When does an underbite need surgery? The short answer is: when Drs. Cartsos and Zavras 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?

Drs. Cartsos and Zavras 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 Chestnut Hill, Massachusetts 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 Drs. Cartsos and Zavras 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 Drs. Cartsos and Zavras 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.

Kids are constantly active and constantly growing. No wonder they’re constantly hungry! When it’s time for a snack, here are some tips to make between meal treats timely, tasty, and tooth-friendly.

Keep snacks to a minimum

Every time we eat, we’re also providing food for the bacteria in our mouths. Bacteria use sugars to produce acids. These acids weaken our enamel and can lead to cavities. Luckily, we have a natural way of protecting our teeth. Saliva washes away food particles and bacteria, and even provides substances that strengthen our teeth in the hours between meals.

When we eat throughout the day, there is no chance for this recovery period to take place. Small children aren’t usually able to get through the day without a few snack periods, which is perfectly normal. Just try to make sure that snacking doesn’t become all-day grazing!

Avoid foods that contain sugar and carbohydrates at snack time

We know that sugar leads to an increased chance of cavities because bacteria convert this sugar into acids that damage our enamel. But carbohydrates should also be in the no-snack zone. Why? Because carbohydrates break down into sugar very quickly. So while you wouldn’t offer your child a daily mid-afternoon snack of sodas and chocolate bars, those muffins, doughnuts, chips, and bagels should be on the “special treat” list as well.

Dental-healthy snacks

Luckily, we are left with many healthy and convenient choices when your child needs a nibble.

• Crunchy, crisp fresh fruits and vegetables provide vitamins as well as a gentle scrubbing action to help clean teeth. They are also rich in water, which helps us produce the saliva that naturally washes away food particles and bacteria.
• Low-fat yogurts and cheeses provide essential calcium for strong teeth and the vitamin D that helps us absorb calcium.
• Whole grain breads, cereals, and crackers are healthier than products made only with white flour because they retain valuable vitamins and minerals that have been removed from refined grains.
• Lean meats, peas, legumes, and eggs provide protein that helps build connective tissue and maintain tooth structure.
• Water helps stimulate saliva production and provides cavity-fighting fluoride. Win/win!

You are constantly looking for ways to make your children’s lives better. Mix and match any of these foods for a snack that’s not only good for their teeth, but rich in the proteins, vitamins, and minerals needed to keep them active and growing throughout their school years. If you have questions about your child’s dietary needs, feel free to ask Drs. Cartsos and Zavras at our Chestnut Hill, Massachusetts office.

Your infant’s first teeth will begin to appear around six to 12 months of age. You might wonder how important these primary teeth really are. After all, baby teeth are destined to fall out within a few years and be replaced by a full set of permanent teeth. However, baby teeth have important functions, and proper care can set the stage for excellent oral and overall health.

Promote Better Nutrition

The appearance of your baby’s primary teeth around six to 12 months of age coincides with changes in your infant’s nutritional needs. Beginning at six months, exclusive breastfeeding is no longer nutritionally sufficient; this is the age at which you should introduce solid foods.

At six to eight months, when your baby can start to chew, strained or pureed fruits and vegetables are appropriate. As your little one’s teeth grow in and chewing abilities progress through 12 months of age, you can gradually add cereal, bread, cooked meats, and other adult foods to his or her nutritious diet.

Increase the Life Expectancy of Baby Teeth

Although baby teeth are inevitably going to fall out and be replaced by permanent ones, making baby teeth last serves an important role that can have benefits into the future. Baby teeth serve as placeholders for permanent teeth. If they decay and fall out too soon, permanent teeth are more likely to grow in crooked.

How to Take Care of Baby Teeth

Your baby’s primary teeth are already in his or her mouth at birth; they are just invisible because they have not broken through the gums. Since they are already present, your baby can get cavities if you do not practice proper oral hygiene from the beginning.

• Do not let your baby fall asleep with a bottle in his or her mouth.
• Brush your child’s baby teeth twice a day as soon as they come in.
• Floss your child’s teeth as soon as he or she has two teeth that touch.
• Visit Convivial Dental for your baby’s first checkup when the first tooth arrives.

Perhaps you are already planning for the years when your teenager will need orthodontic work. But hearing that your seven-year-old would benefit from orthodontic treatment? That might come as a complete surprise! It’s a recommendation with real benefits, though—early intervention can save children from tooth and bite problems now, and even simplify their future orthodontic care.

Treating young children for orthodontic problems is called “interceptive orthodontics.” When the permanent teeth start arriving, there might be problems with spacing, bite or protruding teeth. Often, treatment while the bones are still growing is the best way to prevent more serious problems later.

We recommend that your child have an orthodontic consultation with Drs. Cartsos and Zavras around the age of seven. This exam is especially important for children who may have been thumb suckers or used a pacifier after the age of three, or if you notice obvious teeth, speech or bite issues.

• Crowding and Spacing Issues

Teeth are arranged in two crescent shapes called arches. When the arch of your child’s mouth is small, the permanent teeth can become very crowded as they erupt. Formerly, teeth were removed to make more room. Now, early use of a palatal expander can enlarge the upper dental arch in order to help the permanent teeth come in without crowding. The need for future tooth extraction is reduced, and there is a better chance for correct spacing and alignment with early treatment.

On the other hand, when a child loses a tooth too soon, too much space left between baby teeth can also be a problem. The remaining teeth can shift, leaving the wrong place open for the adult tooth to come in. We might recommend a space maintainer so that there is no shifting of the teeth and there is room for the proper adult tooth to erupt in its proper spot.

• Malocclusions (Bite Problems)

Some malocclusions, like a crossbite, can be caused by problems with jaw and facial structure. Again, we might recommend a palatal expander to help the upper arch of the teeth to fit properly with the lower jaw. Problems with overbite, open bite and other bite issues can also be addressed at this age if necessary. Early care can discourage TMJ (temporomandibular joint) disorders, reduce speech problems, and improve facial symmetry. 

• Protruding Front Teeth

Teeth that protrude are much more likely to be damaged when playing or after a fall. Methods such as braces or appliances can reposition them and protect them from breaking or fracturing.

Many children will not need early intervention, and many can wait until they are older for orthodontic work. But if your young child has orthodontic problems that should be addressed, early intervention can do more than set the stage for successful orthodontics in the teen years. Talk to our Chestnut Hill, Massachusetts team about what we can do for your child. Interceptive orthodontics can protect teeth, guide jaw and speech development, modify harmful oral habits and help to adjust bite problems before they become serious—when it comes to your child’s dental health, the best solutions are early ones!