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FAQ:  Orthodontics - Children - Teens

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Orthodontics Ask The Dentist - Edward Leventhal Question:
My 12 year old daughter has an underbite where the upper front teeth have pushed her lower teeth back, thus, her uppers are over her lowers even with the underbite. She was evaluated by an orthodontist today who says her upper jaw or palate is small and not growing fast enough and her bottom jaw is growing too fast.

He recommends a palate extender on her upper jaw, to be worn approx. 3 months. The extender would be permanently attached and I would use a tool to expand the appliance on a scheduled basis at home with regular visits to assess progress. He then wants to re-evaluate before proceeding with braces. Is this extender appliance treatment appropriate and common for this type of problem at age 12?

If surgery would ever be required what would the surgery procedure involve? What results are reasonable to expect from the extender therapy/braces for and underbite without surgery? ...Karen in NC

Karen, it depends on how strong the genes are for her underbite. Your daughter's problems sounds like a width problem of the upper jaw and an underbite problem developing, like her orthodontist mentioned, with the lower jaw growing at a faster rate than the top jaw, and the top jaw not growing fast enough when compared to the lower jaw.

The expander will address the width problem of the top jaw. An expander has been used for hundreds of years and is very stable. This is the 'easy' part. If her top jaw is not growing fast enough forward, and thus she has a bit of receded top lip, then she could benefit from a reverse pull headgear to help encourage the forward growth to her top jaw. This is only worn if the top jaw is receded.

If there is a strong genetic component of the lower jaw growing, usually determined from the analysis of her cephalometric x-ray (skull film), there are two ways to deal with this, surgery (if she has a strong lower jaw growth) or non-surgical (if she has a mild lower jaw growth). You must discuss your options with your orthodontist, so you can make an informed decision. Hope this helps.

Edward Leventhal, DDS
Baltimore Cosmetic Implant Dentistry
8860 Belair Road
Baltimore, MD 21236
(410) 256-7300

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