Jaw abnormalities can be caused by a variety of reasons - either inherited or the result of developmental or traumatic causes. Apart from affecting your appearance, jaw abnormalities also affect your bite, chew and even speech.

Although braces can help to correct dental abnormalities like crooked teeth and poor bite, jaw abnormalities can only be corrected by jaw surgery.

The Department of Oral and Maxillofacial Surgery, and Dr Ng Jing Hao, Consultant, Department of Orthodontics, both from the National Dental Centre Singapore (NDCS), a member of the SingHealth group, answers your questions in this forum.

Posted by Elaine (Republished by Forum Admin)

Dear Doctor, my daughter has a slightly protruding lower jaw.

• How would you determine if her condition is correctable by wearing braces or if she requires jaw surgery?
• With surgery, does that mean that she will not need to wear braces?
• How long would the surgical procedure take, is it done under GA and is hospital stay needed?
  How long is the recovery period and will she be able to eat normal food during this time?

How would you determine if her condition is correctable by wearing braces or if she requires jaw surgery?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

This will require clinical examination, x-rays and also taking of mould to study the dentition to determine the severity of the protruding jaw. Mild cases may sometimes be able to get away without surgery. Severe cases will most likely need surgery for ideal results.

Answered by Dr Ng Jing Hao:

Because teeth are sitting on the jawbones, a protruding lower jaw frequently results in an anterior crossbite or “underbite”, where the lower front teeth bite in front of the upper front teeth. Hence a patient with a protruding lower jaw usually has both a

• Dental crossbite issue, and a
• Facial Profile / Skeletal issue.

Treatment for these two conditions are distinct but related, and the treatment of choice (jaw surgery or braces) depends on:

• The severity of the jaw protrusion and resulting crossbite,
• The desired outcome of treatment – whether bite correction alone is sufficient, or a facial profile change is desired.

Dental Correction

Mild to moderate cases of crossbite may be able to be treated with braces alone, without jaw surgery. Severe cases will likely need jaw surgery together with braces for ideal results. Determining the severity of the condition will require clinical examination, x-rays and dental moulds to study the jaws and teeth.

Please note that for mild to moderate cases of crossbite that are corrected with braces alone, although the bite is improved, the facial profile with slightly protruding lower jaw will be largely unchanged even after bite correction with braces.

Facial Profile / Skeletal Correction

Dr Ng: Regardless of the severity of jaw protrusion, if the desired outcome is for a facial profile change, the ideal option will be to undergo jaw surgery.

In addition, if your daughter is under the age of 10, her facial profile and appearance of a protruding lower jaw may be improved by growth modifying appliances, which may reduce the chances of her requiring jaw surgery when she has completed her jaw growth.

b) With surgery, does that mean that she will not need to wear braces?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

Braces is almost always required as its used before the surgery to straighten the teeth and then after the surgery to do the fine tuning.

Answered by Dr Ng Jing Hao:

As the jaw positions and bite are significantly changed by jaw surgery, braces are usually required to ensure that the teeth can still bite well in the new jaw positions. The braces are usually present both before and after jaw surgery.

c) How long would the surgical procedure take, is it done under GA and is hospital stay needed?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

The surgical procedure can take between 3 to 8hrs depending on the complexity of surgery. It is done under GA and a hospital stay of about 2-4 days is expected after the surgery.

d) How long would the surgical procedure take, is it done under GA and is hospital stay needed?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

The recovery period after the surgery can take up to 3 months:

Week 1-2: Strict liquid diet

Week 2-6: Mashed/Puree diet

Week 7-12: Soft diet

Thereafter: Normal diet

Dear Dr, I’ve always been conscious about my protruding jaw (it doesn’t help too that I’ve been teased about it a lot since young). Recently, I’m seriously considering to do something about it. I’m currently 34, my questions are:

• Is surgery the only option? Or are there non-surgical options?
• If I do decide to undergo surgery, how can I best prepare myself for it? (this would be my first surgery)
• How much pain and discomfort must I endure after the procedure? Can I even take solid foods? How long would it take before I can eat normally again?
• As mentioned, I’m really conscious about my appearance. After the procedure, would my entire face be bandaged and swollen? I don’t think I can face the world that way so will probably hide at home during this time. How long must I wait before I can show the world my improved appearance? (This is so I can estimate the number of leave days I’ll need to take)

a) Is surgery the only option? Or are there non-surgical options?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

Surgery is not the only option. Sometimes braces alone may be able to help. However, this will depend on the severity of your protruding jaw and also your expectations. Usually moderate to severe protruding jaw will require surgery to have a good result.

