Treatments

Dentofacial Orthopedics

You may have noticed that Dr. Johnson and Dr. Cohen specialize in “Orthodontics and Dentofacial Orthopedics.” While most people have heard of orthodontics, many are confused by the “dentofacial orthopedics” part of the title. We can explain!

Every orthodontist starts out in dental school. Upon completion of dental school, some graduates immediately go into practice as dentists. Others choose to pursue a dental specialty, which requires additional schooling during a two-to-three-year residency program. There are nine specialties sanctioned by the American Dental Association. Some you may be familiar with are Pediatric Dentistry (dentistry for children), Periodontics (dentistry focusing on the gums), and Oral Surgery.

One of the nine specialties is “Orthodontics and Dentofacial Orthopedics.” You probably know that an orthodontist straightens teeth, and indeed: “ortho” comes from the Greek for “straight” or “correct,” and “dontic” from the Greek for “teeth.” But what about dentofacial orthopedics? “Dentofacial” is “teeth” plus “face” while “ortho” again means “straight” and “pedic” is from the Greek for “child.”

Essentially, orthodontics entails the management of tooth movement; it is only one part of comprehensive treatment. Dentofacial orthopedics involves the guidance of facial growth and development, jaw positioning, and airway modification. Since growth occurs largely during childhood, most treatments will involve the use of both types of appliances – the more familiar braces for orthodontics, and other specialized appliances, like expanders and Herbst Appliances for orthopedics. Sometimes orthopedic treatment may precede conventional braces, but often the two are accomplished at the same time. So if your child gets braces and other strange-looking appliances, he’s undergoing orthodontics and dentofacial orthopedics! We treat more than just teeth!

Because Dr. Johnson and Dr. Cohen are skilled in both areas, they are able to diagnose any misalignments in the teeth and jaw as well as the facial structure and can devise a treatment plan that integrates both orthodontic and dentofacial orthopedic treatments. It truly is the best of both worlds.

Sleep apnea

Are you drowsy during the day with no explanation? Do you snore loudly, or wake up breathless in the middle of the night? If so, you may be one of more than twelve million Americans affected by sleep apnea.

What is sleep apnea?

Sleep apnea is a condition in which breathing stops periodically during sleep, as many as 20-30 times per hour. (“Apnea” is the Greek word for “without breath.”) If you suffer from sleep apnea, each time your breathing stops, the resulting lack of oxygen alerts your brain, which temporarily wakes you up to restart proper breathing. Because the time spent awake is so brief, most people with sleep apnea don’t remember it – and many think they are getting a good night’s sleep. However, the constant wake-sleep-wake-sleep cycle precludes the deep sleep that refreshes the body and sufferers are frequently drowsy during the day.

What are the signs of sleep apnea?

The following symptoms can indicate the presence of sleep apnea. If you notice one or more of these, give us a call, and we can refer you to a sleep apnea specialist.

  • Insomnia or difficulty sleeping
  • Loud snoring at night
  • Waking up at night short of breath
  • Snorting or choking sounds during the night (indicating a restart of breathing)
  • Headaches upon waking in the morning
  • Falling asleep unintentionally during the day
  • Extreme drowsiness throughout the day

Are there different types of sleep apnea?

There are three categories of sleep apnea. The most common is called obstructive sleep apnea (OSA), which occurs due to a physical blockage usually the collapsing of the soft tissue in the back of the throat. Less common is central sleep apnea (CSA), in which breathing stops because the muscles involved don’t receive the proper signal from the brain. And some people suffer from “mixed” or “complex” sleep apnea, which is a combination of obstructive and central.

What are risk factors for sleep apnea?

Obstructive sleep apnea is more common in males than females, and more common in older adults (40 and up) than younger adults and children. However, anyone – regardless of gender or age – can suffer from sleep apnea. Other risk factors include obesity, smoking, drinking, use of sedatives or tranquilizers, high blood pressure, and family history. Central sleep apnea strikes most often in people with heart disorders, neuromuscular disorders, strokes or brain tumors. It is also more common in males.

Is sleep apnea dangerous?

Sleep apnea is considered a serious medical problem, and if left untreated can lead to high blood pressure, which increases the risk of heart failure and stroke. The ongoing state of fatigue caused by sleep apnea can lead to problems at work or school, as well as danger when operating cars or other heavy machinery. Sleep apnea can also cause complications with medication or surgery: sedation by anesthesia can be risky, as can lay flat in bed after an operation. If you know or suspect you suffer from sleep apnea, alert any doctors who prescribe medication or advise surgery.

