Braces on the upper jaw only: does it work?

The full answer

Many people ask for the upper jaw only, and the reason makes sense. It is the one that shows when you smile, and the lower jaw hides behind the lip. But your teeth are not two separate sets. They are one set: every upper tooth has a place where it meets the lower teeth when you close your mouth and chew.

So when the upper teeth move, the way they meet the lower teeth changes. If that change leaves the bite meeting properly, or keeps it that way, one jaw is enough. If it makes the upper teeth knock against the lower ones, or opens a gap in the bite, the lower jaw has to come into the plan. The same if the upper teeth cannot reach their place because the lower teeth are in the way. Even if it looks tidy from the outside.

So the real question is not “one jaw or two”. It is “how will my teeth meet when treatment ends?”. The answer comes from the examination and the x-ray, not from preference, not from an article, not even this one.

Why the lower jaw matters when you cannot see it

Because the lower teeth are the floor the upper teeth rest on. The upper front teeth sit slightly in front of the lower ones and cover them a little from above. Those two distances set how far the upper teeth can come back or forward. If the lower jaw is crowded or tilted, the upper jaw has to follow it. We would be lining up the top on a bottom that is not lined up. In many adults the lower front teeth crowd up on their own over the years, even if they were fine before.

If you were wondering about age in the first place, age is not the barrier: Braces as an adult: age is not the barrier. The types of braces and what happens at each visit are on Braces.

When one jaw is enough, and when it is not

This is the general rule, and the doctor applies it to your mouth, not to the average one:

One jaw is usually enough when

• Your bite is already sound. The molars and canines meet properly, and the problem is confined to the upper front teeth.
• The movement needed is small. A slight tilt, a small gap, or one tooth sitting a little out or in, and straightening it does not change the bite.
• Mild drifting after old braces. You stopped wearing the retainer, the upper teeth moved a little, and the lower ones stayed where they were.
• And in every case, the lower jaw is tidy or not part of the problem. Its state does not stop the upper teeth reaching their proper place.

When it is usually not enough

• The upper teeth stick out. To come back they need room, and the lower teeth set how far they can come. Too far and they knock against them; not far enough and they still stick out. In many of these cases the answer involves the lower jaw, or the whole bite.
• There is crowding that needs space. Straightening crowded teeth without making space pushes them forward, which adds to the protrusion and changes the bite. Making space, by light filing between the teeth or an extraction, is a decision worked out on both jaws together, not on one alone.
• The bite is reversed or deep. When upper teeth close behind the lower ones, or cover them too much, the problem is in how the two rows of teeth meet, not in one jaw. So the plan usually takes in both.
• The lower jaw is crowded or tilted. Line up the top on a bottom that is not lined up and it either drifts back or ends in a bite that is not comfortable.
• The problem is the jaw itself. Sometimes the lower jaw sits further back or further forward than the upper, or the two jaws do not match in size. Moving the teeth of one jaw does not fix that. In a child, growth can be guided. In an adult the answer is braces that compensate for the difference, or, in the larger cases, braces coordinated with a jaw surgeon. The doctor refers you if your case needs it.

What the doctor looks at to decide

• How your teeth meet with your mouth closed: from the front and from both sides, and the distance between the upper and lower front teeth.
• How much crowding or spacing there is in each jaw, and whether there is room to move or room has to be made.
• The lower jaw: tidy, crowded, tilted, or in need of work as well.
• Whether the problem is in the teeth or in the jaw itself, which shows on the x-ray and in the profile of the face.
• The gums and the bone around the roots, because braces go onto a healthy mouth.

Then an x-ray if it is needed: a panoramic x-ray of both jaws, and sometimes a side view of the head that shows how the jaws relate to each other. Then you hear the answer for your own case: one jaw is enough, or both, and why.

Does it hurt?

