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Maybe you’ve known people with braces and aligners—maybe you’ve worn them yourself!—so if braces or aligners are in your teen’s future, you have some idea what to expect and when to expect it.

But quite often, orthodontic issues require more treatment than braces alone can provide. When misalignment affects not only the teeth but the jaw as well, treatment can be more effective when it begins earlier and makes use of a different kind of appliance—the “functional appliance.”

During the years your child’s bones are still rapidly growing and forming, around the ages of eight to 14, functional appliances can help guide tooth movement and encourage jaw growth and development. One of the most widely used of these devices is the Herbst® appliance.

What does the Herbst appliance do?

There are several types of malocclusions, or “bad bites” treated by Drs. Lawrence Hier and Michelle Palmer. A common condition called a Class II malocclusion occurs when the upper jaw and teeth project too far forward over the lower jaw and teeth. Signs of a Class II malocclusion might include an overjet (protruding upper teeth), and/or a small or recessive lower jaw.

While correcting this malocclusion often enhances facial symmetry, which can be very important for a child’s confidence, correcting a Class II malocclusion also promotes jaw and dental health. Misaligned teeth are more difficult to clean, which can lead to decay and gum disease. Bite problems can cause persistent jaw pain and damage to the teeth. And, with an overjet, a child’s upper teeth are more at risk for injury.

The Herbst appliance was developed to treat this kind of malocclusion. It moves the lower jaw and teeth forward to create a balanced, healthy smile.

How does the Herbst appliance work?

The Herbst appliance is fixed in place with stainless steel bands or crowns that are secured to four teeth in the rear of the mouth, often the first molars on each side of the upper and lower jaws. The band or crown on each lower tooth is equipped with a small bar that extends toward the front of the mouth.

An arm on each side links the bands or crowns on the upper teeth to the front of the bar assemblies on the lower teeth. Each arm consists of a rod that fits smoothly into a tube. The telescoping action of the rod and tube allows the mouth to open and close normally. When the mouth is closed, the arms on both sides telescope shut, forming compact cylinders that hold the jaw forward.

While a child’s bones are still growing, the lower jaw’s new forward position can stimulate further bone growth and remodeling to maintain the jaw in that forward position. The Herbst appliance also has a restraining effect on the forward movement of the upper jaw. The result is a steady, noticeable improvement in the relationship between the upper teeth and jaw and the lower teeth and jaw.

Is the Herbst appliance hard to take care of?

The Herbst appliance is fairly low maintenance, but, like any orthodontic gear, it should be treated with care.

• It’s important to watch your child’s diet, because sticky, crunchy, and chewy foods can damage the appliance. Save the caramels for a post-treatment celebration!
• Carefully cleaning around the appliance is necessary, because a buildup of bacteria and plaque leads to consequences like bad breath, gum disease, and tooth decay. A water flosser can make reaching and cleaning tight spots easier if a brush alone isn’t effective.
• If the Herbst appliance is damaged, some minor fixes might be doable at home with instructions from your treatment team. But if a band or crown comes loose, or if there’s a problem you’re unfamiliar with, call our Boynton Beach, FL office right away.
• To help avoid the need for minor (or major) fixes, playing with the appliance with fingers or tongue, nibbling on pens and pencils, chewing on ice, or any other risky habits should be strictly off limits.

When it comes to your child’s health, you always have high expectations. Drs. Lawrence Hier and Michelle Palmer and our team have all the answers you’ll need about what to expect from this phase of your child’s orthodontic treatment, and just why the Herbst appliance is the very best option to create a future of attractive, healthy smiles.

Bite problems are so common that most of us know someone who’s worn braces. So perhaps you’re already familiar with the terms “overbite” and “underbite”—but if you’ve been diagnosed with an “overjet,” that just might be an orthodontic diagnosis that is new to you. If so, here are a few questions and answers to help promote overjet understanding.

Just what is an “overjet”?

An overjet is a type of malocclusion, which means that there’s a problem with your bite, the way your jaws and teeth fit together when you bite down. In a healthy bite, the front top teeth project slightly beyond, and slightly overlap, the bottom teeth. The key word here is “slightly.”

An overjet is a Class II malocclusion, which means that the upper front teeth project further beyond the lower teeth than they should. Overjets and overbites are both Class II malocclusions, and the words are often used interchangeably, but there’s a notable difference between the two conditions.

