Do I need surgery for obstructive sleep apnea (OSA)?

Obstructive sleep apnea (OSA) is considered a potentially serious sleep disorder, where breathing stops and starts throughout the night due to relaxation of the throat muscles. OSA can lead to loud snoring, waking up gasping, headaches, dry mouth in the morning, and excessive daytime sleepiness. 

Obstructive sleep apnea can not only lead to extreme sleepiness but also more severe problems such as high blood pressure, strain on the cardiovascular system, type 2 diabetes, liver problems, and metabolic syndrome. 

How does surgery correct obstructive sleep apnea?

Surgery is often a treatment option for those with severe sleep apnea that don’t respond to treatment with a CPAP device. How surgery will work to correct the problem, will largely depend on which type of surgical procedure your doctor recommends. Surgical procedure options for the treatment of obstructive sleep apnea include:

Uvulopalatopharyngoplasty (UPPP)

This is the most common type of procedure associated with sleep apnea and involves removing excess tissue from both the pharynx and the soft palate. In the event the patient still has their tonsils, those will be removed as well. Once the tissue is removed, the area will be sutured to reduce the risk of collapse and keep the area open so that air can easily pass through the upper airway. 

Nasal surgery

Nasal obstruction can play a critical role in sleep apnea. The three components of the nose that can be affected include the septum, the nasal valve, and the turbinates. The most common nasal procedures include reducing the size of the turbinates or straightening out the septum. By correcting these areas, air will be able to pass more freely through the nasal passages. 

Pillar Procedure

The Pillar Procedure, also referred to as soft palate implants, is a simplistic surgical procedure where three polyester rods are placed into the soft palate. Once placed, an inflammatory response will occur within the surrounding tissues that will cause the soft palate to stiffen. When this occurs, the soft palate will be less likely to come into contact with the pharynx during sleep. 

Hyoid advancement

The bone in the neck where the tongue base and pharynx attach is called the hyoid bone. If you have sleep apnea, you likely have a larger tongue base, and when you enter into a deep sleep and your muscles relax, your tongue can fall back, coming into contact with the pharynx. When this occurs, the air will be obstructed. During a hyoid advancement, the bone will be repositioned surgically using a suture attached to the front jaw bone, which will extend the airway. 

Tongue advancement

During this procedure, the genioglossus, one of the main tongue muscles, will be moved forward so that it can not slip as far backwards during sleep. A cut will be made in the jaw bone, and it will be fixed in place with a titanium plate. Once positioned, the tongue will be less likely to be able to retract toward the back floor of the mouth. 

If you struggle with sleep apnea, and CPAP therapy does not help you get a better night’s sleep, then a surgical procedure may be your best option. Discuss with your doctor which surgical procedure may work best for your specific situation. 

What Are The Signs It’s Time for Your Wisdom Teeth to Come Out?

wisdom teeth x-rays

Your wisdom teeth are a third set of molars, which usually appear when you are between 17 and 21 years of age. These teeth are rarely functional and therefore cause crowding and other issues within the mouth. Therefore, dental professionals will often recommend removing them before they break through to prevent any potential problems. The following are some common signs it might be time for your wisdom teeth to come out. If you notice any of these signs, contact us today to schedule a consultation:

Signs of Impacted Wisdom Teeth

If your wisdom teeth try to come in but don’t have the space to emerge fully from the gums, they become impacted. This can lead to:

  • Jaw pain.
  • Difficulty opening your mouth.
  • Bad breath.
  • Stiffness or swelling in the jaw.
  • Bleeding, tender or swollen gums.

General Symptoms of Wisdom Teeth Issues

Even if your wisdom teeth aren’t impacted, they can still cause issues. You could experience the following:

  • Irritation & Pain: As your wisdom teeth grow, they can cause pain and discomfort in the mouth. An x-ray can rule out other causes of pain and zero in on the wisdom tooth problem.
  • Problems Eating: Sometimes, when your wisdom teeth are trying to come through, it can cause food to get stuck between the tops of those teeth and your gums. This can cause issues with eating and can make proper oral hygiene nearly impossible. Often, extraction is recommended to prevent further complications. 
  • Shifting Teeth: If your teeth were straight and now are beginning to look crooked or crowded, newly emerged wisdom teeth could be the culprit. 
  • Sinus Problems: When wisdom teeth come in through the upper gums, the roots can rub against or put pressure on the sinuses, which can lead to sinus related issues. In some cases, it can even lead to congestion and headaches.
  • Inflamed Gums: The tissue around the emerging or not yet broken through wisdom teeth can easily become inflamed due to various issues like trapped food. This is a condition called pericoronitis. 
  • Cavities: When your gums are irritated and you are unable to properly brush due to food getting stuck, this can obviously lead to cavities. Bacteria thrive in this type of environment, making your teeth more susceptible to the development of cavities. 

