How to Fix Underbite Braces Without Surgery
Defining Underbite: Causes, Symptoms, and Treatments
An underbite is an oral condition where lower front teeth protrude outward farther than the upper front teeth. Underbite can be dental or skeletal in nature. The dental term for it is Class III malocclusion or crossbite, while the anatomical term is prognathism. It creates a concave and bulldog-like facial appearance.
How To Fix Underbite Braces Naturally
Want to know how to fix underbite braces naturally, It goes without saying that obtaining perfect dental health is more than crucial for one’s oral health. Still, the road to optimal oral health and the perfect smile is oftentimes not the easiest to endure. Among the numerous dental issues both children and adults face, teeth alignment sets out to become one of the greatest. For that, the necessity to pay attention to our oral wellbeing is highly emphasized.
More specifically, today there is a growing number in both children and adults suffering from a variety of dental conditions, one of which is underbite braces. An underbite represents a medical condition that affects the lower teeth, gums, and jaw in individuals of all ages. The condition itself is not a matter of life or death. However, underbites have a serious tendency of escalating and causing additional dental complications. Of course, this further compromises your and your children’s overall oral health.
If you have this problem you might experience Eating problems, Speaking problems, Chronic jaw or joint (TMJ) pain, Tooth decay or worn out tooth enamel, Low self-esteem, and deformed facial features. Look for ways – how to fix underbite braces to avoid the issues.
Underbites are not an aesthetic problem alone. In fact, the condition also affects the overall teeth development, growth, and replacement in youngsters and adults. As a result, underbites can completely and negatively change one’s facial expression. Unfortunately, the issue of underbite braces remains a stigma among patients. The reason for this is the general misinformation or insufficient introductions to the condition itself and the risks thereof.
To better recognize the problem, and act adequately to prevent it, in the article below we will shed light on everything you need to know on underbites. Learn the leading causes, symptoms, health threats and of course, effective treatments in dealing with an underbite.
What is an underbite?
Unlike an overbite, an underbite is a condition that mostly affects the lower teeth, jaw, and gums. At the same time, underbite represents a condition that is less common among patients, compared to an overbite. An underbite is also known as Class III malocclusion or prognathism. This condition represents a protrusion of the lower teeth cover the upper teeth and jaw, thus forcing the bottom teeth into an uncomfortable and painful position. What is more, while an underbite is not the most ordinary of conditions, it is far more noticeable visually, unlike with overbites.
How is an Underbite Diagnosed?
Before diagnosing underbite teeth, your dentist will have to determine the type of malocclusion you are suffering from and an appropriate procedure about how to fix underbite braces? All existent malocclusions can be diagnosed and determined through a detailed dental exam. Your dentist might recognize initial symptoms of the condition, after which you are likely to meet your orthodontist as well. Commonly, you will have to do X-rays to define the severity and type of the underbite braces.
Currently, there are three main types of malocclusions. Type 1 refers to slight overlaps and normal bites in one’s jaw. This is also the most common type of malocclusion.
Next is Type 2 malocclusion, where the upper teeth are overlapping the lower jaw. This is medically known as an overbite.
Finally, Type 3 malocclusion is an underbite, also referred to as prognathism. Here, there is a drastic protrusion forward in the bottom jaw and teeth. According to the typology, your conditions belong to, your dentist will be able to make a proper diagnosis, and will then suggest further treatment.
Prognathism, or an underbite, is typically related to ‘bad bites,’ and can be a result of various factors, depending on its severity and the patient’s age. Oftentimes, underbites make it hard to understand a person’s accurate facial reaction, as the lower jaw is unable to engage in achieving the desired expression.
The scary thing about suffering an underbite is that, although the condition is rarer than an overbite, it is certainly more likely to progress faster and cause serious health issues. So let’s first understand how underbite actually occurs.
Can My Orthodontist Fix an Underbite Braces?
Many individuals have been scared by hearing from their dental office or from their orthodontic specialist that they have an underbite problem. However, this may not be as worrisome as it may seem. Although getting any diagnosis can make people feel scared for their health or their finances, you really need not worry as underbites are very treatable.
According to Declan Millett & Richard Welbury, (Welbury, 2005) there are many types of poor bites. An underbite is one of the many types. To fix a poor bite, an orthodontist needs to be able to determine the cause of the problem. This means you will need to meet with your orthodontist and talk with them about some of your options. How to fix underbite braces? You can confirm the solution by talking with your orthodontist will you be able to know for sure.