An overbite occurs when the top teeth overlap the bottom teeth too far vertically, and you can’t see as much of the lower teeth as you should when you bite down.

An overjet is considered more horizontal in nature, where the top teeth project at an outward angle toward the lips instead of pointing straight down toward the bottom teeth. This condition is sometimes called protruding or buck teeth.

What causes an overjet?

The reason for your overjet might be dental (caused by tooth alignment), or skeletal (caused by bone development), or a combination of both.

Overjets can run in families. They can also be caused by the size and position of your jaws and the shape and position of your teeth, all of which affect your bite alignment. But early oral habits, such as prolonged and vigorous thumb-sucking or pacifier use, can also contribute to overjet development.

How do we treat an overjet?

There are many types of treatment available. Drs. Lawrence Hier and Michelle Palmer will recommend a treatment plan based on the cause and severity of your overjet. Because some treatments are effective while bones are still growing, age plays a part as well.

• Braces and Aligners

If you have a mild overjet, and minor dental issues are the main cause of the malocclusion, braces or clear aligners can effective.

• Functional Appliances

If the overjet is caused by a problem with upper and lower jaw development, devices called functional appliances can be used to help guide the growth of the jawbones while a child’s bones are still forming.

For young patients, there are several appliances which can help correct an overjet. Some, such as the Twin Block and the Forsus Spring appliances, work inside the mouth, while others, like headgear, are worn externally. Your orthodontist will recommend the most effective appliance for your needs.

• Surgical treatment

In some cases, where the malocclusion is skeletal in nature as well as dental, surgical treatment might be necessary to reshape the jawbone itself.

If we recommend surgery, oral and maxillofacial surgeons are experts in surgical procedures designed to create a healthy and symmetrical jaw alignment. Drs. Lawrence Hier and Michelle Palmer will work with your surgeon to design a treatment plan, which will usually include braces or other appliances following surgery.

Why treat your overjet?

A serious, moderate, or even mild overjet can lead to many dental and medical problems, including:

• Concerns about facial and dental appearance
• Front teeth which are more at risk for injury
• Difficulty closing the lips
• Problems speaking or chewing
• Headaches, facial, and temporomandibular (jaw) joint pain

When you work with our Boynton Beach, FL team to correct your overjet, you’re not just correcting a problem. You’re also creating something—a healthy, comfortable bite, and an attractive, confident smile. We can talk about general answers to your overjet questions, but when it comes to understanding your very individual smile, Drs. Lawrence Hier and Michelle Palmer will have all the answers you need to make that healthy bite and that confident smile a reality! 

There are many great reasons to see an orthodontist. For a healthier bite. For straighter teeth. For a more confident smile. So why are you hesitating? If the visibility of traditional braces is what’s holding you back, ask Drs. Lawrence Hier and Michelle Palmer about lingual braces.

With regular braces, brackets are bonded to the front of each tooth with a special adhesive. Ligatures around each bracket or bracket clips grip an archwire, which does the work of moving the teeth. The gentle pressure from the wire guides the teeth into alignment in gradual stages. Every adjustment moves the teeth to their perfect positions. These braces are quite effective—and they are usually quite visible.

Lingual braces, on the other hand, are virtually invisible. Lingual means “toward the tongue,” and this placement is the difference between lingual braces and more traditional types of orthodontic braces.

Lingual braces are custom designed to be applied to the inside of your teeth. Specially designed brackets are attached to the backs of the teeth. Individually crafted archwires are used to guide your teeth to their best alignment.

Lingual braces can be the solution to many orthodontic concerns:

• If you need or want invisible braces for personal or professional reasons, lingual braces are a great option. Because they are behind your teeth, they are even less noticeable than clear aligners—and you don’t need to keep track of your hours wearing them.
• Lingual braces keep the front of your teeth braces-free for playing a brass or reed instrument, or for participating in sports. (Just remember, a mouthguard is always a good idea for athletic activities, and especially when you wear braces.)
• Both brackets and wires can be customized to fit your teeth perfectly, and new lingual brackets and wires are more comfortable than ever.

You might be a good candidate for lingual braces if:

• You have a large enough tooth surface to place a bracket. Adults with small teeth—or children—might not be have enough room on the back of each tooth to hold a bracket.
• You don’t have a major malocclusion (bite problem) which would make lingual braces impractical. A deep overbite, for example, could cause the wires and brackets behind the upper teeth to come loose or detach as they come in contact with lower teeth.
• You are dedicated to keeping up with your oral hygiene. Because wires and brackets are behind the teeth, it can be harder to keep them free from food particles and plaque.

