Dr. James Douglas Bates, D.D.S., M.D.

Thank you very much for your question!

A board-certified oral and maxillofacial surgeon would be the best doctor to see for jaw alignment surgery!

Regards,

Jim Bates, DDS, MD, FACS

Thanks for your question! The recovery time after TMJ surgery depends on what operation you are actually going to have. There are different types of TMJ surgery, including arthroscopy, arthroplasty and total joint replacement. Arthroscopy and arthroplasty are generally minimally invasive procedures done on an outpatient basis and take about 7 to 10 days to recover from. Total joint replacement, on the other hand, is much more complex and generally a patient stays in the hospital for one or two nights, and recovery may take 3 to 6 weeks. It all depends on the nature of the actual surgery which is planned for you.

Thanks for your question! Generally speaking, after dental implant surgery, you should be on a soft diet for at least a week or two, and of course this depends on how many implants are placed and where they are placed and whether or not you have a temporary prosthesis over the implants. The goal is to avoid any force being applied to the implants as the tissues around them heal.

Thanks for your question! I'm not sure about other surgeons, but I haven't kept patient's teeth wired together after reconstructive jaw surgery for about 30 years. We generally always use rigid internal fixation, which means titanium plates and screws, to secure the bones as they heal and allow patients to resume normal range of motion and function as soon as possible after surgery. I hope this helps!

Thanks for your question! I would not consider jaw reduction surgery dangerous, although as with any surgical procedure, regardless of how minor or major it is, there are certain risks and potential complications associated with the surgery. Jaw reduction surgery may be done one of several ways, and the risks depend on the actual operation that is planned or performed. We generally use the sagittal ramus osteotomy for jaw setback, and one of the risks is temporary or permanent injury to the sensory nerve that runs through the jaw that gives you feeling to your lower lip, chin, gums, tongue and teeth, on one or both sides. This may result in numbness or loss of sensation in these areas for several months after surgery, but most patients have complete return of normal sensation after about 3 to 6 months. So, the answer would be generally no, jaw reduction surgery is not dangerous, but there are inherent risks that need to be considered and weighed in the balance, although generally the benefits of the surgery are considered to outweigh the risks. I hope this helps!

Thanks for your question! It's actually quite rare these days for us to have to wire a patient's teeth together for any significant length of time after surgery. However, when we do temporarily wire a patient's teeth together, we can use a variety of techniques. Many times patients undergoing reconstructive jaw surgery are wearing orthodontic braces, and we simply use these appliances to wire the teeth together using stainless steel wire loops around the upper and lower braces which are tightened to bring the teeth together into the right alignment. For patients undergoing wiring for a traumatic injury such as a broken jaw, we then have to apply the braces to the jaws using strips of metal with hooks on them that are called arch bars. After contouring the arch bars to the teeth, we then pass individual stainless steel wires around the teeth and the arch bars to secure them in position. We then use stainless steel wire loops to engage the hooks on the upper and lower arch bars in order to wire the teeth together. I hope this helps!

Thanks for your question! Reconstructive jaw surgery can last anywhere from 1 to 8 hours, depending on the actual procedures performed. For example, a simple genioplasty, or chin augmentation, takes about an hour, while upper and lower jaw procedures generally take 2 to 3 hours each. In addition, there may be supplemental procedures required which may add time to the operation, such as a nasal septoplasty, a turbinate reduction or a TMJ procedure. I hope this helps!

Thanks for your question! Fortunately, relapse after reconstructive jaw surgery is quite rare these days due to many advancements in the surgical techniques we use to move and stabilize the upper and lower jaws. When we do see relapse, it's usually in the range of 1 to 2 mm, which is generally negligible and sometimes not clinically significant. However, with contemporary rigid internal fixation using titanium plates and screws, we generally see essentially no relapse that can be clinically observed, and we find that it does not generally affect the occlusal outcome of the operation, or the bite. I hope this helps!

Thanks for your question! The answer depends on what actual jaw surgery procedure you're planning to undergo. I can only speak for myself, but the majority of my patients are able to open their mouth at least a little bit immediately after the operation even in the recovery room. Of course, the range of motion of the lower jaw may be limited, again depending on the operation, for several weeks. For example, patients having only upper jaw surgery recover faster and with greater range of motion than patients having lower jaw surgery, because it's the lower jaw that actually moves at the hinge joint when you open your mouth. I hope this helps!

Thanks for your question! The answer depends on the nature and type of operation you are going to have. Most patients are on a liquid diet for at least a few days, and then are able to choose soft solid foods for another 2 to 3 weeks before resuming a normal solid diet. I hope this helps!