Some people ask can braces fix an underbite? Can Invisalign fix an underbite? Can you fix underbite without surgery? The answer to all three of these questions is the same, maybe. Let’s learn more.
According to Mulligan, T.F. (Mulligan, 1979) an orthodontist needs to be realistic and practical in understanding the information garnered from the textbooks and then be able to apply it in practice. The same applies to underbites. The training will give likely causes, and the orthodontist must apply this to the patient in the office.
In essence, the only way you’ll be able to know for sure what will be the best course of treatment for you is to simply talk with your orthodontic office. There are some general things that are known. According to Declan Millett & Richard Welbury, (Welbury, 2005) holistic problem solving is encouraged in orthodontics. So finding an orthodontic office that takes the time to talk with you and explain various treatment options while assessing your needs can all be a huge boost to your peace of mind and comfort.
Underbite Correction Without Surgery
When in doubt, to address underbite without medical procedure in grown-ups, there are three primary choices: Invisalign, supports, and corrective methodologies like veneers or crowns. Careful underbite adjustment is for the most part just essential when there is a more genuine skeletal issue liable for the bad bite.
Understanding Underbite: How Does it Happen?
Before we can talk about underbites, we should first introduce the term occlusion. Medically, occlusion represents the proper alignment of our teeth. When your teeth are aligned adequately, they should fit easily into the oral cavity ideally. If the occlusion is right, your teeth and jaw will pose no issues for oral health. When it comes to occlusion, or proper teeth placement, the oral cavity is safe from dental issues like teeth crowding or spacing.
Furthermore, rotating or crooked teeth can also affect the occlusion or the teeth’s perfect alignment. Ideally, occlusion means a mild overlap of the upper jaw and teeth over the bottom jaw and teeth. This also means a proper and natural placement of the teeth and jaws in the cavity itself.
Anything which derails from these dental standards is known as malocclusion. And while malocclusion can refer to overbite, crossbite and similar conditions, underbites need a particular dental care. The reason this is so is because the lower teeth are often in charge of keeping the tongue safely placed in the oral cavity. On the flip side, in underbite cases, the tongue suffers potential biting injuries due to the teeth’s improper placement.
What Causes an Underbite?
One of the main reasons underbite occurs in the first place is due to the hereditary factor. Therefore, if one of your parents, grandparents or siblings suffers from underbite, you are likely to experience it as well. The same goes for both children and adults, with adults developing the issue later on or ignoring the condition altogether earlier in life.
Some of the other causes of underbite may include:
- Thumb sucking, especially if prolonged
- Pushing the tongue against the teeth
- Using pacifiers or baby bottles for infants
- Misalignment in the jaw, as a result of a birth defect
- Hereditary Crouzon syndrome, also known as basal cell nevus
- Ethnicity (different ethnicities are more likely to suffer the condition)
- Eating difficulties
- Challenges with speaking
- Chronic jaw or joint (TMJ) pain, as well as head- and earaches
- Tooth decay from excessive wear of the tooth enamel
- Chronic breathing through the mouth,
- Bacterial infections
- Sleep apnea
- Snoring and related breathing issues at night
- Tooth decay
- Poor oral hygiene
Given that underbites impair both the natural course of chewing and swallowing, the condition can further compromise the entire jaw health. With that, an underbite can easily lead to jaw pain, and jaw muscles tension/straining. The main cause of an underbite is a misalignment of the lower jaw, which is usually first noticed at birth.
Who suffers from underbite the most?
Both toddlers, teenagers, and adults can suffer from the condition itself. However, regardless of the severity, underbite can be successfully treated in all groups of patients. It is also favorable to know that children are prone to a quicker recovery and their treatments are far cheaper than adults’, who are also looking at a longer recovery time.
Underbite symptoms and indications
Certain symptoms could indicate the development of an underbite, such as:
- A cleft lip
- Using pacifiers for infants, especially in children over 3 years old
- An excessive use of baby bottles during childhood
- Thumb sucking in infants and younger children
- Physical injuries of the jaw
- Mouth or jaw tumors
- Oddly-shaped or protruded teeth
- An inadequate placement or orthodontic devices like crowns, braces or dental fillings
- Breathing difficulties through the nose
- Allergy or tonsils swelling
- A changed appearance in the face, bottom jaw noticeably protruding
- Biting the inner cheek flesh or the tongue
- Uneasiness while biting or chewing
- Lisps and related speech difficulties
- Mostly breathing through the mouth
- Teeth crowding
How do you treat an underbite?
