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When does an underbite need surgery? The short answer is: when Drs. Lawrence Hier and Michelle Palmer 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. Lawrence Hier and Michelle Palmer 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 Boynton Beach, FL 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. Lawrence Hier and Michelle Palmer 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. Lawrence Hier and Michelle Palmer 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.

Straightening your teeth with traditional braces used to be something of a public affair. While traditional teeth-straightening methods yielded high-quality results, it was also essentially impossible to wear them undetected as you went about your day. The visibility of braces could be especially troubling to teens in the high-stress environment of high school and even during the early years of college.

With Invisalign Teen, Drs. Lawrence Hier and Michelle Palmer and our team at Hier & Palmer Orthodontics will tell you that many of those concerns are no longer as relevant as they once were. Because Invisalign Teen aligners are constructed out of a plastic that is both smooth and clear, in all likelihood friends and family members won’t even realize the teen is wearing them. The smooth and clear plastic also makes the aligners much more comfortable than traditional braces, which means the teenaged user won’t have to deal with something large and obstructive in his or her mouth.

Additionally, the Invisalign Teen aligners are specifically made to be removable when the need arises. Your son or daughter won’t have to worry about getting food stuck in the alignment trays because they can be pulled out before a meal and popped back in afterwards. Invisalign Teen wearers can remove the aligners before brushing, which allows them to make sure their teeth are free and clear of all obstructions.

Invisalign Teen aligners also allow wearers to keep doing all the activities they have previously enjoyed. If your teen plays sports, for example, he or she won't have to worry about a mouth filled with metal brackets getting injured during play. If your teen plays an instrument, he or she won’t have to worry about traditional braces affecting normal playing techniques. The aligners will remain both comfortable and convenient during all of those activities and more.

If your teen is concerned about physical appearance and worried that braces will adversely affect his or her life for a year or more, Invisalign Teen treatment with Drs. Lawrence Hier and Michelle Palmer is definitely the right choice. Teens don’t have to be shy about their smile, won’t have to change any of the activities they normally do, and will still get all the benefits of straight teeth when the process is completed.

For more information about Invisalign Teen, or to schedule an initial consultation with Drs. Lawrence Hier and Michelle Palmer, please give us a call at our convenient Boynton Beach, FL office today!

Valentine’s Day is the holiday to celebrate all the treasured relationships in your life. It’s a time to honor love in all shapes and forms with cards, social gatherings, and sometimes even binge eating of sweets.

It's hard to look the other way when grocery stores and pharmacies are invaded with goodies connected to the Valentine’s Day theme, and especially if you’re on the receiving end of some of these sweets. We get it. In fact, we’re all for it!

However, we also support a cavity-free smile. So in the interest of your dental and general health, and because we think it’s genuinely tasty, Drs. Lawrence Hier and Michelle Palmer recommends an alternative to the Valentine treats you may be accustomed to: dark chocolate. 

Yes, Healthy Chocolate Exists

Studies have shown that dark chocolate is high in flavonoids, an ingredient found in the cocoa beans used to make chocolate. Flavonoids can help protect the body against toxins, reduce blood pressure, and improve blood flow to the heart and brain.

By opting for dark chocolate rather than milk chocolate, you get to reap these benefits! Pretty sweet, right? Just make sure to stick to high-quality dark chocolates that have undergone minimal processing.

Dark Chocolate, AKA Protector of Teeth

Not only does dark chocolate provide some nice benefits for your overall health, it also helps protect your teeth against cavities! According to the Texas A&M Health Science Center, dark chocolate contains high amounts of tannins, another ingredient present in cocoa beans.

Tannins can actually help prevent cavities by interfering with the bacteria that causes them. Think of them as scarecrows for bacteria. They don’t always prevail, but isn’t it nice to have them there?

Smooth Never Sticky

Unlike many popular candies, dark chocolate is less likely to stick in the crevices of your teeth. Chewy, gooey sweets are more likely to hang around in your mouth for longer periods of time, which means they raise the odds of your harboring cavity-creating bacteria.

While some dark chocolates have additives like caramel or marshmallow, it’s best to opt for the plain varieties, which are just as delicious. If you’re feeling festive, though, a dark chocolate with caramel is still better than a milk chocolate with caramel, so that’s the way to go!

While dark chocolate has some pretty sweet benefits, the most important thing to remember (whether you go the dark chocolate route or not), is that moderation is key. That being said, we hope you have fun satisfying your sweet tooth and shopping for treats for your friends and loved ones. Happy Valentine’s Day from all of us at Hier & Palmer Orthodontics!

Although teeth seem to be solidly fixed in their sockets (at least they don’t wobble when we chew!), all teeth can easily be moved if Drs. Lawrence Hier and Michelle Palmer and our staff attach brackets and wires to them called braces. In the past, all braces were made of stainless steel, but today’s advanced dental technology gives people the option of wearing transparent, acrylic mouth trays called Invisalign®, or relying on traditional metal braces for correcting malocclusions.

Brackets, Slots, and Arch Wires – Oh My!

When light pressure is consistently exerted on teeth, they will gradually move in the direction of the force. For example, affixing brackets to front teeth and threading a flexible, metal wire through tiny slots on the front of the brackets allows the orthodontist to tighten this arch wire enough to initiate desired movement of teeth. Generally, orthodontic patients visit Hier & Palmer Orthodontics once a month to have this wire tightened to keep teeth moving in the desired direction.

Tissues surrounding the teeth that experience pressure from arch wires will slowly (and, for the most part, painlessly) stretch, and allow the socket to enlarge so the tooth and its root become looser temporarily. This allows the root to move without causing bleeding or pain. Once Drs. Lawrence Hier and Michelle Palmer and our staff are satisfied with the repositioning of teeth, we will remove the braces and let bone material fill in the socket so that teeth are solidified into their new (and straighter) positions.

Clear Braces vs. Traditional Braces

Both types of orthodontic corrective devices move teeth in the same manner: by applying a continual force against teeth. Clear aligners, like Invisalign, are mouth trays made of hard acrylic material that people wear for at least 23 hours a day. Unlike metal braces, Invisalign can be removed for eating and brushing purposes and the aligners are nearly invisible because of their transparency.

Invisalign aligners are usually reserved for people with gaps between their teeth or whose teeth are only slightly crooked. Traditional metal braces are often necessary when severe malocclusion exists and requires more pressure than Invisalign offers.