Wisdom Teeth

Wisdom Teeth: Does everyone have their wisdom teeth taken out?

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 in-tact but should be monitored periodically.

Why are wisdom teeth taken out?

Wisdom teeth are commonly removed due to infection, high infection potential, damage to adjacent teeth, crowding, in preparation for jaw surgery, cyst or tumor formation, damage to adjacent nerves/bones/tissues.

Do my wisdom teeth need to be taken out?

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.

When should wisdom teeth come out?

Again, with wisdom teeth removal, 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 early as 12 or 13, but they are most commonly removed in the 15 to 18 year age range. Wisdom teeth should be monitored by your dentist for referral to AOFS for removal.

Should I be sedated?

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.

Should I have my wisdom teeth all out at once or in separate appointments?

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

What can I eat afterward?

A soft non-chew diet for two to three days is recommended. 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 one week.

What can I do afterward?

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

Days 4-7: Moderate activity including school and light exercise

Days 7 and after: Resume normal activity

How long does it hurt?

When you go home you will be numb, so it should not hurt for one to two hours. 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 three 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.)

Corrective Jaw Surgery (Orthognathic Surgery)

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.

Why do some patients need jaw surgery?

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.

What is the benefit or change with jaw surgery?

Benefits that are individual to each case can be an 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 a strain on the muscles and joints. If this is the case, orthognathic surgery can help align the jaw and reduce/relieve posturing)

Do I have to have my jaws wired shut after corrective jaw surgery?

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.

What can I eat, and do I have to eat liquid for two to three months?

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

Do you break my jaw?

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.

How long will I take to heal?

You will likely need one to two weeks off from work or school. In the first week you should not do much, but then you can resume light activity at one week. After two 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 (three months for these).

Obstructive Sleep Apnea and Maxillomandibular Advancement

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a condition in which patients have a tendency for a collapsed 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.

What treatments are there for OSA?

Many. Traditionally the gold standard has been CPAP appliance. This is a 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 a tracheostomy.

Why shouldn’t I just get a CPAP if I have OSA?

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.

How do I get diagnosed?

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

What is Maxillomandibular Advancement?

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.)

Who is a candidate for Maxillomandibular Advancement Surgery?

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

Will my insurance cover this 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.

If I snore, do I have OSA?

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.)

Why have Maxillomandibular Advancement (MMA) for OSA?

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.


Alaska Center For Oral + Facial Surgery is an accredited surgery center (AAAHC – Accreditation Association for Ambulatory Health Care). Does this mean you are like a hospital?

AAAHC accreditation holds Alaska Center For Oral + Facial Surgery up to the highest designated safety and cleanliness standards, similar to a hospital operating room; unlike a hospital, an accredited surgery center offers the highest state-of-the-art safety, without obligatory hospital charges that often make surgical procedures prohibitively expensive for the patient.

Is Anesthesia care safer at Alaska Center For Oral + Facial Surgery than other places in town?

All of the surgeons at Alaska Center For Oral + Facial Surgery are both Dentists and Physicians, with extensive training in anesthesia care in both medical and residency training. These are qualifications not shared by general dentists or by most other oral surgeons. Additionally, our AAAHC (Accreditation Association for Ambulatory Health Care) designation requires our office to uphold much higher safety standards than general dental offices and other oral surgery offices that offer I.V. sedation for surgical procedures.

Will an anesthesiologist put me to sleep for my procedure?

Alaska Center For Oral + Facial Surgery employs specialty anesthesia physicians (anesthesiologists) who are available to provide complete anesthesia care for patients undergoing major surgical procedures such as corrective jaw surgery, TMJ procedures, and reconstructive facial surgery, amongst operations.

What is “outpatient anesthesia” and what does it mean for my surgery?

At Alaska Center For Oral + Facial Surgery, the majority of our procedures are considered “outpatient anesthesia” surgeries, which means your surgeon feels comfortable with you recovering optimally from your anesthesia and operation at home, generally with patients leaving our office within 30 minutes after completing procedures.

After my major surgical procedure, shouldn’t I stay in a hospital to be safe?

Some surgical procedure are best completed in the hospital setting in order to offer the patient twenty-four-hour post-operative nursing care. Our Surgeons at Alaska Center For Oral + Facial Surgery have full staff privileges at both Providence Alaska Medical Center and Alaska Regional Hospital. In this case, our surgeons will plan for your procedure to take place in a hospital operating room with a scheduled overnight stay.