Greetings,

Thanks for your question. In general, regarding diagnostic imaging for reconstructive jaw surgery, we generally obtain the following studies:

-High-resolution thin section maxillofacial cone beam CT
-Digital intraoral full arch scans of the teeth and the dental occlusion
-High-resolution facial and intraoral photographs

From these studies, we can obtain very clear views of the upper and lower jaws and the teeth, the temporomandibular joints and the airway. We are able then to stitch the intraoral scans with the raw DICOM data, perform detailed cephalometric analyses of the facial skeleton, and perform virtual surgery in three dimensions with 3D printing of any necessary surgical splints.
I hope this answers your question.

Thank you!

Jim Bates, DDS, MD

Yes, it is safe to have all four wisdom teeth removed at once! In fact, this is probably the safest and most effective and efficient way to remove wisdom teeth. It is generally done under intravenous sedation in combination with local anesthesia and can be and usually is a reasonably pleasant and uncomplicated procedure. Removing all four wisdom teeth in one setting eliminates the need for multiple office visits and multiple anesthetics and multiple surgical interventions and the associated recovery process.
Hope this answers your question!

Jim Bates, DDS, MD

Greetings:

Thanks for your question. In general, after a tooth is extracted, the blood clot in the tooth socket should remain there for several weeks until the tooth socket completely heals with bone.

If the blood clot comes out or dissolves prematurely, that can lead to a condition called dry socket, which we call alveolar osteitis, an inflammatory condition that can be very painful with exposed bone and delayed healing. However, this only occurs about 20% of the time, and is less common if routine postoperative instructions are followed. This would include avoiding anything that might dislodge the blood clot, such as avoiding carbonated beverages, forceful spitting, smoking cigarettes, drinking through a straw or anything that might create a vacuum in the mouth. We generally recommend gently rinsing with dilute salt water or a prescription chlorhexidine mouth rinse after an extraction to speed healing and reduce inflammation.

Should a dry socket develop, it's easy to treat. Just let your doctor know if your pain increases after two or three days rather than getting better. They will be able to dress the wound with a sedative dressing material that will ease the pain and healing will progress normally from there.
Hope that answers your question!

Jim Bates, DDS, MD

Greetings:

In answer to your question about when you can chew after jaw surgery, the answer is: it depends!

It depends on what kind of jaw surgery you're having and how extensive it will be. For example, if you're just having some wisdom teeth removed, you should be back to chewing soft foods after a couple of days and back to a normal diet by about 10 days.

However, if you're having major reconstructive jaw surgery, it will take a bit longer for you to resume chewing foods, and even that depends on how much surgery you're having. Most people are chewing soft solid foods after about 10 days and back to a normal diet after about four weeks.

I hope that helps! Stay healthy and safe.

Jim Bates, DDS, MD
Diplomate, American Board of Oral and Maxillofacial Surgery
Fellow, American Association of Oral and Maxillofacial Surgeons
Texas Oral and Maxillofacial Surgery
3001 Knox Street, Suite 301
Dallas, TX 75205-5593
214.824.8960
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Greetings, and thank you for your question!

Having wisdom teeth removed is a common procedure for adolescents and young adults. I'm sure your daughter will do splendidly. We generally recommend that patients sleep with their head elevated after any kind of jaw surgery. This will help reduce swelling and discomfort. I usually tell our patients to sleep with their head elevated on two or three pillows, or to sleep in a recliner with their head elevated 15-30 degrees. Most postoperative patients generally sleep well after surgery, in fact often more than usual, so don't be surprised. Some patients wake up with pain or bleeding during the night. Your daughter may want to take pain medication before going to bed for the night so it last longer. Should she wake up with some bleeding from her mouth, that is also not unusual. Applying firm pressure with teeth on cotton gauze placed over the extraction sites will help reduce any bleeding. Of course, your daughter should follow the postoperative instructions provided by her own doctor as well.
Hope this answers your questions. Stay safe and healthy!

Jim Bates, DDS, MD

Yes, it is very common for general dentists to refer patients to see an oral and maxillofacial surgeon regarding jaw clicking, particularly if you complained about it to your dentist.

The jaw joint, or the temporomandibular joint, connects the lower jaw to the skull. It is a ball and socket joint, with a disk between the ball and socket to cushion the joint. Normally, the disk sits right on top of the ball, and moves forward and down with the ball when opening mouth, and also moves up and back with the ball when closing the mouth. Clicking in the jaw joint when opening the mouth often indicates that the disc inside the joint may be partially displaced. The disc cannot be seen on x-rays, and is best visualized on an MRI, or magnetic resonance imaging.

If the jaw joint clicking is not painful and does not affect function, it may not require treatment. However, if pain or dysfunction is associated with the clicking jaw joint, treatment may help relieve the pain and improve function. This is probably why your dentist recommended that you see an oral surgeon.

Hope this helps!

The information contained in this e-mail message is intended only for the use of the individual or entity named above and is privileged and confidential. Any dissemination, distribution or copy of this communication other than to the individual or entity named above is strictly prohibited. If you have received this communication in error, please notify us immediately by telephone.