, so be sure to put it in a spot pets can’t reach when you’re not wearing it.

• Keep Your Retainer Clean

Just like plaque can build up on your teeth, minerals and calcium can build up on your retainer. Different types of retainers require different cleaning methods, so talk to Dr. Asbury about how to keep your retainer clean and bacteria-free. We will be happy to give you instructions on the best way to take care of your particular appliance. And don’t forget to clean your case regularly!

Accidents will happen, of course. If your retainer is lost or damaged, call our San Diego office as soon as possible. We might be able to fix minor damage, and, if needed, we can replace a lost retainer quickly.

Your time in braces is over, but your teeth are still stabilizing in their new, healthy positions. Wearing your retainer regularly is the final step in producing the beautiful smile you’ve worked so hard for. Keep your retainer clean, keep it safe, and keep it with you, and you can enjoy that smile now and for years to come!

These days it's becoming more and more common to see adults at our San Diego office getting their teeth straightened with Invisalign clear aligners — that is, if you can see them! Treatment with Invisalign is effective and aesthetically pleasing for all ages, but adults have certainly taken to them.

For some it may be to overcome the stigma that "braces are just for kids," but for others it may be the displeasing appearance and discomfort of traditional braces. According to the American Association of Orthodontics, from 1994 to 2010 the number of adults 18 and older getting braces increased by 58 percent, from 680,000 to 1.1 million annually. Many of these adults opt for Invisalign because of how discreet they are and since they don't need to avoid any foods or make dietary changes like you do with traditional braces.

The benefits of getting your teeth into proper alignment are many, and so are the advantages of Invisalign. By following your individual course of Invisalign treatment, you can expect to enjoy the following benefits over traditional braces:

• The total treatment time is more precise with Invisalign since your treatment is modeled by a computer, as compared to traditional braces where it is really just an estimate.
• You'll need to make fewer trips to our San Diego office since you can change your trays on your own every few weeks or as prescribed.
• There's less risk to the health of your tooth enamel since there is no need to place brackets on your teeth.
• Invisalign aligners are clear and practically invisible, so most people won't even know you're wearing them!

If you're interested in Invisalign treatment, please let Dr. Asbury know. We'd be happy to help you on your journey to a straighter, healthier smile!

It's the end of summer, and fall is just around the corner. Soon the temperatures will cool down, the leaves will start to change, and Dr. Asbury and our team at Braces San Diego are sure that you’ll soon be thinking about Halloween costumes and Thanksgiving plans in no time. But wait! First, we want to know about your favorite parts of the summer! Did you go on a wonderful family trip? Did you pick up a new hobby? Did you try to spend as much time outside and in the sun as possible?

Share your favorite memories, stories, or photos with us by leaving a comment below or on our Facebook page.