Answered by Dr Ng Jing Hao:

Because teeth are sitting on the jawbones, a protruding lower jaw frequently results in an anterior crossbite or “underbite”, where the lower front teeth bite in front of the upper front teeth. Hence a patient with a protruding lower jaw usually has both a

• Dental crossbite issue, and a
• Facial Profile / Skeletal issue.   

Treatment for these two conditions are distinct but related, and the treatment of choice (surgical or non-surgical) depends on:

• The severity of the jaw protrusion and resulting crossbite,
• The desired outcome of treatment – whether bite correction alone is sufficient, or a facial profile change is desired.

Dental Correction

Mild to moderate cases of crossbite may be able to be treated with braces alone, without jaw surgery. Severe cases will likely need jaw surgery together with braces for ideal results.

Determining the severity of the condition will require clinical examination, x-rays and dental moulds to study the jaws and teeth.

Please note that for mild to moderate cases of crossbite that are corrected with braces alone, although the bite is improved, the facial profile with slightly protruding lower jaw will be largely unchanged even after bite correction with braces.

Facial Profile / Skeletal Correction

Regardless of the severity of jaw protrusion, if the desired outcome is for a facial profile change, the ideal option will be to undergo jaw surgery.

b) If I do decide to undergo surgery, how can I best prepare myself for it? (this would be my first surgery)

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

Physically, not much preparation is required if you are fit and healthy. Mentally, it would be good to have a conversation with us to understand exactly what to expect after the surgery.

c) How much pain and discomfort must I endure after the procedure? Can I even take solid foods? How long would it take before I can eat normally again?   

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

Pain after this surgery is usually well tolerated as you will be on painkillers. Discomfort will probably come from the swelling and the inability to eat properly. The recovery period after the surgery can take up to 3 months:

Week 1-2: Strict liquid diet

Week 2-6: Mashed/Puree diet

Week 7-12: Soft diet

Thereafter: Normal diet

d) As mentioned, I’m really conscious about my appearance. After the procedure, would my entire face be bandaged and swollen? I don’t think I can face the world that way so will probably hide at home during this time. How long must I wait before I can show the world my improved appearance? (This is so I can estimate the number of leave days I’ll need to take)

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

There will be swelling to be expected after the surgery which can look quite alarming. However, 80% of the swelling will subside within the first 2 weeks. The other 20% will slowly subside over 2 months. We usually give our patients 4 to 6 weeks of hospitalization leave after the surgery depending on their recovery.

Posted by David (Republished by Forum Admin)

Hello Dr,

I am writing in because I have hearing loss in my right ear for slightly more than 1 year now.

When last checked, I can hear sounds that are 40dB and above. The doctors did an Endoscopy and found nothing, they also sent me for an MRI and found nothing. The only solution was to send me back and have an appointment a year later.

I actually only saw the doctor after 6 months from my hearing loss as I was hoping it would heal by itself. Also there was no pain and did not directly affect me.

In recent months after doing some reading online, I realised that I do get a clenched jaw occasionally (where it takes a little more strength than usual to open my mouth, there will be a crack sound in my jaw.)

So I think my question is, is it possible for my hearing loss to be attributed to a clenched jaw and what do I do from here?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

It is quite unlikely that the hearing loss is attributed by the clenching of jaw. The clenching of jaw and cracking sound is mostly likely a separate issue associated with the temporomandibular joint.

Posted by Mxxxx (Republished by Forum Admin)

Hi Doctor,

I have been suffering from constant jaw pains and crossbite.

Left side of my gum/cheekbone is higher than the right side. Hence when I smile or speak, it appears as if my mouth is slanted, but it is actually due to the misalignment.

I did my braces many years ago (Upper Secondary) but despite the extended time frame of 4 years, the teeth gaps simply just refused to close up. According to the dentist, it was due to some "bone-vein" blocking issue.   

Now in my mid-thirties, the condition has worsened a lot, and also caused tremendous stress on my jaw bones, facial muscles, teeth grinding, crooked teeth again, long-term headaches.... My outlook appearance is also troubling me, as my face looks perpetually slightly swollen.

Please help me~

I would like to know:

1. Method of Surgery
   Is this considered to be a skeletal issue? And if so, how long will I need for the treatment? Will there be a waiting period before I can start treatment?
   
