Underbite - orthodontics VS surgery

[optifree]

When I was 11, I had an expander put on my top jaw and a face mask to wear at night. I was told this would correct my skeletal underbite.

Is it true that orthodontics can move your jaws and give you the same facial esthetic results that orthognatic jaw surgery would? Or do orthodontic treatments not take into account facial profile/balance and simply move your teeth (disregarding your actual jaws) into correct positioning?

This is when I was 11 or 12, so my jaw would have still been growing. Does that make a difference?

[Zoso]

Yes, the fact that you were growing then makes all the difference. Once you reach adulthood, orthodontic treatment is really only about moving the teeth around within the bones that are already there, whereas in a growing patient, the development of the underlying skeleton can be influenced.

Whether an issue such as an underbite could be successfully treated in an adult patient without surgery really depends upon the magnitude, and also whether it is purely dental in origin (teeth poorly positioned within jaws) or whether the issue is skeletal.

[Zoso]

Should add: it's not just important what results can be achieved, but also how stable they would be, and whether the health of the teeth and gums might be impaired.

[mikedatooth]

my sister had an overbite and had the palatal expander put in. Her upper jaw was too narrow according to the ortho. WHen the expander did its work, it actually slid the jaw forward a little too. Braces were applied for the next 2 years and her bite was fixed about 80% without the surgery. This was when she was a teenager. Till this day she wears her retainer at night...

I realize her case was not severe and this wont work for everyone, but you should always get many opinions before having surgery.

Good Luck

[optifree]

Yes, the fact that you were growing then makes all the difference. Once you reach adulthood, orthodontic treatment is really only about moving the teeth around within the bones that are already there, whereas in a growing patient, the development of the underlying skeleton can be influenced.

Whether an issue such as an underbite could be successfully treated in an adult patient without surgery really depends upon the magnitude, and also whether it is purely dental in origin (teeth poorly positioned within jaws) or whether the issue is skeletal.

I see. So I have two more questions...

1. When I wore the face mask at age 11 or 12 (can't remember for sure), my underbite was fixed and it seemed all fine and good, but I didn't wear my retainer and it seemed to eventually relapse back to an underbite, which to this day I still have. Was that my actual top jaw shifting back, or simply my teeth (within the jaw) that shifted back? Or do you think my jaw alignment just got worse as I aged? If it was my teeth that moved back to position, then I'm actually glad I didn't wear my retainer because it's my overall jaw I want fixed, not my teeth separately.

2. So if a patient has a somewhat severe skeletal underbite (that's me), and the orthodontist wants to see if he can treat it purely orthodontically (moving the teeth and leaving the messed up jaws where they are), could that in theory be making things worse if I eventually wanted my jaws to be aligned properly?

Because I don't want my teeth to be in proper position if my jaws aren't. My main concern is the overall esthetic results of my face profile, so the teeth shifting within would be detrimental to the eventual result, right?

[Zoso]

Heh, you're the opposite of what I more usually read - a lot of people will try to move heaven and earth to avoid surgery!

If I had to make a guess about why your underbite returned, I'd say that continued growth is a strong possibility.

What I would do, if I were you, is have a couple more consultations. Be aware that some orthodontists are not very comfortable working with surgical cases, so tend not to suggest that route; some others sort of assume that pretty much nobody would want to go surgical, and therefore don't open the discussion for that reason. Make it clear up front that one of your goals, in addition to addressing your bite and overall dental health is to address the facial aesthetic - make it clear that you are willing to consider surgery if that is deemed a good option for you.

Good luck.

[optifree]

Heh, you're the opposite of what I more usually read - a lot of people will try to move heaven and earth to avoid surgery!

If I had to make a guess about why your underbite returned, I'd say that continued growth is a strong possibility.

What I would do, if I were you, is have a couple more consultations. Be aware that some orthodontists are not very comfortable working with surgical cases, so tend not to suggest that route; some others sort of assume that pretty much nobody would want to go surgical, and therefore don't open the discussion for that reason. Make it clear up front that one of your goals, in addition to addressing your bite and overall dental health is to address the facial aesthetic - make it clear that you are willing to consider surgery if that is deemed a good option for you.