Today, there are available underbite treatments for every age group of patients. However, depending on how the condition develops, the age group the patient belongs to and more, the treatments may vary. To treat and underbite, you will first have to make an appointment with your orthodontist near me. In children, the parents are responsible for detecting possible symptoms of the condition and then reporting it to their family dentist for further consultation.
After setting up the diagnosis, the orthodontist may recommend the following as an underbite treatment:
Braces and Teeth Slenderizing
Dental braces are quite popular among all generations, and are very an effective way to deal with an underbite. Braces are also among the most commonly prescribed underbite treatments today. Often for mild underbites, the orthodontist will recommend teeth slenderizing (IPR inter proximal reduction) – polishing between lower teeth to make space to bring protruding teeth more back. In case you or your children are not fans of metal braces, you can always choose transparent and rubbery braces which will help take the self-consciousness away.
Learn More about Teeth Slenderizing (IPR – inter proximal reduction) process that can treat underbite at https://ivanovortho.com/interproximal-reduction-dark-triangles/
Braces with Teeth Removal
When there is a teeth crowding within the lower jaw or teeth are more forward than normal, your orthodontist might recommend extracting unnecessary teeth to free up some space and move the lower teeth back to better position (orthodontic camouflage). This will help manage the teeth and their placement inside the jaw. The orthodontist may also recommend teeth slenderizing of lower anterior teeth to gain additional improvement.
Early Treatment Appliances (Phase 1)
Orthodontists can create many tools, custom-made for a specific patient’s needs. Of course, all appliances used in this treatment initially depend on the patient’s condition phase. For children, orthodontists usually suggest using jaw expanders, retainers, and reverse pull headgear (also known as protraction face mask).
A jaw expander is based on using a key to expand the jawline and make enough room for the lower teeth. It usually focuses on the upper jaw and allows the bottom jaw to come back into its natural space. Expanders are worn for up to a year, after which the patient proceeds with wearing retainers.
Moving on to “reverse-pull” face masks, or a headgear, this is considered a more severe tool to use in underbite treatment. The headgear is usually placed on the child’s head and serves the purpose of drawing the upper jaw backward. Other appliances also used in the process of managing an underbite include wires or plates. Both of these have a purpose of keeping the jaw bone in place, thus preventing an overlap.
Learn More about Rapid Palatal Expander (RPE) at https://ivanovortho.com/palate-expander/
Learn More about Removable Expander (Shwartz expander) at https://ivanovortho.com/schwartz-expander/
Learn More about Reverse Pull Headgear (Protraction Face Mask) at Facemask Fixing Underbite In Children
When an underbite is not as severe underbite, a simple, cosmetic procedure can help fix the issue. Thus usually includes extraction and reshaping the lower teeth through veneers. The veneers are then placed in the patient’s mouth, giving them more lower-jaw room and a bigger comfort.
Sometimes, dentists may also use other techniques, such as bonding, or capping, both of which serve the same purpose of drawing the lower jaw back into its righteous place.
A surgical procedure is a rarity in underbite cases and is thought of as the last resort, as far as treatments are concerned. With underbite operations, a maxillofacial surgeon detaches the back jaw part from the front and molds it to fit the patient’s oral cavity better. This will further allow the lower teeth to eventually settle back into their respective place. Again, the surgery is recommended only for seniors and adults.
How to Prevent an Underbite?
The first thing you should do in terms of underbite prevention is to make an orthodontist appointment when your child turns 7. As for yourself, as an adult, the sooner you address the problem, the bigger odds you have at fixing the issue completely.
Other aspects to keep in mind in the prevention of underbites is oral hygiene. Namely, experts suggest brushing of the teeth at least twice a day. Another useful prevention measure is flossing, also recommended for both children and adults.
With infants, it is advised that parents to limit or completely eradicate bottle feeding. Additionally, the same goes for using pacifiers, especially in a long-term sense.
Finally, using an antibacterial mouthwash daily can also repress possible underbite symptoms.