2. Cost of Treatment
   How much is the estimated cost range?
   Since it is with NDCS, will there be government subsidies? Can I use Medisave? Is CHAS blue card applicable? Are interest-free instalment plans available? Can I get a free consultation on the treatment and the financial payment?
   
3. Recovery
   How soon can I go back to work? Speaking properly? Will I need to stay hospitalized for a long period? Or can I stay home? Do I need to go back to hospital for post-surgery treatment or check-up?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

1. From your description, this sounds like a skeletal issue as you have described that your cheekbones are asymmetrical and slanted. Depending on the severity of the problem, treatment duration can take anything from 2 to 4 years. Even though it may be predominantly a skeletal problem, sometimes there are also dental problems as well which will require braces and braces treatment will require time for the teeth to move.
2. The first consultation and pre-operation examination at NDCS will be subsidised if you have a referral from a Polyclinic or CHAS clinic (for CHAS cardholder). Do note that CHAS is only applicable to outpatient bills, not inpatient bills. Patients undergoing surgery and admission for hospitalisation will receive financial counselling to understand their bill size and how much they can claim from Medisave. You may wish to visit www.sgh.com.sg/patient-services/charges-payment/pages/types-wards.aspx to have a better idea about ward rates.
3. After surgery, the hospitalisation stay is about 2-3 days before discharge. Also, you will be covered with 4 to 6 weeks’ hospitalization leave. In the first 4 weeks after discharge, there will be weekly review appointment at our institution to monitor the progress of your recovery. Most patients are able to go back to work after 4 to 6 weeks of rest. Speaking will be difficult for the first 2 weeks as the teeth may be tied up and there is a lot of swelling. However, it will gradually improve and most patient can talk normally after 4 weeks.

Posted by Joann (Republished by Forum Admin)

Hi,

My jaw is misaligned and I always have headache all the time. May I know if braces is a better choice?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

Jaw malalignment may be treated by braces alone or in conjunction with surgery. The method of treatment will depend on the severity of the malalignment on a case by case basis.

Answered by Dr Ng Jing Hao:

Your headache might be unrelated to your jaw alignment. Depending on the cause of the headache, it might be best to start jaw or braces treatment only after it has resolved.
Unfortunately, without more information about your facial profile, jaw positions and teeth positions, we are unable to advise you on whether braces are a better choice for your jaw misalignment.
We will be better able to explain your treatment options after a thorough examination.

Posted by lixianeo231081 (Republished by Forum Admin)

Hi Dr,
Is it abnormal to hear a click sound when my mouth is widely open? Feel cramp on the right jaw while chewing and does it cause asymmetrical jawline?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

A clicking sound in the jaw joint when opening the mouth may be a sign of temporomandibular disorder (TMD). TMD itself usually does not cause asymmetrical jawline. However, asymmetrical jawline may occasionally aggravate TMD.

Posted by Maanasa (Republished by Forum Admin)

Hello doctors,

Saw this email address on the healthxchange page and would really appreciate your help.

I'm a 23-year-old female and I used to have a severe jaw clenching/grinding problem in my sleep when I was younger, to the extent that I couldn't open my jaws open without pain. I was given mouth guards to wear in the night to prevent this and stopped using them about a year ago when I felt the condition had improved drastically. Lately however, I seem to have started clenching my jaws again in my sleep and wanted to know if wearing mouth guards is the only solution to this problem? If so, how do I get a new pair in Singapore? Who do I go to for this? Thank you.

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

Teeth clenching and grinding can be managed in other ways beside mouth guards. For example, some cases may be managed with muscular injections to reduce the intensity and amount of force the jaw muscle can exert. The type of treatment would be decided on a case by case basis upon examination.

Fabrication of mouth guards can be done in National Dental Centre Singapore and it can be done by either Prosthodontists or Oral and Maxillofacial Surgeons.

Posted by Nikki (Republished by Forum Admin)

Dear Dr,

I have noticed that my jaw clicks when I chew food, especially if it is chewy texture. I have no pain and I can chew and swallow properly. It is just very annoying with the clicking sound every time I eat. Also, my jaw tends to get tired if it clicks during meal. Sometimes, it does not click but most of the time, it clicks.

What is wrong and can I do something about it? I hope it is treatable.

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

A clicking sound in the jaw joint when opening the mouth may be a sign of temporomandibular disorder (TMD). Clicking sounds without any pain or limitation in opening are usually benign and do not require any treatment.