Good luck.

Thanks Zoso. The last thing I'm worried about is that my teeth have already moved into positions that are unnatural with the jaw. What I mean is that when I wore my face mask when I was younger and when my orthodontist started me on elastics (then I told him what I just told you, that I am aiming for the facial esthetics), and he told me to stop wearing the elastics and we'll talk when I get back in town (am at school right now).

So, because I have had the dental approach with the orthodontics in the past and a bit of elastics on my braces, do you think I have ruined my chances for optimal results with surgery? Maybe my jaw won't have to move as much now to get the normal bite due to my teeth already having moved a bit, but the problem is that I want my jaw to have to move so that it looks normal. Do you think my orthodontist could reverse the treatment and move my teeth back to even a worse underbite (if possible) so that my jaw surgery can be even more improving to my overall facial esthetics?

Sorry if that's confusing, but that's the best way I can word it.

[Zoso]

Remember: this is just pseudo-advice from someone who is not a dental professional, and has just picked up info following other people's stories on forums like this, and also reading some of the few professional papers that are freely available online.

From what I've seen, it could be possible to "decompensate" the teeth - put them back into a far worse bite, that after surgery would then be correct.

But as I said, you can get a better answer from professionals who have access to at least your current records.

[optifree]

Alright I'll make sure to have some long talks with my orthodontist and some oral surgeons when I return home in a month. Thanks Zoso, you've been a big help.

[Zoso]

Good luck in your quest!

[coolestSamantha]

It all depends on whether or growing or not and if you have an overbite because of the position of you teeth or because your skelton is that way.

[optifree]

Well also, when growing patients wear face masks or head gear, does that move the teeth as well within the jaws or just the jaws only? If it were the teeth as well then it would seem that it would be best to wait until fully grown and have jaw surgery so that the jaws are put into the best position possible. Right?

[Zoso]

I don't know. But it would seem logical to think that even in a growing patient, the headgear would effect dental as well as skeletal change. I have no idea of the relative maginitudes.

But I do know that in everything I've ever read about it, yes, they do want to wait until growth has completed before embarking on surgical correction. One way that has been commonly used to try to ascertain whether growth is complete is wrist X-ray, though I've also seen some discussion questioning the accuracy of this as a determining factor.

[JoyW]

My son Jerry, who is now 10 years old, had a facemask to correct his underbite for about 3 years (started with a palate expander and then facemask), his facemask came off this past October 2008 and today (12/29/08) he went in for a regular cleaning and the Dr. told us that he has 4 cavities. I’m suspect that the cavity happen due to the metal (used during the treatment) was cover around his upper teeth for so long and not be able to do the proper cleaning like dental floss and brushing. Can anybody tell me if you have the same problem with your child? By the way we did everything by the book and more to care for our son teeth; 2 regular cleaning per year, we don’t allow too much candy or gum. He properly had candies no more than 10 times a year.

One more thing if anyone out there no how long does a sealant last? Jerry had a sealant done about 3 years ago around his premolars and this past July he went in for his regular cleaning his Dr. told us that we had to reapply the sealant. I thought that sealant should last longer then that.

Thank you in advance.

[Zoso]

That's vexing! It's certainly true that proper brushing and flossing are much more of a challenge with braces, and expecially with appliances such as expanders in place. But it is possible still to do a thorough job - it's just that kids (and heck, even some adults) are just not careful enough. I don't know if that's been the case with your son. It's also possible, even though you avoided candies, that other dietary factors played in: did you allow him to drink any acidic drinks? (pop/soda, sports drinks, lemonade, etc.)

Another possibility, depending where the cavities are, might be that the bands came loose at some point, and that this was not detected (by you, your son, or his ortho) and the decay was just under the margin of the bands. This is pretty unlikely though, as the ortho and/or his staff would usually check for the bands being properly bonded at each appointment.