Do Wisdom Teeth Always Have to Come Out?

There are several schools of thought on the subject. Some experts believe you should leave wisdom teeth alone if they aren’t bothering anything or trying to emerge, or if the mouth has room to accommodate them, should they push through. Others believe it’s best to remove them if you suspect they will try to come in and there isn’t room to accommodate them in the mouth. Some orthodontists recommend having them out early, when a patient is still in braces to prevent a potential shift in a newly straightened smile should they come through the gum line. Thankfully, the skilled professionals at Aspire Surgical can easily determine which category you fall into and either recommend extraction or promote and wait and see approach. Contact us today to schedule a visit to learn more.

Five Questions to Ask Your Oral Surgeon

The prospect of surgery is scary, no matter the reason for the procedure. Thankfully, patients can calm their fears, at least mostly, by meeting with their oral surgeon before their scheduled procedure. This consultation visit is the ideal opportunity for patients to ask questions they might have of the surgeon and ease their mind over the upcoming procedure. It’s important to have questions ready, before stepping into a consultation, so the appointment is as useful and educational as possible.

Five Questions to Ask Your Oral Surgeon During a Consultation Visit

1.) Why is This Surgery Necessary?

The most important question you need answered is the “why” for your surgery. Your oral surgeon wants you to understand your need for surgery. They never want you to go into a procedure feeling it’s unnecessary. You should walk away from your consultation understanding fully why this particular surgery is your best option to remedy the problem with which you are dealing.

2.) What is the Sequence of My Procedure?

You want to know what the surgeon plans on doing during your surgery. Ask. Let them go through step-by-step and tell you what to expect with each phase of the surgery, beginning with anesthesia. This question is important, because it gives you an accurate view of your procedure, so you know what to expect on the day of surgery.

3.) How Long will My Procedure Last?

Of course, not every patient is the same and complications can arise that prolong a surgery. However, a specialist in oral surgery, such as your oral surgeon, can give you an accurate estimation on surgery length. Keep in mind, your surgeon cannot foresee every unknown factor, so allow for some extra time when scheduling other tasks immediately after your surgery.

4.) What Will My Recovery Look Like?

Again, every patient is different. Therefore, your recovery process will not be exactly like anyone else’s. However, your oral surgeon should be able to tell you the time frame for typical recovery and what that looks like in most patients. For example, they can tell you, most patients return to work a week after this procedure. You might not need that long, but you might need longer. In addition, your surgeon should tell you how long you can expect pain, if at all. The idea is to give you a good idea of what recovery usually looks like in most patients.

5.) What Are The Risks of This Surgery?

Last but not least, you want to ask about the risks. Every surgery, no matter how common, comes along with a bit of risk. This can be scary, hearing what “could” happen. However, going over these “what ifs” can actually make you feel better about the procedure because you will learn what the worst possible outcome could be, while your surgeon explains why that won’t be the case in your situation. We recommend a consultation between you, the patient, and your surgeon before any wisdom teeth, implants, bone graph, or other oral surgery. The five questions listed above are a great way to get communication started and ensure you know exactly what to expect on the day of your oral surgery.

Helping Your Child Prepare for Oral Surgery

Oral surgery, as with any medical procedure, can be a frightening experience for anyone. For a child, it can be even more so because they are likely to have encountered fewer procedures in their young lives, and the fear of the unknown can be nerve-wracking and lead to anxiety. The good news is, you can help better prepare your child for the procedure and recovery and put their mind at ease, so they go into the process with no fear and fewer anxieties.

Discuss With Them the Benefits of the Procedure

As a child, they may not fully understand the reasoning behind their dental procedure. Discuss with them why they need to have the procedure. Will it help them to avoid future pain? Will it prevent them from having to have other corrective procedures in the future? Will it help them to speak or eat more easily once it is done? By understanding the positive outcomes of the procedure, they will better understand the need for it and can look forward to future benefits.

Fully Explain the Procedure to Them in a Calm Manner

Even if your child is young, they will want to understand what is going to happen during their procedure. When they don’t know what a procedure entails, they will tend to expect the worse, feeding into their fears. The important thing when explaining the procedure is to stay calm. A child reads their parent’s emotions and can definitely sense when you are afraid or nervous, so be sure to get yourself in a calm and relaxed place before discussing the procedure with them, even if you are worried.