Posted by A (Republished by Forum Admin)

Hi Doctors,

Both sides of my jaw produce a loud cracking sound whenever I open my mouth to eat. I first notice the sound a few years ago, recently it got louder and one side of my jaw aches. What could be the cause for it? Thanks for your advice.

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

A clicking or cracking sound in the jaw joint when opening the mouth may be a sign of temporomandibular disorder (TMD). Clicking sounds without any pain or limitation in opening are usually benign and do not require any treatment. If the sounds are associated with pain, it may suggest aggravation of the TMD. I would advise you to have a proper clinical and radiographic examination at our institution.

Posted by Bavani Lyra (Republished by Forum Admin)

Hi,

I have been having clicking or popping sounds in my jaw for the past 3 years. I did see a dental surgeon then but he said it was due to stress and that it should go off in time. Since then, I have been bearing with this problem.

But for last 3 months, I have been experiencing some pain. Again, I went to see a Dentist who recommended laser treatment. After three sessions of treatment, there is no improvement.

Please advise what would be next course of action.

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

A clicking or cracking sound in the jaw joint when opening the mouth may be a sign of temporomandibular disorder (TMD). Clicking sounds without any pain or limitation in opening are usually benign and do not require any treatment. If the sounds are associated with pain, it may suggest aggravation of the TMD. I would advise you to have a proper clinical and radiographic examination at our institution before we can suggest any follow up treatment.

Posted by Elizabeth Yovita (Republished by Forum Admin)

Hi,

How do we find out if our child has jaw abnormalities? My son is 3,5 years old. So far he can only pronounce vowels: a , e for albert
consonants: p, m, h, w, y, k

Thanks

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

Jaw abnormalities are usually developmental in nature and rarely present so early on in life. If there is a congenital severe jaw abnormality, it would have most likely been detected by the paediatrician. I would advise regular visits to the dentist as your child gets older so that we can watch out for any developmental jaw abnormalities.

Regarding the pronunciation of words, it would be more appropriate to seek the advice of a speech therapist.

Answered by Dr Ng Jing Hao:

You can bring your child for an assessment by a paediatric dentist or orthodontist to find out if your child has jaw abnormalities.

Some jaw abnormalities may only become apparent when the child undergoes his / her pubertal growth spurt.

You son’s speech patterns may be unrelated to his jaws. You can see a speech therapist for further assessment of his speech.

Posted by Snow (Republished by Forum Admin)

Hi,

I saw this event/Q&A opportunity from HealthXchange.sg and would like to ask you about my condition.

I have quite significant underbite, but I suspect it surfaced after the growth of wisdom teeth?
As I had frequent visits to the school dentist in my secondary school years and only when I was 15 onwards did the dentist suggest to me to put on braces. Even then I did not have an underbite yet, and lower front teeth were right below upper front teeth (with a 1mm gap, but not protruding), side profile - nothing obvious as well.

But over the years the underbite grew more and more significantly, now the gap is about 5mm wide and lower jaw protruding, from the side profile it's very obvious.

Then without knowing when, I realised I had 4 fully grown wisdom teeth already.
Could wisdom teeth be the reason for my underbite?

Also the wisdom teeth are fully grown and not unhealthy at this moment. Do you suggest that I pluck the wisdom teeth and put braces to correct the gap and underbite? If I can’t correct the underbite, I would really hope at least my teeth can meet as I am having increasing difficulty chewing from the front, and a lisp that's getting worse...

Thanks for your advice!

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

There is no concrete evidence to show that the development of wisdom teeth can cause the teeth to develop an underbite as the force of eruption is insignificant compared to the stability of the teeth roots.

In order to correct your underbite, it is likely you will require braces and jaw surgery in order to get a favourable outcome. Removal of wisdom teeth itself is unlikely to solve the problem.

Answered by Dr Ng Jing Hao:

It is unlikely that wisdom teeth are the reason for your underbite.

The lower jaw continues to grow until a later age compared to the upper jaw. This may be why you experienced an increasing underbite and lower jaw protrusion over the years.

Most cases of underbite will not require treatment if the patient is able to cope with the compromised biting and speech.

However, if you wish to correct or reduce your underbite, you will require treatment with braces, with or without jaw surgery.

Mild to moderate cases of underbite may be able to be treated with braces alone, without jaw surgery. Severe cases will likely need jaw surgery together with braces for ideal results. Determining the severity of the condition will require clinical examination, x-rays and dental moulds to study the jaws and teeth.

