Our Blog

When does an underbite need surgery? The short answer is: when Dr. Clark Knowlton 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. Clark Knowlton 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 Sherman 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. Clark Knowlton 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. Clark Knowlton 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.

It's springtime and it's again time to remind our patients at Knowlton Family Orthodontics, to protect their faces and pearly whites while out on the field playing sports. According to the National Youth Sports Safety Foundation, children, high-school athletes and adults have more than 5,000,000 teeth knocked out in sporting events annually.

If you are planning on participating in spring sports, it’s imperative to have a proper-fitting mouthguard. Mouthguards can prevent chipped or broken teeth, lip and cheek injuries, jaw fractures, mouth lacerations and even concussions.

Having a mouthguard can make the difference between losing your teeth or not, and because many of our patients who play high school sports have jaws that are still growing, last year’s mouthguard may no longer fit as it should. Dr. Clark Knowlton and our team at Knowlton Family Orthodontics, can fit you for a new guard.

To learn more about mouthguards or for general questions about your treatment at our Sherman office, please give us a call!

If you are a student of Speech or Drama, you know how important it is to be clear and articulate. You’ve worked on pronunciation and projection, and the audience in the back row can understand every word.

And now you’ve gotten braces, and, suddenly, you don’t sound quite like yourself. Why? And, more important, what can you do?

• Don’t Panic!

Many patients see no change at all in their speech after getting braces. With some orthodontic conditions or appliances, you might have problems pronouncing certain sounds, but these changes in articulation are usually quite temporary. 

• Why Are You Sounding Off?

Every consonant is formed in a precise way as tongue, lips, and teeth work together. If you have brackets and wires in the way, or just got a new retainer, or have a set of aligners, you might find that your articulation is a little off, especially for sibilant sounds such as S’s and Z’s. Luckily, we humans are a flexible bunch, and it usually takes a very short time for our tongues and mouths to adapt to orthodontic appliances and return to normal pronunciation.

If your speech is affected at first because your lips and cheeks are sore or sensitive after getting braces, take time to take care of yourself! Use wax as often as needed to cover irritating brackets and wires, eat foods that are low in salt, spice, and acids, and follow your orthodontist’s instructions for taking care of your mouth. You should start feeling better within a few days, and should be fine after a week or two. If pain or discomfort persists, call your orthodontist.

• Practice Makes Perfect

If you want to speed along the process of getting back to your normal pronunciation habits, practice! Read aloud, sing along to your favorite songs, recite lists of words with the specific sounds you want to work on. Oddly enough, to get back to your normal speech more quickly, slow down. Thinking before you speak is never a bad idea, and, in this case, thinking while you speak can help you position your tongue and mouth to verbalize tricky sounds more easily.

You don’t have to be a national debate champion or the world’s most blood-curdling Lady Macbeth to be concerned about clear speech. Talk to Dr. Clark Knowlton during your next appointment at our Sherman office if you find you are having problems with pronunciation. Whether your appliance needs an adjustment, or you need a few suggestions for speech exercises, or it’s simply a matter of time, soon you’ll be back on the road to perfect pronunciation—and on the way to your perfect smile.

Dr. Clark Knowlton and our team at Knowlton Family Orthodontics, know that for some of our patients wearing braces, it can be difficult to weave through those wires and brackets as you brush and floss during your treatment.

Some of our patients use a water pick to flush out food and other particles and bacteria stuck between their teeth as the water can reach behind the metal wires and hit spots where your floss simply cannot reach. People suffering from gum disease also find water picks quite effective because of their ability to flush out bacteria from inside the deep pockets.

Water picks are friendly to braces and are also gentle on the gums. They are less likely to cause bleeding for people with sensitive teeth or gums. But as many benefits as they may have, Dr. Clark Knowlton and our team want you to know that water picks should never be used as a substitute for flossing. Though they are great tools for helping improve oral health while you are in treatment, they are just not a good enough tool on their own to keep your mouth and gums gingivitis- and decay-free. Water picks are also incapable of removing plaque from teeth as effectively as floss can. While water picks rinse the sticky bacteria off your teeth, flossing is actually more effective as it actually scrapes the bacteria off of your pearly whites.

If you have any questions about water picks or any general questions or concerns about your orthodontic treatment, we encourage you to please ask us below or give us a call!