As to sealants, I don't really know. From what I have read, if a sealant lasts anywhere from three to five years, it is considered successful (and many dental insurance companies will only provide benefits for sealing teeth once every three years) but apparently they can, and do, sometimes last longer than this. How long they last can also depend to some extent on which teeth are sealed, and on the particular anatomy of the tooth - its exact shape. It is possible for all, or part of a sealant to become dislodged, in which case it will only remain effective if repaired or replaced.

[JoyW]

First of all thank you so much for reply so quickly. Because of the appliances and that he’s young; we did all the brushing for him. Since, the appliances came off we have been doing the flossing, he then brushes and we do the spot check afterward. As far as his dietary, it’s pretty well balance, he doesn’t like soda occasionally sports drinks and lemonade, he prefers water. The doctor told me that the cavities are between two teeth, I have a hard time spotting them the only thing that I noticed are the slight discoloration in some area at around where the bands used to be (some spots I noticed right the way on the day that the bands came off, but the Dr. said that is normal because it had been under the bands for so long). The reason that I contemplate about the bands being the cause of the cavities, because back in July during his regular visited and in October when the bands came off they were no sign of any cavities, but now in December not just one, but 4! cavities and they are all in the area where the bands touched.

I’m debating whether or not to call his Dr. to clear all my concerns, but in the other hand I don’t want to ruin our relationship if he takes this in the wrong way. Sorry, English is my second language; I hope you understand my grammar.

[Zoso]

Neither the bands themselves, nor the bonding agent used should cause cavities. In fact, I seem to recall reading that many of the bonding agents actually release fluoride very slowly over time. Again, unless the band became loose during treatment (and that was not corrected) there should be no way for cavities to form under the band. If any cavities did form under the band (due to failure of bonding) then those wouldn't those have been apparent at debanding? Rereading your post, I wonder if this is what happened: maybe there was some slight decalcification of the enamel - it lost minerals and became weaker/softer - right at the edge of where the bands were (but not under them) and that has since developed into cavities? The area right at the edge of bands or brackets is usually the very hardest to keep clean, especially down between banded teeth.

Do you use fluoride? Especially if your municipal water supply does not have fluoride added (or if you drink bottled or filtered water) I'd suggest including a fluoride rinse last thing at night. Beyond that, I don't know what to say.

I think you should talk to your dentist and ask him what he thinks (I am not sure if your dentist did the braces work too?) The main thing here is to take all the steps you can to prevent any further decay, but understanding why this has happened in the first place, despite your care, and your son's good dietary habits, would be an important part of that. Hopefully if you approach the discussion from this viewpoint, there should be no issues.

(Your English, by the way, is to be complimented - it is excellent.)

[JoyW]

Thank you so much for caring enough to took your precious time to shed some light into my vexing questions. We use everything, start with floss then fluoride toothpaste and top with fluoride rise at least twice a day (must also brush right after any sweet). I did everything by the book, but still cavities, that’s what frustrates me (like to say mad as hell!). My husband has perfect teeth no cavities and he doesn’t even care for his teeth as well as the rest of the family. When I was in my early teens, I had 4 cavities and that because no one had ever told me how important to care for my teeth nor had anyone taken me to see a dentist until it was too late. That’s why I vow that when I have my own children, they’ll have perfect teeth.

I’ll definitely have to talk to my dentist, because this eating me up very badly. I’ll use your approach when I talk to him and hopefully he’ll take it well and I can sleep at night afterward.

Thank you once again for your kindness and God Bless your heart for caring. Have a Happy New Year that full with peace & joy.

[Zoso]

Poor Joy! You really do seem to be making every reasonable effort. It must be doubly frustrating too that your husband enjoys such great dental health with so little effort - genetics certainly does play into how easily we get decay (gum disease too) and he is very lucky - a shame Jerry did not inherit his dad's tendency to great dental health!

Good luck with your chat with your dentist - I do hope he will be supportive and that he might have some good ideas on what can be done.

Happy New Year to you too.

[JoyW]

Thank you

[eatyourpeas]

Wow, you've gone over 100% in your efforts to keep your son's teeth cavity free! What a let down to find that he's got 4 cavities!!

