QUESTION: My daughter is 9 years old.  Her bottom front teeth bite the top gum behind her top teeth.  Her dentist said she should go to see an orthodontist and her lower jaw needs to be brought to forward.  The overbite is about 5mm.
I took her to see an orthodontist and the orthodontist said that she has very thin gum tissue around her bottom front teeth and should not bring her lower jaw too far forward.  
The orthodontist suggested after the rest of her teeth come through (about six months), she may be need extraction of certain upper teeth.
I do not like extraction teeth if it can be avoided.
I would like to know if the gum tissue can be damaged by pulling the lower jaw forward.  I do not know why moving the lower jaw bone forward can damage the gum tissue. Can you please explain?
Thank you very much

ANSWER: Your question is an excellent one and I'll try to give you some generalized information to help you understand.  The photo, however, is too unfocused to be useful so my answer may or not apply to your daughter's situation.

There is a distinction that must be made to answer your question and that has to do with the difference between bringing the lower jaw forward (and all the teeth that are attached) and simply tipping the lower teeth forward.  The relationship between the lower incisors and their supporting gum and bone is extremely important.  If the lower incisors move too far forward off their supporting bone there is a significant risk of damage to the bone surrounding those teeth as well as the gum tissue covering the bone.  These are periodontal considerations that must be considered in developing a treatment plan.  Advancing the lower jaw, however, is theoretically possible and can be done carefully without tipping the lower incisors forward.  If successful treatment can be done by advancing the lower jaw without tipping the lower incisors, then that may be a reasonable approach.  

This discussion centers around one part of the overall problem.  Usually things are not quite so simple and there are many other factors that enter into a comprehensive orthodontic treatment plan.  Such a plan cannot be developed without a complete examination including x-rays of the teeth and jaws, photographs, and study casts.

---------- FOLLOW-UP ----------

QUESTION: Dear Dr Randolph Myerson, Thank you very much for your very quick reply and helpful information.
Do you mean if just advancing the lower jaw without tipping the lower incisors, it will not affect lower front teeth's gum and bone, even her orthodontist said that she has very thin gum tissue around her bottom front teeth?
I let my daughter move her lower jaw forward and her appearence looked much better and I think different treatment would not just affect her teeth but also her appearence as well. Her orthodontist said that she normally just extracts teeth. She did not give us another option and fully explain why her plan is the best for my daughter.

I can't address your daughter's specific situation concerning the gum tissue around the lower incisors since I have not had the benefit of conducting an examination.  

The absence of an explanation regarding the treatment plan and the absence of a second treatment option combined with the statement that this orthodontist only extracts teeth suggests that you have your daughter evaluated with another orthodontist for a second opinion.  


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Dr. Randolph Myerson


Please limit your inquiry to questions about orthodontics (braces) and children's dentistry. I am both an Orthodontist and a Pediatric Dentist, having been trained in both of these dental specialty fields. Orthodontics is the dental specialty that treats problems of tooth, bite and jaw alignment using braces and removable appliances. Pediatric Dentistry is the dental specialty also known as dentistry for children, which deals specifically with the dental problems of this special age group from infants to adolescents. I am also experienced in Forensic Dentistry, the application of dentistry to law enforcement and identification using dental records.


I have been in the private practice of orthodontics and pediatric dentistry for over 20 years. Prior to that I served for three years on the Cleft Palate and Cranio-facial Reconstruction team at Children''s Hospital of Philadelphia and was an Assistant Professor of Dentistry at University of Pennsylvania School of Dental Medicine. I also served as a dentist in the U.S.Air Force, stationed at Andrews AFB in Washington, DC.

I am a Fellow in the American Academy of Pediatric Dentistry, and a member of the American Association of Orthodontics, as well as a member of the American Dental Association and the Dental Society of the State of New York.

I received my BA in Biology from Frankin & Marshall College in 1969, and my dental degree from University of Pennsylvania School of Dental Medicine in 1973. In 1978 I received both my Certificate in Orthodontics from University of Pennsylvania School of Dental Medicine, and my Certificate in Pediatric Dentistry from Children''s Hospital of Philadelphia after completing a three year Teaching Fellowship in Orthodontics and Pediatric Dentistry in 1978.

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