Posted by Ms Tan (Republished by Forum Admin)

I've had TMD for a few years and it had resulted in an open bite. At first I had constant and persistent pain on my jaws, and it had given me very bad migraine which affected my concentration at work. I initially sought treatment at NDCS but was told it was a rare case, and chances of having it was 1 out of a million, so besides popping pain killers, there was nothing much the doctors can do for me. Although there was another option, which is surgery, I was also told that there is no guarantee that it will not relapse.

So I've chosen to take painkillers instead, but over the years, with the prolong taking of painkillers, I'd also developed gastric problems. Now I am simply enduring the pain without any painkillers. In recent years, I've heard more people mentioning that they have TMD, so I am wondering, with the advanced medical knowledge, is there a better & safer option/solution for me now, so that I can be freed from the constant pain? Greatly appreciate your advice. Thank you.

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

From your description, it does sound like a severe case of TMD. Without knowing the case in detail, it would be impossible to suggest any alternative plan. However, you mentioned that you have been offered the option of surgery before. Although there hasn’t been any new breakthrough in surgical techniques, surgical techniques are continuously refined and improved upon. It may be wise to have a consultation with our institution again to learn about any new plans we may be able to offer you.

Posted by Jamie (Republished by Forum Admin)

Is it a cause for concern for my jaw to "click"? I can feel it move in and out of its socket when I fully extend my jaw. What kind of problems can this pose and is it necessary to get it treated if it does not otherwise cause discomfort?

Answered by Department of Oral and Maxillofacial Surgery, NDCS:

A clicking or cracking sound in the jaw joint when opening the mouth may be a sign of temporomandibular disorder (TMD). Clicking sounds without any pain or limitation in opening are usually benign and do not require any treatment. If the sounds are associated with pain, it may suggest aggravation of the TMD. Other problems that may occur are dislocation of the jaw. I would advise you to have a proper clinical and radiographic examination at our institution.

Posted by Jamie (Republished by Forum Admin)

Hi,

My girl is 15+ and has an underbite and it’s troubling her a lot. Ideally, it would be best if she can put on her braces and also do a surgery. As she is still so young, I would not opt for surgery at this moment.

I have brought her to the dentist and was suggested that she needed to remove her two teeth from the side at the lower jaw before she puts on her braces.

1. May I know that would by removing her two side teeth, can she still choose to go for surgery next time when she gets older?
2. Is removing teeth a must/necessary for braces?
3. She is 15+ and will be 16 in next April. Will her jaw be still continuing to grow? At what age will her jaw stop growing?

Thanks for your reply.

Answered by Dr Ng Jing Hao:

1. As the jaw positions and bite are significantly changed by jaw surgery, braces are usually required at the same time as jaw surgery to ensure that the teeth can still bite well in the new jaw positions.
   
   Planning extractions for the braces treatment is ideally done together with planning for the jaw surgery, and extractions are sometimes not required.
   
   If your girl intends to go for jaw surgery in future, it would be better to delay the extractions and braces until she is ready for jaw surgery, especially if the two side teeth are currently not causing her any problems.
   
   
2. Removing teeth is not a must for braces and is assessed on a case-to-case basis.
   
   Reported extraction rates for braces treatment range from around 25% in Caucasian populations (Konstantonis et al 2013, Jackson et al 2017) to about 60% in a Korean population (Jung 2012). Non-Caucasians seem to have higher extraction rates than Caucasians (Jackson et al 2017). Locally, Dr. Qian Li from NDCS is conducting a study on extraction rates for braces treatment in our local population and will be reporting his results soon!
   
   
3. Age alone is not a good indicator of whether or not jaw growth has stopped, as there is no fixed age at which jaws stop growing and it varies considerably from person to person.
   
   There are various methods to determine the end of jaw growth, but a good way is to go for yearly monitoring of the teeth and jaw positions. This is sometimes done together with x-ray measurements.
   

About Dr Ng Jing Hao

Dr Ng Jing Hao is a Consultant in the Department of Orthodontics at the National Dental Centre Singapore. He completed his Bachelor in Dental Surgery from the National University of Singapore (NUS) in 2009. He proceeded to do his postgraduate training in orthodontics and completed the accreditation examination in 2017. In addition, he is a clinical teacher for orthodontic residents at the Faculty of Dentistry, NUS.