Supplemental Content – Camouflage Orthodontic Treatment
Usually, camouflage means to mask an item so as to hide it from something or somebody. In the field of orthodontics, however, camouflage refers to the use of orthodontic appliances like braces to move teeth in a certain way so as to cover an underlying jaw or skeletal discrepancy. Numerous people have jaw discrepancies of varying degrees. As an example, some people have a situation where their upper or lower jaw is larger than its counterpart. Hence, camouflage is an exceedingly popular practice in orthodontics and is known to produce exceptional results without inclusion of surgery.
Camouflage is of different kinds, including the orthodontic camouflage that is further grouped into class II camouflage, class III camouflage, camouflage of skeletal open bite, and camouflage of asymmetry. Another type of camouflage is the surgical one that is sub-divided into a chin surgery, nasal surgery and single jaw surgery in a patient with double jaw problems. Since all of these kinds of camouflages are too extensive to describe here, we will only focus on discussing the class III camouflage.
It is usually done so as to correct a class III malocclusion. This malocclusion can be caused by the mandibular prognathism, maxillary retrusion or both, unlike several class II skeletal discrepancies that are largely triggered by a mandibular deficiency. A class III malocclusion varies based on what incisor relationship is found. It can be anything, including a reduced overjet incisor relationship or an obvious reversed overjet incisor relationship. The level of severity of any relationship clearly depicts the seriousness of the underlying skeletal discrepancy. In certain cases, however, orthodontists find considerable dento-alveolar compensation that disguises the discrepancy in question.
And when maxilla is deficient in three spatial planes, which is largely the case, serious teeth crowding and posterior crossbites can occur. When an anterior displacement masks an underlying class I base relationship, dental specialists refer to it as Pseudo-class III situation. In class III malocclusions, skeletal asymmetries that happen along with mandibular prognathism are common as well as cases where patients are found to have a full range of vertical growth patterns. While class III malocclusions are not reported often in the U.S and other western nations, it is still a problem that orthodontists encounter and are unable to determine whether a camouflage treatment is better than an orthodontic surgery. All in all, patients who have repaired a cleft lip and palate have higher odds of developing a class III malocclusion.
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Who Needs Camouflage Treatment to Correct Class III Malocclusion?
Early correction techniques are needed if you have any of these problems:
- Average or increased overbite
- Average or reduced lower face height
- Retroclined upper incisors
- Proclined lower incisors
- Anterior mandibular displacement
The bottom-line is that planning treatment in class III malocclusion is really difficult. It is also affected by the kind of skeletal discrepancy one has, size of the reverse overjet, degree of crowding of teeth and whether there is dento-alveolar compensation of any extent. But there are only three ways through which class III malocclusion is solved. These are: growth modification, orthodontic camouflage and surgery.
If you are suffering from a mild class III skeletal discrepancy, and dento-alveolar compensation exists, there are definite treatments that can be done in the permanent dentition. In this case, an orthodontist uses fixed appliances with class III inter-arch elastic traction. To camouflage an incisor relationship and stop a mixed dentition issue, orthodontists use removable appliances and sectional fixed appliances. Moreover, if needed when trying to camouflage the lower arch, extractions are performed to create space for the retraction of the lower labial segment.
Further, orthodontists can perform mid-arch premolar extractions in upper and lower arches or only lower arch if needed; but in the case of an adult, they may do a single lower incisor extraction. While determining the presence of an overjet and an overbite is usually the first thing, a professional orthodontist must as well establish the pattern and level of further growth in future. When a doctor discovers that a patient has extremely severe skeletal class III relationship with compensated incisors, he or she may recommend an orthognatic surgery treatment. Prior to providing this sort of treatment, though, an orthodontist will take the time to establish if your case is appropriate. In case you are found to have a substantial antero-posterior or vertical skeletal component to your bad bite, your orthodontist might combine camouflage with maxillo-mandibular surgery to achieve perfect restoration.
Surgery should be the last resort, as always, but if it must be done, then it should be deferred until the mandibular growth is complete. If it is done when the mandibular growth is going on, the end result could be skeletal relapse. Therefore, the best practice is to observe and monitor the mandibular growth of a child during teenage so as to consider a surgical plan when it is safe to do so. Camouflage is hardly possible if the mandibular incisors are too retroclined and the maxillary incisors are too proclined.
