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When does an underbite need surgery? The short answer is: when Dr. Frech 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. Frech 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 Wichita Falls, 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. Frech 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. Frech 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.

One of the most common reasons for choosing clear aligners is that they are just that—clear! You can achieve a healthy, beautiful smile without the more obvious wires and brackets of traditional braces. But if your aligners are noticeably stained well before it’s time to replace them, you can be facing days or weeks of self-conscious smiles.

Luckily, this problem is preventable. Let’s look at some of the common causes of aligner discoloration and how to avoid them.

• Beverages that Stain Teeth Stain Aligners

You take your aligners out to eat, of course, but do you always remember to remove them when you drink a beverage? Red wines, coffee, tea, dark juices, and sodas don’t just cause enamel staining—they can discolor your aligners as well. Even worse, drinking an acidic or sugary drink with your aligners on gives that acidic, sugary beverage an opportunity to bathe your teeth in acids and sugar over a period of time. Keep your aligners (and your enamel) protected by removing them when you drink anything other than water, and brush your teeth before you replace them. If you absolutely can’t remove aligners, a straw will reduce the risk of staining.

• Soaking in Mouthwash

Mouthwash is a way to keep your teeth and mouth fresh-smelling and free from bacteria. You also want your aligners to stay fresh and bacteria-free. So, what could be the problem in giving your aligners a good soak? Well, sometimes a colorful mouthwash can stain your aligners to match! If you’re not a fan of tinted aligners, talk to us about the safest ways to use mouthwash with your appliance.

• Using Harsh Cleaners

There are products specifically made for aligners which will keep them their cleanest and clearest. Harsh cleaners and even toothpastes can be abrasive, leaving visible scratches or cloudiness. We’re happy to recommend the best and safest cleaning products for your aligners.

• Inadequate Cleaning

Plaque, that bacteria film that can stick to your enamel and around your gum line, can also stick to your aligners. If you notice a white film on your appliance, it could be plaque. Thorough and regularly scheduled cleanings are essential. Talk to us about the best schedule and methods for keeping your aligners not only clear, but sanitary.

What if, despite taking precautions, your aligners do get stained? If your aligners are new, we might be able to offer you some suggestions to get you through the next week or so. If you are almost ready for your next set of aligners, you might have no problem waiting. But the simplest solution to stained aligners is prevention.

Talk to Dr. Frech at our Wichita Falls, TX office about how to keep your aligners looking their best—and least visible. Whether it’s diet suggestions or the most effective soaking and cleaning techniques, we have the answers to ensure your brightest, most confident smile. After all, isn’t that one of the reasons you chose clear aligners?

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. Frech 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. Frech about your brushing habits at your next appointment at our Wichita Falls, 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!

Modern orthodontic technology has changed the way you wear braces. Brackets are smaller and come in a variety of shapes and colors. Wires are more efficient. Clear aligners can eliminate the need for brackets and wires altogether. And your high-tech advantages don’t stop there—today’s digital X-rays make creating your treatment plan even more convenient and efficient.

Why Are X-rays Necessary?

Beautifully aligned teeth and a healthy bite are the visible result of your orthodontic work, but there’s a lot going on above and below the surface that needs to be discovered and taken into account before your treatment even begins. X-rays help Dr. Frech evaluate:

• The size, shape, and position of your teeth, including impacted teeth and wisdom teeth
• The size, position, and health of your roots throughout treatment
• The size and shape of your jaw bones, and how they affect your teeth alignment and bite
• Your progress during different phases of treatment
• The most effective type of retainer for protecting your beautiful smile after treatment.

How Do X-rays Work?

Traditional X-rays, or radiographs, make use of film just like traditional cameras. When you have an intraoral X-ray, for example, the film is sealed in a moisture- and light-proof packet, and placed inside the mouth to capture images of specific teeth and the bone around them.

The X-ray machine is aligned precisely with the film and an exposure is taken. The image at this point is latent, and won’t show on the film, because, just like photo film, traditional radiographs need to be chemically processed before they produce a visible image.

Digital technology, on the other hand, uses an electronic sensor instead of film. For an intraoral digital X-ray, a small sensor is positioned in the mouth just like a film. When the X-ray is taken, a digital image capture device produces an image which is formed by a matrix of pixels instead of a photo-like film exposure. This format allows the image to be sent directly to a computer for immediate display without requiring processing.

Even though these methods seem very similar, digital X-rays offer some significant advantages over traditional films. Let’s look at how they compare, more or less.

• More Diagnostic Advantages

A traditional X-ray is a fixed image. It cannot be modified or enhanced. Here the digital X-ray offers a clear advantage in evaluating your teeth and the bone structure surrounding them.

Just as you can enlarge certain types of images on your computer without blurring or losing detail, a digital X-ray uses computer software to magnify images while keeping their details sharp. They can also be enhanced through brightness and contrast applications to make details stand out even more.

There is even digital subtraction radiography software available that can be used to compare recent images to older ones, removing (“subtracting”) all the similarities in the two images to display only the changes in the two—even small changes—that have taken place over time.

• Less Exposure to Radiation

Modern technology means traditional X-rays expose patients to less radiation than ever before, but digital X-rays have significant advantages here as well. Radiation exposure can be reduced by an additional 10%, 20%, or more with a digital radiograph.

And while all types of dental X-rays expose you to very little radiation, it’s always best to reduce exposure whenever possible.

• More Convenient for Sharing and Transmitting

If you need to share your X-rays with another dentist or physician, digital technology allows you to simply have them e-mailed to another office or multiple offices. You no longer need to worry about preserving physical copies, either.

• Less Waste

Unlike traditional X-rays, digital X-rays don’t need to be processed, so you save time in the office. And while the processing time is not significant (usually several minutes), if you need to repeat some X-rays for a clearer picture, or require different images for several teeth, this time can add up.

Digital X-rays are also more eco-friendly.  The fact that they don’t need to be developed means that the chemicals used to process traditional films are no longer necessary—which also means that there is no need to dispose of chemical waste products afterward.

Our goal is to provide you with the safest, most efficient, and most effective treatment possible. Digital X-rays are an important tool for orthodontists, helping us to provide you with the best treatment plan possible. If you have any questions about digital X-ray technology, contact our Wichita Falls, TX office. We’re happy to explain the science—and the benefits—behind this high-tech diagnostic tool.