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ORTHOGNATHIC SURGERY
Often when a dentist or an orthodontist suggests that jaw surgery may be required to resolve a bite problem, many people stop listening or reject the idea completely -- a normal reaction but one that limits the possibilities for improved health if one "closes the door" permanently.
There are many people who keep the door open, have surgery and are absolutely delighted with their decision and with the results. If you need jaw surgery, you could be delighted also!
After the initial shock has worn off, the time to really listen is at hand. Why would your dentist or orthodontist suggest surgery? Very · simply -- there is a severe discrepancy in the alignment of the jaw bones, i.e. they just do not match up properly. Generally there are four types of problems that require jaw surgery in adults:
1) Lower jaw too large (Dick Tracey)
2) Lower jaw too small (Bucky Beaver)
3) Upper jaw too small (rarely is the upper jaw too large, "buck teeth" usually result when the lower jaw is too small)
4) Upper jaw over-developed vertically due to longterm mouthbreathing, producing an "openbite" (Carol Burnette before jaw surgery)
In these situations the teeth are not the problem -- the jaws are the problem. The correct solution is to alter the size or position of the discrepant jaw -- not to extract teeth in the normal jaw so as to align the teeth in the normal jaw to the abnormal jaw. Extraction Therapy may result in straight teeth but often produces a "funny-looking face". For the most part, what you end up with after treatment is what you must live with the rest of your life. Why not make it as near perfect as possible?
If you require jaw surgery to harmonize the jaws, improve the function of your teeth and enhance facial appearance, there are some things you need to know:
1) Jaw surgery requires the combined efforts of the orthodontist, the jaw surgeon and your dentist.
2) The teeth are extensions of the jaws and if the teeth in the opposing jaws do not fit correctly at the time of surgery, the jaws will not fit properly.
3) The orthodontist is trained to identify discrepancies in the size, shape and position of the jaws and works in coordination with the jaw surgeon and your dentist to arrive at the most ideal treatment for each particular surgical case.
The role of the orthodontist is to:
A) identify the discrepant jaw
B) align the teeth in such a manner as to allow the jaws to fit together ideally after surgery
C) consult with the surgeon and your dentist prior to surgery to finalize the treatment plan
D) complete the alignment of teeth following surgery
The role of the jaw surgeon is to work with the general dentist and the orthodontist to identify the problem at hand and to plan and perform the surgical procedures required to achieve the goal in accordance with his training and experience.
The role of your dentist is to recognize the skeletal problem and refer for evaluation, assist in the surgical decision, monitor progress and see you on a regular basis throughout all phases of treatment to monitor and supervise the care and maintenance of your teeth, gums and supporting bone. In addition, your dentist may need to provide special restorative needs (crowns, bridges) at the end of treatment when needed to idealize the results.
In certain situations, your dentist may refer you to a periodontist for more specialized care of your periodontium (roots of teeth, gums, periodontal ligament and alveolar bone).
To accept and follow an orthognathic surgical program for a particular facial skeletal problem, one must:
1) Recognize that one has a skeletal discrepancy
2) Understand and appreciate the rationale and effort a surgical solution requires
3) See and believe the health benefits and cosmetic benefits that result
4) Be willing and able to fund the treatment
And most important of all
5) Want to have it done
The surgical and hospital component of orthognathic surgery is almost always covered by medical insurance. The orthodontic component, although it should be covered also, may not be covered by medical insurance. If you have orthodontic insurance, a part of the orthodontic fee will be covered. Your dentist can tell you about your dental insurance benefits.
Often those who are considering orthognathic surgery are referred to an otolaryngologist for an upper airway evaluation if it appears an upper airway obstruction is present. You can easily appreciate the acute problem that may accrue if the jaws need to be wired together for a short period of time following jaw surgery and you cannot breathe through your nose. Those who elect not to have jaw surgery but have an upper airway obstruction should see the otolaryngologist for an airway evaluation since it has been shown mouthbreathers have a higher incidence of high blood pressure, heart disease, sleep disturbances and temporomandibular joint dysfunction problems.
Young children with jaw discrepancies and airway problems should be seen as early in life as possible by the orthodontist trained in early treatment inasmuch as proper early treatment can eliminate completely or drasticly minimize the possibility of jaw surgery. All children should be seen by an orthodontic specialist by age 3.
To clearly understand all aspects of your particular problem, I recommend you:
1) Confer with your general dentist
2) Complete an indepth study by your orthodontist
3) Consult with the oral surgeon suggested by your orthodontist
4) Contact someone your orthodontist and surgeon have treated with the same procedures and get a firsthand report of their experiences and feelings
5) Have the orthodontist and oral surgeon submit a pre-surgical insurance report regarding your particular case to your insurance carrier
6) Make your own decision!
5/13/93