Potential future growth in people with class III malocclusion is very possible, such that the mandibular development continues even after teenage years. This is detrimental and could lead to a reverse overjet reestablishment during treatment or afterwards. That’s why orthodontic treatment for camouflaging skeletal discrepancy should be done in either late teenage or early twenties. In severe cases of Class III malocclusions, orthodontists run the risk of being unable to attain a class I incisor relationship. But as long as you are being treated by a knowledgeable and experienced dental physician, and you are committed to the treatment, camouflage risks are likely to be few to none.
When camouflaging class III malocclusions, this dental expert will use all their knowledge and skills to achieve successful corrections. This includes the use of either fixed or removable orthodontic appliances to correct a particular type of a class III malocclusion. Whether it is you or your child who has class III malocclusion problems, camouflaging could be the best kind of treatment. In case it isn’t, surgery might be the ultimate choice. Ignoring underbite can lead to rapid teeth wear, speech problems, and chewing difficulties.
Fix underbite Braces without surgery
Let’s start off with the biggest question, can underbite sometimes be fixed without need of surgery? The answer in many cases is yes. Only skeletal underbites where there is actually a deformation or misshapen jaw that is causing the underbite problem will most likely need to be addressed with surgery.
The simple reason why this one most often needs surgery as opposed to other types that may be causing your underbite is simply because if your underbite is caused by teeth issues the teeth can be moved utilizing orthodontic appliances like Invisalign or braces.
Can Invisalign fix underbite? Can braces fix underbite?
However, if things are in the wrong position because your bone itself is out of shape then simply moving the teeth will not actually change the position of the jaw bone. There are lesser cases though where minor surgery can fix it. This can happen if overcrowding of your teeth is what is causing the underbite. If it’s a simple case of overcrowding then removing a tooth can free up enough space to minimize or even eliminate the underbite problem in its entirety. However in many cases it is simply teeth being in the wrong positions and so fixing an underbite can be done quite readily utilizing traditional orthodontic treatments like braces and Invisalign.
Fix underbite Braces
Some individuals may ask, is underbite really all that big of a deal? Well the simple answer is, yes. While you may not be experiencing issues at this moment in time, if your teeth are not in the correct positions it can open yourself up to a whole host of potential dental problems like gingivitis and other issues including things that may seem unrelated like headaches and being unable to chew your food properly.
Your teeth are made to work together to chew food evenly. If your teeth are in the incorrect positions, not only will you be less able to properly eat your food but worse than that, your teeth will often grind or get worn down at an increased rate which can lead to cavities and possibly the need for tooth extractions. In some rare cases, you may even need dentures at a far younger age than would have been necessary had you simply talked with your orthodontic office about your prognosis and possible treatment options.
The best treatment is the treatment that can get done soonest. The quicker individuals talk with their orthodontic office about their underbite, the sooner they can have peace of mind about whether this is something that is not a big deal or something that may require treatment. If it does require treatment, delay can cost you more than money – it can potentially cost you your teeth and your comfort as well as your oral health. The surest way of saving money in the long term is to seek out expert advice as soon as possible.
Why Do You Need To Fix Underbite?
Underbites always need medical intervention for correction. If you left them untreated, severe pain, jaw problems, and dental can come on the surface to bother you. Common problems of an untreated underbite include:
Increased Risk for Tooth Decay
An underbite puts in danger of tooth enamel damage because of the austerity of misalignment. However, if you use the underbite braces, it will be helpful to stop decay.
Other difficulties with untreated underbites are:
- Difficulties speaking, unclear words, taking a bite and swallowing.
- Heightened risk of forming gum disease.
- Skeletal mouth and smile transformations.
- Irregular or crooked teeth.
- Bad breath, even after maintaining proper dental hygiene.
- Poor mental health and social anxiety.
- Heightened the necessity for invasive jaw surgery.
The good news is an underbite can be fixed with braces. Seek out expert advice as soon as possible.
Fix Underbite (Crossbite) Without Surgery
When it comes to correcting and managing an underbite, there are plenty of options to choose from. Still, making the best decision for you, and especially your children, is best done by consulting your orthodontist. If you happen to notice any of the abovementioned symptoms of the disease, don’t hesitate to reach out and ask for help at once.
