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When does an underbite need surgery? The short answer is: when Dr. Robert Kubo and Dr. James Kubo 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. Robert Kubo and Dr. James Kubo 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 Fresno, CA 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. Robert Kubo and Dr. James Kubo 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. Robert Kubo and Dr. James Kubo 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.

If you’ve been following your dentist’s advice, you know that you should be devoting two minutes twice a day to gentle, thorough brushing, and floss carefully at least once a day. It’s automatic. It’s habit. You’re in the zone. Now that you have braces or aligners, though, it’s time to step up your game!

Removing Food Particles

No one wants to worry about food particles stuck in braces right after lunch—or, worse, noticed hours after lunch! Because food tends to stick around brackets and wires, Dr. Robert Kubo and Dr. James Kubo and our Fresno, CA team recommend brushing after a meal. Not only will you be confident in your smile, you’ll be improving your dental health.

But why?

Better Plaque Removal

Plaque is a sticky film containing acid-producing bacteria. These acids lead to weakened enamel and, eventually, cavities. Careful brushing with a fluoride toothpaste helps eliminate plaque. But as you may have discovered, it can be more difficult to clean around brackets and wires. Brushing after eating will help keep plaque from forming on your enamel, and using the right tools (floss made for braces and interproximal brushes) will help clean plaque more effectively.

But what about aligners?

If you wear clear aligners, you take them out when you eat. This avoids the problem of food particles trapped in brackets and difficulty brushing around wires. 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 remove 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 can remain on your teeth after you replace your aligners, increasing the risk of enamel erosion and decay.

Brushing helps keep your aligners clear as well. If you notice aligner discoloration, this could be the result of food residue such as tomato sauce or coffee that remained on the teeth after a meal. Anything that stains your enamel can stain your aligners. And don’t forget about plaque. Plaque can stick not only to your enamel but to your aligners as well. If you notice that your aligners are cloudy, or have an unpleasant odor, talk to us about the best way to keep them their cleanest.

Make a Plan

So, what can you do to make brushing more convenient during a busy day? Be prepared! Keep a small kit with you containing a travel brush, a small tube of toothpaste, floss, and an interproximal brush for quick cleanings when you’re out and about, and you’ll never have to worry about your smile.

Of course, there are occasions when it’s just not possible to brush. At times like this, whether you have traditional braces or aligners, it’s a good idea to rinse well with water after meals or snacks, and brush as soon as you can.

Start your new dental routine now, and soon it will be automatic. An everyday habit. Your new comfort zone. After all, taking a few extra minutes from your day to brush after every meal will be well worth it when you end your orthodontic treatment with a smile that is as healthy as it is beautiful!

The weather out there might be frightful for most of us, but not for you! You’ve been waiting all year for a fresh coat of powder and all the outdoor sporting activities winter brings. But before you grab those ski poles, strap into that snowboard, lace up those skates, or dust off that sled, be sure to remember one more essential piece of gear—your mouthguard!

Mouthguards aren’t just for contact sports. While all that lovely new snow looks like powder, it doesn’t feel like it when you land hard. If there’s a chance of a fall or an impact in any sport, there’s a chance you can suffer dental injuries.

Falls or collisions can result in chipped, broken, or dislodged teeth. Your mouthguard will help protect your smile from these accidents, and also works to protect you from biting your tongue and mouth in case of impact. It can even reduce the chance of jaw injuries.

Luckily, finding a mouthguard that works for you is even easier than finding the perfect board or the best wax for your skis. You have several options to choose from:

• Ready-made appliances. These are available in drugstores and sporting goods stores, but come in pre-formed sizes, so they might not provide the best fit.
• The “boil-and-bite” model. This mouthguard form is placed in hot water. You then bite down while it is pliable to shape it to your mouth and teeth.
• Custom mouthguards. These guards can be fabricated just for you. They are molded to fit your individual mouth and teeth, so provide a better fit and better protection. They are also usually more durable and more comfortable. If you wear braces, a custom mouthguard can be your best option for preventing an injury to your mouth and your braces. Talk to Dr. Robert Kubo and Dr. James Kubo if you are interested in a guard fitted specifically for you.

When you visit our Fresno, CA office, let’s discuss all the best ways to keep your teeth and mouth protected before you set out for winter sports. And then when you’re ready to go? Let it snow!

One of the most common reasons for getting braces is because there’s just not enough room for all your teeth to fit next to each other evenly. The result is overlapping and crooked teeth. What’s the first step in creating the space you need? Well, that depends on just how much room you need to align your teeth and bite properly.

When there is going to be a serious need for space, there are orthodontic solutions that can help, including palatal expanders, surgical options, and extractions. But if you only need a tiny bit of room so that regular braces will fit properly, we have a tiny solution—orthodontic spacers!

Why do you need to make space before you get braces? Because Dr. Robert Kubo and Dr. James Kubo might need to make some room around crowded molars so your braces can be installed properly.

For example, you might need orthodontic bands to anchor your braces. An orthodontic band is a slim, custom-fitted ring of metal which fits snugly around a molar. It is durable, provides a place to attach bands and springs to help correct malocclusions (bite problems), and can securely surround a tooth that might be weak because of a large filling. Spacers can separate crowded teeth just enough to allow a band to be fitted around a molar.

Even if you don’t need bands, sometimes separators are necessary to provide enough space between the teeth for your braces to work effectively. The back teeth tend to move even closer together with braces, and, without adequate space, bite problems, risk of decay, and other difficulties can arise.

And while you might think that some serious equipment is in order to make room between those sturdy molars, the typical spacer, or separator, is actually extremely simple--usually a tiny, round elastic band, often made of rubber. Spacers can be placed between tight teeth in a matter of minutes. Each ring is stretched and positioned between your teeth with a special tool. As it returns to its original shape, the spacer’s width provides just enough pressure on the teeth it touches to make a bit of space between them. And a bit of space is usually all you’ll need.

What do spacers feel like? For some people, they can be uncomfortable. You might feel soreness, some pressure, or as though a piece of food is stuck between your teeth. Ask us for suggestions on making you more comfortable, whether it’s dining on ice cream and cold drinks, eating soft foods, or taking over-the-counter pain relief. Separators are only designed to be in place for a very short period (usually under two weeks), but if they are causing you pain, give us a call.

What do you need to do to help the process along? Actually, it’s more what you need not to do. Don’t use dental picks or floss on your separators, avoid chewing gum, and take chewy and sticky foods off the menu. And don’t be tempted to touch or play with your spacers!

Spacers can create space between the teeth so quickly and efficiently that they often fall out on their own after a few days. If your separators fall out, give our Fresno, CA office a call. It could mean that you are ready for your braces, and on the way to a lifetime of healthy, beautiful smiles. And it’s a journey that begins with a tiny, springy step.