How is sleep apnea treated?

Treatments range widely and depend on the severity of the problem and the type of apnea. Basic treatment can be behavioral – for instance, patients are instructed to lose weight, stop smoking, or sleep on their sides instead of on their backs. Beyond that, oral devices can be used to position the mouth in such a way that prevents throat blockage. In more severe cases, surgery may be the best option.

What should I do if I suspect that someone in my family suffers from sleep apnea?

Give us a call, and we can refer you to a sleep apnea specialist. The specialist may recommend a “sleep study” to diagnose the precise extent of the problem and can prescribe appropriate treatment. Depending on your situation, treatment may involve an oral device that we can custom-create for you.

Surgical Orthodontics

What are surgical orthodontics?

Just as orthodontics repositions teeth, surgical orthodontics (also known as orthognathic surgery) corrects jaw irregularities to improve the patient’s ability to chew, speak, and breathe, and for improved facial appearances. In other words, surgical orthodontics straightens your jaw. Moving the jaws also moves the teeth, so braces are always performed in conjunction with jaw correction. This ensures that teeth are in their proper positions after surgery.

Who needs surgical orthodontics?

Dr. Johnson and Dr. Cohen will consider surgical orthodontic treatment for non-growing adult patients with improper bites and those with facial aesthetic concerns. Jaw growth is usually completed by age 16 for girls and 18 for boys. All growth must be completed before jaw surgery can be performed. However, the pre-surgical tooth movements can begin one to two years prior to these ages.

How does it work?

During your orthodontic treatment, which usually lasts 6–18 months, you wear braces and will visit your orthodontist for scheduled adjustments to your braces. As your teeth move with the braces, you may think that your bite is getting worse rather than better. However, when your jaws are placed into proper alignment during orthognathic surgery, the teeth will then fit into their proper positions.

Surgery is performed in the hospital with an oral surgeon and can take several hours, depending on the amount and type of surgery needed. In lower jaw surgery, the jawbone behind the teeth is separated and the tooth-bearing portion is moved forward or backward, as needed. In upper jaw surgery, the jaw can be repositioned forward or backward, or the jaw can be raised or lowered. Certain movements may require the jaws to be separated, with bone added/removed to achieve the proper alignment and stability. Other facial bones that contribute to alignment may also be repositioned or augmented.

When you have completed surgery, you should be able to return to school or work within two weeks. After the necessary healing time (about 4–8 weeks), Dr. Cohen and Dr. Johnson will “fine-tune” your bite. In most cases, braces are removed within 6–12 months following surgery. After your braces are removed, you will wear a retainer to maintain your beautiful new smile.

TMJ / TMD

Temporomandibular Disorder

Millions of Americans suffer from chronic facial and neck pain as well as recurrent headaches. In some cases, this pain is due to Temporomandibular Disorder, or TMD.

Your temporomandibular joints, or jaw joints, connect your lower jawbone to your skull. As you may imagine, these joints get quite a lot of use throughout the day as you speak, chew, swallow, and yawn. Pain in and around these joints can be unpleasant and may even restrict movement.

Symptoms of TMJ / TMD include:

  • Pain in the jaw area
  • Pain, ringing, or stuffiness in the ears
  • Frequent headaches or neck aches
  • Clicking or popping sound when the jaw moves
  • Swelling on the sides of the face
  • Muscle spasms in the jaw area
  • A change in the alignment of top and bottom teeth
  • Locked jaw or limited opening of the mouth

Should you notice any of these symptoms, let us know! We can help advise you as to whether they indicate the presence of TMJ / TMD, and what sort of treatment is appropriate for you.

If you don’t have any of these symptoms, let’s keep it that way! There are some simple things you can do at home or work to prevent TMJ / TMD from occurring in your jaw joints:

  • Relax your face – remember the rule: “Lips together, teeth apart”
  • Avoid grinding your teeth
  • Avoid constant gum chewing
  • Don’t cradle the phone receiver between your head and shoulder – either use a headset or hold the receiver to your ear
  • Chew food evenly on both sides of your mouth
  • Do not sit with your chin rested on your hand
  • Practice good posture – keep your head up, back straight, and shoulders squared