Finally, even if lingual braces aren’t the perfect match for your orthodontic needs, there are other options that can work for you. Smaller metal brackets, ceramic brackets that blend in with your enamel, and clear aligners mean today’s orthodontic work is more subtle and discreet than ever before.

For a healthier bite, for straighter teeth, for a more confident smile—don’t hesitate. Contact our Boynton Beach, FL office to discuss the many great options you have available to give you the smile you’ve always wanted—front and center.

It’s a new year, and it couldn’t come fast enough for many of us! Let’s do our part to make this a better year in every way—and you can start by making this the year you quit smoking once and for all.

You know that smoking is very damaging to your body. Smokers are more likely to suffer from lung disease, heart attacks, and strokes. You’re at greater risk for cancer, high blood pressure, blood clots, and blood vessel disorders. With far-reaching consequences like this, it’s no surprise that your oral health suffers when you smoke as well.

How does smoking affect your teeth and mouth?

• Appearance

While this is possibly the least harmful side effect of smoking, it’s a very visible one. Tar and nicotine start staining teeth right away. After months and years of smoking, your teeth can take on an unappealing dark yellow, orange, or brown color. Tobacco staining might require professional whitening treatments because it penetrates the enamel over time.

• Plaque and Tartar

Bacterial plaque and tartar cause cavities and gum disease, and smokers suffer from plaque and tartar buildup more than non-smokers. Tartar, hardened plaque which can only be removed by a dental professional, is especially hard on delicate gum tissue.

• Bad Breath

The chemicals in cigarettes linger on the surfaces of your mouth causing an unpleasant odor, but that’s not the only source of smoker’s breath. Smoking also dries out the mouth, and, without the normal flow of saliva to wash away food particles and bacteria, bad breath results. Another common cause of bad breath? Gum disease—which is also found more frequently among smokers.

• Gum Disease

Smoking has been linked to greater numbers of harmful oral bacteria in the mouth and a greater risk of gingivitis (early gum disease). Periodontitis, or severe gum disease, is much more common among smokers, and can lead to bone and tooth loss. Unsurprisingly, tooth loss is also more common among smokers.  

• Implant Failure

Tooth implants look and function like our original teeth, and are one of the best solutions for tooth loss. While implant failure isn’t common, it does occur significantly more often among smokers. Studies suggest that there are multiple factors at work, which may include a smoker’s bone quality and density, gum tissue affected by constricted blood vessels, and compromised healing.

• Healing Ability

Smoking has been linked to weakened immune systems, so it’s harder to fight off an infection and to heal after injury. Because smoking affects the immune system’s response to inflammation and infection, smokers suffering from gum disease don’t respond as well to treatment. Smokers experience a higher rate of root infections, and smoking also slows the healing process after oral surgeries or trauma.

• Dry Socket

Smoking following a tooth extraction can cause a painful condition called “dry socket.” After extraction, a clot forms to protect the tooth socket. Just as this clot can be dislodged by sucking through a straw or spitting, it can also be dislodged by the force of inhaling and exhaling while smoking.

• Oral Cancer

Research has shown again and again that smoking is the single most serious risk factor for oral cancer. Studies have also shown that you reduce your risk of oral cancer significantly when you quit smoking.

• Consequences for Orthodontic Treatment

Finally, if this is the year that you’re investing the time and effort needed to create an attractive, healthy smile with orthodontic treatment, don’t sabotage yourself by smoking!

Cosmetically, smoking doesn’t just discolor your tooth enamel—tar and nicotine discolor your aligners and braces as well. If one of the reasons you chose clear aligners or ceramic brackets is for their invisible appearance, the last thing you want is yellow aligners and brackets.

More important, smoking, it’s been suggested, can interfere with your orthodontic progress. When blood vessels are constricted, your gums, periodontal ligaments, and bones can’t function at their healthy best, moving your teeth where they need to be steadily and efficiently. This means that your treatment could take longer. And if your smoking has caused gum disease, you might have to put any orthodontic treatment on hold completely until it’s under control.

Quitting smoking is a major accomplishment that will improve your life on every level. It’s always a good idea to talk to Drs. Lawrence Hier and Michelle Palmer for strategies to help you achieve your wellness goals for the new year. Make this the year you stop smoking, and the year your health improves in countless ways because you did.