You will need to tailor the discussion to their age, making sure it is at their level of comprehension so that they can understand. You don’t need to get too graphic or too detailed, but make sure that you walk them through the process, including how they will be prepped for the procedure and what will happen when they get to recovery.

Help Them to Keep Their Strength Up

Your child’s recovery will go the smoothest if they are as healthy and strong as possible. Reduce their chances of getting sick by keeping them on a healthy diet and sleep schedule. If they develop a cold or other health issues before the procedure, be sure to inform your oral surgeon and determine if there is anything you need to do beforehand. Be sure to follow all of the required pre-op procedures, such as not eating or drinking before the surgery so that they will be able to handle the anesthetic without complications.

Be Prepared for Recovery

Have everything you will need for the recovery process, such as soft or cold foods, making sure to find items that they are fond of. It is ok to spoil a child after their procedure and make their recovery as comfortable as possible.

It is also a good idea to take care of yourself before your child’s procedure so that you can remain calm and be the strong support they need through the process from preparation to recovery.

Understanding The Differences Between Dentistry And OMS

OMS looking at xray

When to See a Dentist

The following situations constitute a visit to a regular dentist office. It’s important to note that regular visits to the dentist are essential for optimal oral health. See a dentist for:

  • Repairs to damaged teeth, requiring crowns, onlays, or fillings.
  • Root canals.
  • Dentures.
  • Routine dental care, such as teeth cleanings.

When to See an OMS

Oral and maxillofacial surgeons have completed extensive training that starts in dental school but includes an additional four years of surgical residency, based in a hospital. This means an oral maxillofacial surgeon is an expert in jaw, mouth and facial surgery and can provide a level of care above and beyond basic dentistry needs, including the administration of anesthesia for various procedures. See an OMS for:

  • Oral surgeries such as bone grafting, expose and bond and frenectomy.
  • Obstructive sleep apnea.
  • Craniofacial, palate or cleft lip surgery.
  • Neck, head or oral pathology.
  • Trauma to the facial area.
  • Corrective jaw surgical procedures.
  • Cosmetic surgery of the facial region.
  • Facial pain and TMJ
  • Tooth extractions.
  • Extraction or management of wisdom teeth.
  • Dental implants.

Is There Any Overlap Between OMS and Dentistry?

Yes. There are some overlapping treatments that appear in both OMS and dentistry. However, in general, if a patient needs anesthesia for a procedure or requires more than a simple oral repair or maintenance, a visit to an OMS is likely in order.

What if It’s Still Not Clear

Any patient who still isn’t sure if their oral condition or pain falls under the jurisdiction of a dentist or an oral maxillofacial surgeon, they can simply call an OMS and ask if their specific case merits the attention of a specialist in the form of an OMS or could be handled by a dentist.

What About Orthodontics?

Another extension of dentistry commonly confused with OMS and regular dentistry is orthodontics. An orthodontist is a dentist who has graduated from dental school, who then undergoes additional specialized training in straightening teeth. If a patient’s teeth are misaligned, has gaps or their bite is off, their dentist will likely recommend a trip to the orthodontist, which will often result in the patient utilizing braces or retainers in order to straighten their teeth. Although orthodontia is thought of by many as simply cosmetic, ensuring the teeth are aligned properly actually makes it easier to keep teeth clean and healthy and reduces the risk of developing painful conditions affecting the jaw.

All Dental Professionals Have One Goal in Mind

The field of dentistry is broad and encompasses several niche specialties. Each is important to overall oral health and applicable in differing situations. Patients are always advised to make regular dental visits a habit in order to keep their teeth clean and healthy. However, sometimes, patients need more than maintenance and cleanings. That’s when an OMS comes into play. They can help a patient overcome debilitating oral conditions affecting their teeth, jaws and facial regions. Patients are encouraged to contact an OMS to learn more about whether their specific situation would be best addressed by an OMS, dentist or orthodontist.

Anesthesia For Oral Surgery

Oral surgery is a procedure that many people will require at some point in their lives. Whether it’s pulling a tooth, extracting impacted wisdom teeth, or more invasive procedures like reconstruction, most of us will find ourselves sitting in that chair for more than a routine check-up.

Many of the frequent questions we receive concern how they will be sedated during their operation. Will I be awake during the procedure? Will it hurt? Anxiety over oral surgery is completely normal and in this article, we’ll explore the different kinds of anesthesia used in oral surgery.

