Frequently Asked Questions

No, if wisdom teeth are functional and healthy they do not need to be removed. Or if wisdom teeth removal would be highly likely to cause harm, they are often left but should be monitored periodically.

The most common are: Infection, high infection potential, damage to adjacent teeth, crowding, in preparation for jaw surgery, cyst or tumor formation, damage to adjacent nerves/bones/tissues

At AOFS a consultation can walk you through the pros and cons to having your wisdom teeth removed, which ones to remove, which type of anesthesia to be used (AOFS can offer all levels—Local, Nitrous, IV sedation and General Anesthesia) and when to have it done. The bottom line is that every case is different, and yours should be evaluated as such.

Again every case is unique, but in general the earlier the better. When teeth are less than ½ to 2/3 formed is ideal. This could be as soon as 12 or 13, but they are most commonly removed in the 15-18yr range. Wisdom teeth should be monitored by your dentist for referral to AOFS for removal.

The majority of Dr. Nordstrom’s patients having wisdom teeth extracted are sedated to some degree. This again is an individual answer, but all levels are available as appropriate at AOFS.

In general if wisdom teeth need to be removed, they should be done all at once to minimize surgeries and sedations. Of course some patients choose to have them done at separate appointments based upon symptoms, finances, personal schedules and a variety of others. There is no defined plan—we will work with you.

Soft non-chew diet for 2-3 days. Avoid High temperature foods, spicy, sour, carbonated drinks, seeds and nuts, and chewy or crunchy foods initially. This can be advanced as tolerated to a normal diet after about 1 week.

Days 1-3: Minimal to light activity, (movies, moving around the house or short neighborhood walks)

Days 4-7: Moderate activity, school, light exercise

Days 7 and after: Resume normal activity

When you go home you will be numb, so it should not hurt for 1-2 hrs. After that, you will have prescription pain medication that should be taken for 2-3 days as needed (you will be achy and sore, but it should not be intolerable.) After about 3 days, you should have pain well-controlled with over-the-counter medication such as Ibuprofen or Tylenol—whatever is appropriate for you. (Note: While taking prescription pain medications, you are legally intoxicated and should avoid certain activities accordingly.)

Orthognathic surgery literally means “Normal Jaw”. This is in reference to the goals of the surgery, which is to make the jaws normal. That is not to say that if you are a candidate for it you are abnormal, but likely your jaws are in an abnormal position relative to one another. This can be for a variety of reasons.

Most commonly patients that need jaw surgery have a size difference between the upper and lower jaws. It can be that one did not grow enough or one grew too much, or a combination of both. When the difference is more than a certain amount, the teeth cannot and should not be moved enough to cover this up. The solution is to move the jaws to a proper position relative to one another, so that the teeth can line up properly.

Benefits that are individual to each case can be: Improvement in chewing function, improvement in speech, improvement or change in facial appearance, improvement in breathing/treatment of Obstructive Sleep Apnea, Improvement in jaw/muscle pain (Orthognathic surgery is not a treatment for TMJ dysfunction. Many patients have to posture to achieve a good bite which puts strain on the muscles and joints. If this is the case, orthognathic surgery can help align the jaw and reduce/relieve posturing)

No, this is very rare nowadays. Before titanium plates and screws, this was the case. Now small but strong plates and screws placed on the bones, underneath the tissues keep bones in place, and we rarely need wire stabilization. You may have some elastics on your braces similar to what orthodontists place.   Avoiding wires allows more movement and functions such as eating, speaking and brushing more easily.

Very unlikely. For the first 2 weeks your diet will be strictly non-chew diet (think blenderized). After that from weeks 2-6, you will have a mostly non-chew diet as scrambled eggs, very soft pasta. At weeks 6-8 you will advance to slightly chewier foods such as soft hamburger etc. At 8 weeks you will likely be able to resume a full diet.

No, the jaw is cut with a series of precision cuts and then slowly separated in a reproducible pattern. Once the jaw is separated—it is repositioned to the new correct position and fixated with plates and/or screws.

You will likely need 1-2 weeks off from work or school. In the first week you should not do much, but then you can resume light activity at 1 week. After 2 weeks if you are feeling well, you can resume full, non-contact type activities, and at 2 months you can resume most contact activities with the exception of very high risk physical injury activities (3 months for these).

Obstructive Sleep Apnea or OSA is a condition in which patients have a tendency for collapse of the airway during sleep that prevents normal breathing and airflow during that time. The result is decrease breathing effectiveness and sometimes poor oxygenation during sleep. The brain’s response to poor oxygenation is waking up to improve muscle tone and open the airway—resulting in very poor sleep. Additionally, this can result in negative cardiovascular effects/heart disease, daytime sleepiness, depression, obesity, diabetes, poor work and family performance and a multitude of other negative effects.

Many. Traditionally the gold standard has been CPAP appliance. This is an medical apparatus with a mask designed to fit over the nose and mouth of a patient, which delivers light air pressure to keep the airway slightly “inflated” while sleeping. Others include: appliances, Uvulo-palato-pharyngoplasty, tonsillectomy, tongue reduction, and finally facial bone surgery of the maxilla and mandible (Maxillomandibular Advancement), and tracheostomy. The only definitive treatment for OSA is Tracheostomy.

Maybe you should. But you should keep in mind that compliance with this machine is very low. This is because the appliance is often obtrusive to patient and sleeping partners. It can also be hard to wear and can cause drying of the mouth and nose, it can be displaced, and it restricts the positions in which a patient can sleep. In addition, there can be social prejudice when traveling or sleeping with others. It can also simply be inconvenient. This has historically been the standard in the US, but patients should be advised that they are highly likely to be partially or totally non-compliant.

Patients should have a Sleepiness Scale evaluation, Nasopharyngoscopy, and a formal Polysomnography test.

This is jaw surgery on the bones of the upper and lower jaw repositioning them in a more forward position. This allows for a more open airway, and prevention of collapse during sleep. Sometimes the chin is advanced separately to pull the base of the tongue forward even more (a common location of posterior obstruction.)

Moderate to severe OSA, AHI>15, and appropriate health to undergo surgery.

Most medical plans will cover Jaw Surgery for OSA if they have demonstrated need and sometimes CPAP failure. AOFS can assist with your insurance authorization to find out if and how it is covered.

Maybe. Snoring by itself does not mean that you have OSA, but it can be a red flag for obstruction. Conversely, just because you don’t snore—does not mean that you do not have OSA. Additionally, treatments that have alleviated snoring have not necessarily cured you of OSA. The only way to monitor resolution of OSA is with a follow-up sleep study (Polysomnogram.)

It is a good question. Many patients cannot use a CPAP or don’t want to. Untreated OSA can have serious medical consequences. Jaw surgery (like all surgeries) does not always work, but there is an emerging body of evidence that it can be very effective. When this is the case, patients enjoy the same sleep routines as everyone else. Compliance no longer becomes a question, and patient’s overall health is improved. Many patients with OSA have never heard of jaw surgery as an option—but those that have had it successfully, are extremely happy with the option.