My girls had molar bands for about 5 years each. Their ortho believed in keeping the headgear bands in place until their growth has stopped "just in case" the jaw moved into a bad alignment. My older daughter had her bands removed last year (age 18) and her teeth were cavity free. My youngest still has her bands (age 14) and will probably keep them for another year.

Now, I will certainly encourage her to use a fluoride rinse every night!!!

I certainly wish you and your son the very best and a HAPPY NEW YEAR!!

[JoyW]

Thank you for sharing your story with me, I really appreciated. Now, after reading your post and also reading it from some where else, about keeping the bands on until the growth has stopped, I’ll have to get other confirmation from my doctor since my son is still a growing boy (he did tell me that don’t worry about it if that happen he’ll fix it). Boy, never endless questions and problems.

Since, I got the bad news yesterday, every time when I brush his teeth there a little voice telling me “why are you doing this again, to invite more cavities I guess”. So, you see it’s not just a let down, I just can comprehend any of it everything seem backward.

Anyway, have a very Happy New Year

[cupcakegirl]

I see. So I have two more questions...

1. When I wore the face mask at age 11 or 12 (can't remember for sure), my underbite was fixed and it seemed all fine and good, but I didn't wear my retainer and it seemed to eventually relapse back to an underbite, which to this day I still have. Was that my actual top jaw shifting back, or simply my teeth (within the jaw) that shifted back? Or do you think my jaw alignment just got worse as I aged? If it was my teeth that moved back to position, then I'm actually glad I didn't wear my retainer because it's my overall jaw I want fixed, not my teeth separately.

2. So if a patient has a somewhat severe skeletal underbite (that's me), and the orthodontist wants to see if he can treat it purely orthodontically (moving the teeth and leaving the messed up jaws where they are), could that in theory be making things worse if I eventually wanted my jaws to be aligned properly?

Because I don't want my teeth to be in proper position if my jaws aren't. My main concern is the overall esthetic results of my face profile, so the teeth shifting within would be detrimental to the eventual result, right?

You sound like a older verison of me! I had a pallette expander at 11 and I was supposed to have a face mask. The expander had completly corrected my underbite so my ortho told me to only wear it at night. After about 6 months my underbite had come completely back and I couldnt even fit the expander in my mouth. They had also put me on braces after that and fixed my underbite, when they took them off the underbite came back again! So they sent me to an Oral Surgeon and he said my lower jaw is out growing my upper. My upper is normal size and I have a underbite of almost 7mm. In two weeks I will be getting braces and in a year and a half I will have surgery. So to awnser question 2. I had asked the same thing and they said that they need the teeth to be allgined before they can fix them. So I will have brace through out the whole surgery, they will even keep them on during the surgery and after. You will probably need to see an Oral Surgeon so they can tell you what the problem is. My underbite is really bad and is annoying for smiling and facial profile and just eating things. I cant even bite into french fry if its too limp.

[optifree]

Hey guys I'm back about 10 months later lol. Still haven't had orthognatic surgery yet, but it should happen soon, some time this year.

I still have a concern though. I feel that my facial profile needs a lot of improving. My bottom lip comes out in front of my top lip, and my current teeth positioning would probably require about 4 millimeters of upper jaw forward movement to correct my bite. I've been wearing rubber bands that are making my underbite even more of an underbite in hopes that the surgery will have a greater effect on my face, and I'm still not satisfied. Do you guys know how far elastics can pull your teeth within your skeletal structure? I mean, it clearly can't keep moving forever, hence the need for orthognatic surgery.

And would they perhaps be able to move my jaw even further than necessary (for aesthetic reasoning) and then I could continue to wear rubber bands to put the teeth into position?

[ashleigh]

I had sealants on two of my bottom molars since I was very young and they are still there and is cavity free. Wow, they do last long. It's a good idea to have children's molars sealed with a sealant. It really helps with cavities. Also fluoride helps alot with protecting teeth from new cavities.

[Sunny]

Ashleigh please follow good forum practice and don't comment on threads that are not current. Thanks!