That is the second half of the question, and the answer is the same for any braces, on one jaw or two. The usual feeling with braces is pressure and tenderness, not the throbbing toothache that wakes you at night. Here is what happens and why, so you know what to expect:

What you feel, and when

• The first days after fitting. The wire presses gently on the teeth to move them, and a tooth under pressure feels tender, especially when you bite on something. It starts a few hours after fitting and usually eases on its own within days.
• After each adjustment. The same feeling comes back, usually milder, for a few days, because the wire is changed or tightened to carry the movement on.
• The brackets on the cheek and lip. At first they can rub from the inside until the mouth gets used to them, and orthodontic wax covers them.
• With the upper jaw alone in particular. In the first days your bite may feel different and your teeth may meet somewhere new. The doctor plans for that from the day of fitting.

Why there is pressure at all

A tooth does not move on its own. It moves as the bone around it renews itself: pressure on one side makes the bone dissolve a little, and on the other side it rebuilds. Pressure in the first days is normal, but it is not a gauge: you may feel nothing and the teeth still move. What matters is that it eases rather than builds, and it fades once the tooth settles in its new place.

If you need a painkiller in the first days, there is a suitable one, and the doctor decides which is right for you. You eat soft food for a few days and then go back to normal. What is not normal: pain that gets worse after a few days instead of easing, or pain in one particular tooth. That is a reason to call.

If the fear of pain is what is putting you off braces altogether, say so at the first visit and we go at your pace: When the visit is hard.

What to do now

1. 1

   Book an examination, not a decisionThe examination looks at the bite, the crowding, the lower jaw and the gums, with an x-ray if it is needed. You leave knowing whether one jaw is enough or both, and why, or you hear it once the x-ray is back if one is needed. No pressure to decide in the same visit. If you are pregnant, the timing has its own considerations: Braces during pregnancy.

2. 2

   Say exactly what you wantThe look of the front teeth? One particular gap? A tooth sitting out? When you say what bothers you, the doctor can tell you whether what you want can be done on one jaw or needs more.

3. 3

   Ask: how will my teeth meet at the end?This is the question that matters. Any orthodontic plan has to answer it before it starts, and it is what keeps the plan protecting your bite, not just the look.

4. 4

   Health before hardwareTartar, gum inflammation or decay are treated first. Decay and gum inflammation carry on around the brackets and under the wires if they are not dealt with beforehand.

5. 5

   If the answer is both jaws, hear whyYou hear the reason in your own case: protrusion, crowding, or the bite. If you want to think it over, take your time: in an adult there is usually no rush, unless the examination shows the gums or the bite are being harmed by waiting, and you hear that plainly. In a child, the timing is set by the early check.

6. 6

   If you started braces somewhere elseIf you began treatment in another country and then moved to Amman, or you are only here for a stretch, say so first and bring whatever records you have. After an examination the doctor tells you whether the plan carries on as it is or needs to change. Fixed braces need visits through the course, and that shapes what is realistic.

7. 7

   The retainer from day oneEven with braces on one jaw, the teeth tend to drift back afterwards. The retainer is part of the plan from the start, not an add-on at the end.

When to call

Most of what happens with braces can be sorted out at the next visit. But some things do not wait for the appointment:

• A wire sticking out and cutting your cheek or tongue that you could not cover with wax.
• A bracket that has come off the tooth, or a wire that has snapped.
• Your teeth meeting in a way that stops you eating or closing your mouth comfortably, once the first days have passed.
• Pain that gets worse after a few days instead of easing, or pain in one particular tooth.
• Swelling in the gum or cheek, or heavy gum bleeding that does not stop with gentle brushing.
• A fever with any of the above.

Call during opening hours and we give you the earliest open slot, and tell you what to do until you get here. If a large swelling reaches your eye, or swallowing or breathing becomes difficult, that does not wait for an orthodontic appointment: it is a hospital emergency, and you tell us afterwards. If you have a fever with swelling and the clinic is closed, do not wait for opening hours: go to the nearest hospital emergency department, and tell us afterwards. One tooth that hurts and gets worse at night has its own page: Toothache: what to do right now.

Questions people ask