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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 Dr. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey. 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 Downingtown, PA 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. Dr. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey 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.

One word no one likes to hear is “cavity!”

For those patients of ours wearing braces, hearing that word is especially problematic, considering that delaying any dental work may result in delaying treatment time.

We often blame candy as the culprit behind tooth decay, but other foods and drinks that kids consume can be just as harmful to their teeth, and can lead to cavities and tooth decay. Keeping your teeth or your child’s teeth from decay during treatment starts with a proper diet, and today, our team at Smedley Orthodontics, LTD will explain the negative effects that candy and other treats, including peanut butter, raisins, fruit juice, and chewy fruit snacks, have on your child’s teeth as he or she undergoes orthodontic treatment. Keep in mind that half of your child’s sugar intake may be coming from beverages that he or she drinks. A major offender is soda, but be mindful of fruit juices as well.

While sugar is known to sit in your child’s teeth and in between and under brackets and wires after consumption, it is important to know sugar is not the only cavity-causing culprit. Carbohydrates, starches, acids, and any food that is chewy or sticks break down into sugars, and can promote tooth decay.

So, what are the alternatives?

Candy such as dark chocolate, sugar-free gum, or anything that contains xylitol, a sugar substitute, is not as harmful for your teeth as hard, chewy, or sticky sweets. Sugar-free gum or gum that contains xylitol are known to reduce levels of bacteria on teeth.

And if you’re still looking for something to snack on, we recommend cutting up easy-to-eat fruits and vegetables. You would also be surprised how much eating a banana or sipping on a glass of water helps you curb snack cravings.

If you’re one of those folks who just can’t stay away from sweets, we encourage you to brush your teeth immediately afterward and swish water in your mouth.

Whatever you eat, Dr. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey and our team want you to remember to brush often, floss regularly, and visit your general dentist as your treatment progresses. If you have any questions about sugary foods or drinks, please give us a call or ask us during your next adjustment visit!

Most parents know that routine dental care should begin during their child’s toddler years. And many assume they must wait until their child has all of his or her permanent teeth to visit Dr. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey for an initial orthodontic consultation.

The ideal age for an orthodontic evaluation is age seven. At that age, your child will have a mixture of adult and baby teeth for Dr. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey and our team at Smedley Orthodontics, LTD to make a determination about whether any problems are present. Typically the first molars have come in by the time your child turns seven, giving us an opportunity to check for malocclusion, also known as “bad bite.” Also, by the time your child reaches the age of seven, the incisors have begun to come in, and problems such as crowding, deep bites, and open bites can be detected.

When Dr. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey and our team perform an evaluation on your child at an early age, you get one of two positive outcomes. Although treatment usually will not begin until one to five years after the initial evaluation, it’s still helpful in determining whether your child has any problems with the jaw and teeth early when they are still easy to treat. Earlier treatment can also cost less to correct a potential problem than delayed treatment.

Early evaluation, of course, may signal a need for early treatment. For some children, early treatment can prevent physical and emotional trauma. Aside from spurring years of harmful teasing, misaligned teeth are also prone to injury and are detrimental to good oral hygiene.

If your child is approaching age seven, or has already surpassed his or her seventh birthday, it is time to schedule an appointment for an initial examination at Smedley Orthodontics, LTD.

When does an underbite need surgery? The short answer is: when Dr. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey 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. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey 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 Downingtown, PA 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. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey 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. Larry Smedley, Dr. Christopher Smedley, and Dr. Kendra Smedley Adey 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.