Types of sedation
Under most sedatives, you’ll remain somewhat conscious but many patients feel so relaxed and tranquil that they end up falling asleep during the procedure. Often times, they have no memory of the surgery at all. What type of sedation you’ll use depends on how invasive the procedure is.

Local anesthesia
Local anesthesia is a numbing medication that temporarily prevents the nerve fibers from sending signals to the brain. While using a local anesthetic, such as lidocaine, patients remain fully awake and aware. However, the area around the injection point doesn’t feel any pain. It’s typically used during minimally invasive procedures, such as removing an erupted tooth. But, it’s also used alongside stronger forms of anesthesia for more invasive or complicated surgeries.

After a simple procedure using a local anesthetic, patients will feel numbness for several hours and won’t require precautions such as an escort to drive them home or fasting before the procedure.

Nitrous oxide (laughing gas)
Nitrous oxide, commonly known as laughing gas, is a form of conscious sedation. It’s administered through a mask worn by the patient who then breaths in a steady combination of nitrous oxide and oxygen. It is used with simple as well as more complicated procedures.

Patients feel relaxed and their anxiety is reduced. They may also control how much is administered by simply taking deeper and more frequent breaths. Within several minutes following the procedure, the effects will wear off and the patient will be able to drive themselves home. Another benefit is how little this method costs. There are typically no added expenses associated with nitrous oxide.

Oral medication
The oral medication method typically requires that patients take anti-anxiety pills such as Valium, Halcion, or Ativan, to achieve conscious sedation. This method is usually more effective at sedating patients than nitrous oxide and is also not costly to administer. Patients usually take the medication roughly an hour before the procedure.

One issue with this method is consistency. Some patients may react to unpredictably to the medication, i.e. taking longer to feel its effects, requiring stronger doses, etc. Patients will also require the help of a friend or family member to drive them to and from the office as they will feel very groggy afterward.

IV sedation
The intravenous (IV) sedation process involves administering medication through a vein. The medication is fast acting and is the most effective form of sedation for oral surgeries other than general anesthesia. Patients typically have no recollection of the operation. Like oral medication, patients will need assistance getting home and will feel groggy following the appointment.

General anesthesia
General anesthesia is used for patients who require more extensive surgical procedures such as facial and jaw reconstruction. It is typically administered orally and intravenously and patients will become fully unconscious and have no memory of the procedure.

Your Procedure
Every oral and maxillofacial surgeon receives training for all aspects of anesthesia administration, so patients don’t have anything to worry about. They can rest easy knowing their surgeon and staff are well-prepared professionals. And if you have any questions, don’t be afraid to ask your dentist or surgeon. They’re there to make the procedure as comfortable as possible.

5 Oral Surgery Recovery Tips!

Oral surgery is any procedure where cutting or removing tissue in your mouth is involved. The most common types of oral surgeries are wisdom teeth removal, gum grafts and dental implants.

Recovery is typically very fast. However, we wanted to fill you in on five essential tips to making it the easiest recovery possible.

  1. Rest! Use this to your advantage, and get some sleep! Let your body recover quickly by taking it easy. Especially the day of and after surgery. To avoid as much swelling as possible – use a pillow to prop your head!
  2. Do not smoke (ever) but at the very least until you are healed! Smoking puts you at a greater risk for infection or complication as it lengthens your recovery.
  3. Ice is your friend! Keep an ice pack handy and apply it to your face throughout the first day. Ice reduces inflammation so we recommend you ice on and off for 15 minutes at a time.
  4. Don’t skip on your meds! It’s very important to stay on top of your recommended pain medications. Take them as directed and don’t forget. Getting behind might be something you end up regretting as they should keep pain very minimal.
  5. Don’t eat seeds or berries! This is a funny sounding one but it’s important. Eat smooth foods. If you’re making a smoothie don’t use berries. Little tiny seeds can get stuck in your incision sites and that’s never fun.

Of course, there is a whole list of post operative instructions we will give you when you visit us. We hope these tips help!

Before and After: Mandibular Osteotomy

Lower jaw (mandibular osteotomy). The lower jaw is divided and the front section is moved forward or backward and secured with plates and screws.

Lower jaw surgery, a mandibular osteotomy, can correct:

  • Receding lower jaw
  • Protruding lower jaw

The surgeon makes cuts behind the molars and lengthwise down the jawbone so the front of the jaw can move as one unit. The jaw can then be moved to its new position either forward or backward. Plates and screws hold the jawbone together as it heals.

Pre-Op

Post-Op