Orthodontists and technology nowadays allow quick and effective underbite solutions for patients of all ages. Underbites are, to say the least, an uncomfortable condition to deal with and can lead to plenty of unnecessary pain. Therefore, begin underbite treatment as soon as first symptoms arise and remember – it is always better to be safe than sorry.
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Where to find more information?
Thomas F Mulligan. (1979). Common Sense Mechanics, Part 1. Journal of Clinical Orthodontics. https://www.jco-online.com/archive/1979/09/588/
Declan Millett & Richard Welbury. (2005). Clinical problem solving in orthodontics and pediatric dentistry. Elsevier Churchill Livingstone.
Prado, Daniela GalvÃ£o De Almeida, et al. “Speech Articulatory Characteristics of Individuals With Dentofacial Deformity.” Journal of Craniofacial Surgery, vol. 26, no. 6, 2015, pp. 1835–1839.
Cooper, Barry C., and Israel Kleinberg. “Examination of a Large Patient Population for the Presence of Symptoms and Signs of Temporomandibular Disorders.” CranioÂ®, vol. 25, no. 2, 2007, pp. 114–126.
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What are crossbite braces?
Crossbite introduction and crossbite braces:
Crossbite is a type of malocclusion, where the two dental arches are misaligned. It causes our upper and lower teeth to not sit or connect on correct position when we bite. Crossbite can happen due to a number of reasons including prolonged thumb sucking habits, delay in the loss of baby teeth, genetics, etc. Apart from making psychological problems, it can have some serious impact on your child’s oral health if left untreated. It can cause problems such as discomfort while eating, teeth grinding and can also lead to temporomandibular disorder (TMD) complications. Orthodontic treatment involving the correction of bite may require the use of crossbite braces or clear aligners. For more severe cases, crossbite fix or crossbite treatment may involve jaw alignment surgery.
The ideal or best time for crossbite treatments is in child hood or as a teenager but there are treatment options available for adults too. Orthodontic specialists use different orthodontic appliances to adjust the palate, jaws or teeth.
Braces are used in many orthodontic treatments, including crooked teeth or bite problems. Crossbite fix or crossbite treatment through crossbite braces usually uses a palate expander. A palate expander is a device which helps in widening the upper jaw. This helps the upper teeth to sit on the right position on the lower teeth. Once the palate is expanded to the right size, some further teeth straightening maybe required. Permanent braces and elastics (rubber bands) are used to move the teeth if further straightening are required. You might have to wear retainers after braces to hold the position of the teeth.
What types of crossbite fix exist?
Crossbite fix: Different treatment options:
Crossbite fix or crossbite treatment can be done through different ways. This depends upon the severity of the crossbite. Your orthodontist after examining your teeth and jaws may recommend the best crossbite fix or crossbite treatment option for you. Some of the common methods for crossbite fix or crossbite treatment are as follows:
- Maxillary or Palatal expander: It is an orthodontic device which is attached on the upper teeth and placed on the palate. The device gradually expands the upper palate. It has a special key which needs to be adjusted during the treatment. It is the most effective way for crossbite correction for children.
- Surgery: In this method the jaw bone is intentionally broken from several places. After the surgery, the patient has to wear a custom-made device. Surgical method is used when there is a need of wider expansion of the upper palate which cannot be achieved through palatal expander.
- Crossbite braces: Braces and elastics (rubber bands) helps to align the upper and lower teeth. It can be used after palatal expander or as a crossbite fix or crossbite treatment itself.
Where to get crossbite treatment?
Crossbite treatment orthodontist:
If you are looking for crossbite braces or other treatment options, it is important to find the best orthodontist for effective treatment. Whether you are looking for best orthodontist Miami or an orthodontist in any part of the world, you can use powerful search engines like Google to look for orthodontist near you. Trying using search queries like “crossbite braces near me” or “pediatric orthodontist near me” if you are looking for the treatment of a child. This will help you find orthodontist near you for crossbite fix or crossbite treatment. You can also consult friends and family members who have gone through similar treatment. If their orthodontist is convenient for you to visit and they are satisfied with their treatment, you can consult the same clinic. If you have a busy schedule on weekdays look for an orthodontist open Saturday.
How long does it take to correct an underbite?
In the minor occlusion, underbite fixed with braces can take 4 months, while moderately severe cases can take around a year or so. The time varies upon the type of underbite braces and the severity of the case.