Why are crooked teeth a health problem?

Teeth that are not aligned properly in your mouth can create what orthodontists call “malocclusion” (bad bite.) Left untreated, a bad bite can lead to periodontal disease and create abnormal amounts of stress on the teeth and jaws, which lead to premature wear.

Straightening your teeth can reduce the risk of serious dental problems because it’s easier to clean them properly when they are well-aligned. What we have also learned through scientific research in recent years is that straightening your teeth and correcting your bite can actually help you live a longer, healthier life.

Does this sound too good to be true? It’s not.

When teeth are crooked and crowded it’s hard to keep them clean even if you are very diligent about brushing and flossing. Chances are that over time some hard-to-reach areas will end up being neglected and you will develop periodontal disease. This means that your gums that hold your teeth in place get infected. Your gums become swollen and bleed easily when you brush your teeth. This initial gum infection is called gingivitis.

If left untreated gingivitis can progress to periodontitis, which literally means “inflammation around the tooth.” The gums pull away from the teeth and form little pockets of infection from trapped food and bacteria. Infections activate your body’s immune system, which in turn attacks the bacteria. The battle between bacteria and the immune system will start to break down the gums, connective tissue and bone that hold your teeth in place in the jaws. That can make chewing painful and difficult, and can lead to teeth that become so loose that they fall out or need to be extracted.

The Herbst Appliance

This appliance is not a new appliance. It has been around in the world of orthodontics for about 50 years. It gained popularity in the last 20 years as the focus of orthodontic treatment shifted to individualization of patient care to address specific issues, and not use the same treatment techniques for everyone.

The Herbst appliance is very effective in correcting large overbites due to small lower jaws in patients that are growing. It is used to enhance the growth of the lower jaw in a forward direction. The lower jaw is held forward by a pair of tubes and rods working together similar to a shock absorber to connect the upper and lower jaws.

The Herbst appliance corrects “overbites” by holding the lower jaw in a forward position, which in turn is what encourages lower jaw to accomplish its maximum genetic growth potential, helping it to grow and catch up with the upper jaw. The growth center of the lower jaw is near the joint area and the Herbst appliance works “remodeling” this area.

By utilizing the Herbst appliance while a young patient is growing, we can maximize their growth potential and possibly eliminate the need for extraction of permanent teeth or a jaw advancement surgery to fix the bite in the future.

The Herbst appliance is cemented on the back molars and is in place and active 24 hours a day. It generally stays in place for 12 months along with front braces. Once it is removed, braces are added to the side teeth for an approximately 12-18 months to complete tooth alignment.

Treatment of "Overbites" - part 2/2

But what about those patients whose “overbite” is due to a small lower jaw? Does it make sense to adapt a good upper jaw to a faulty lower one? The answer is no. Limiting the growth of a good upper jaw or moving well-positioned upper front teeth to “fit” a small lower jaw may produce an acceptable bite. It will not, however, produce an attractive face.

Considering the aforementioned, what is the proper way of addressing an “overbite” due to a small lower jaw? The short answer is to encourage the lower jaw to grow and “catch up” with the upper jaw on pre-teen and early-teen patients. This concept gained popularity in Europe in the 50’s and arrived in America in the 70’s.

Although many times orthodontists accomplish corrections that are worthy of “wows,” there’s hardly any magic in what we do. We can’t “grow” a lower jaw or make it grow to pre-determined standards. When it comes to growth, orthodontic treatment is limited to the individual genetic growth potential each person has. What we can do, however, is try to create a treatment environment conducive to taking advantage of the maximum growth potential each person has during the growing years.

When it comes to treating the “overbite” of someone with a small lower jaw, there are many different appliances that once in place in the mouth can encourage the lower jaw to accomplish its maximum genetic growth potential. My appliance of choice is the HERBST APPLIANCE, which I will write more about in my next posting.

Treatment of "Overbites" - part 1/2

The purpose of correcting an “overbite” is not cosmetic. It is important to have a proper bite where the teeth work as they are intended to prevent future problems and breakdown of the teeth and jaw muscles. That said, positive changes to the jaw line and facial profile will also be noticed.

The job of an orthodontist is not to solely move teeth. Our specialty is called “Orthodontics and Dentofacial Orthopedics” and this means that we also must consider the structure of the whole face when deciding how to move teeth.

In the past, all “overbites” were treated with either a headgear or the removal of two permanent upper teeth to allow moving the front teeth towards the back (towards meeting the lower teeth). You may be wondering: “are headgears still around??” The answer is, you bet they are. And you want to know why? Because they are efficient if properly worn.

The headgear is an appliance that prevents the upper jaw from continuing to outgrow the lower jaw. The appliance is attached to the upper first permanent molars (back teeth), via bands and tubes. A backwards force is the applied through a neck or head strap to limit the forward growth of the upper jaw. This type of treatment works well for patients that have a prominent upper jaw and/or upper front teeth that need to be moved back.

Headgears can also be used to make more space for teeth to come in. In this instance the headgear is attached to the molars and a light force is applied to help to draw these molars backwards in the mouth, opening up space for the front teeth to be moved back using braces and bands. Multiple appliances and accessories are typically used along with the headgear, especially braces and elastics.

But what about those patients whose “overbite” is due to a small lower jaw? Does it make sense to adapt a good upper jaw to a faulty lower one? Stay tuned for the answer in my next entry

"Overbites"

One of the most common bite situations an orthodontist deals with on a frequent basis is the correction of bites where lower teeth are set back relative to the top teeth. Such situations are often referred to as “overbites” by most people. In orthodontics, however, overbites mean something else. What the public calls “overbite” is called excessive overjet by orthodontists. For the purpose of this blog entry, I will use the term “overbite” in quotes so my colleagues will not think wrong of me.

In order to determine the best treatment for someone with an “overbite” problem, it is important to establish which jaw is at fault. An orthodontist is trained to look at a patient's facial profile much like a Plastic Surgeon.

Basically, the orthodontist needs to determine why the upper front teeth are far from the lower front teeth. Is it because the upper jaw is too big for the lower jaw? Is it because the lower jaw is too small? Or is it because of both?

A thorough first examination plus a complete set of records, with digital photographs, radiographs and study models are key to helping me determine which jaw is at fault and what is the proper treatment for an ideal correction that improves the bite and the facial profile.

The purpose of correcting an “overbite” is not cosmetic. It is important to have a proper bite where the teeth work as they are intended to prevent future problems and breakdown of the teeth and jaw muscles. That said, positive changes to the jaw line and facial profile will also be noticed.