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MESSAGES TO

Jaw Surgery

A DxD Session with Dr Ho Kok Sen


Ended on Mon Dec 10 2018
Ended

Top Answers


Hi Shiro, 

Thanks for the D2D. An underbite (mandibular prognathism) is a type of dental misalignment (malocclusion) in which one’s lower jaw protrudes or extends further than the upper jaw.               

Depending on the severity of the protrusion, an underbite affects a person functionally and aesthetically in the following ways:

  • Unable to chew foods efficiently
  • Worn down tooth enamel, increasing susceptibility to tooth decay, sensitivity and other dental issues
  • Chronic headaches and temporomandibular joint disorder
  • Affected speech clarity
  • Extended or prominent chin

Possible treatment options for an adult with underbite include orthodontics and corrective jaw surgery. That will help to correct your bite, change your facial profile and improve the symptoms associated with an underbite.

 It is recommended that you consult with an oral & maxillofacial surgeon so that he/she can assess your dental condition, advise on the appropriate treatment for you and go through the benefits and risks so that you can make an informed decision.

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Hi Zhong Hua, 

Thanks for the D2D. As an oral & maxillofacial surgeon, jaw surgery is a very technical dental procedure that is under our dental specialty. Each successful case requires close teamwork and communication between an oral surgeon and orthodontist.

Your oral surgeon will first determine what type of corrective jaw surgical procedure is appropriate in your case. He/she is also the one carrying out the procedure.

I normally do a joint consultation with an orthodontist at our group practice for my patients so that they are clear of the entire process – orthodontics and surgery. During the consultation, a CT-scan and radiographs will be taken so that your dental condition can be correctly diagnosed.

The surgery portion is performed after the pre-surgical orthodontic phase is completed, when your teeth are in the correct surgical alignment.

Here are some common types of jaw surgery:

  • To correct an open bite: some of the bone in the upper jaw is removed and the upper jaw is secured in its new position
  • To correct a protruding lower jaw (underbite): bone in the back portion of the jaw is separated from the front and surgically modified so that the lower jaw can be moved back into proper alignment
  • To correct a receding lower jaw: the bone in the lower portion of the jaw is separated and modified so that a portion of the chin can be repositioned forward 

When the jaw is aligned, the new alignment will be held together with screws and plates underneath your gums. These screws and plates are osseointegrated and fully compatible with your body, hence there is no need to take them out. 

The surgery is mostly done from the inside of your mouth so that there are no scars on your face, chin, jaw and around the mouth. In some cases, a small cut may be made on the jaw, but it will eventually go away after a few weeks. 

You will be under general anesthesia during the surgery so that you are completely unconscious. 

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Hi Rachela, 

Thanks for the D2D. Jaw surgery is considered a safe and effective treatment for misaligned jaws. Nonetheless, as it is a surgery after all, there are risks in the short and long run.

The risks that may occur right after surgery includes:

  • Bleeding – Minor nose bleeds may be experienced for one or two weeks after surgery on the upper jaw
  • Swelling – Swelling usually becomes worse on the third day.
  • Abrasion – As the surgery is done from inside your mouth, there might be abrasions at the corners of your lips. You may be given a medicated cream to apply or Vaseline works as well.
  • Infection – This is possible after any type of surgery. A course of antibiotics and anti-inflammatory medication will be given to mitigate this.
  • Numbness - After the surgery, some numbness or altered sensation is expected. It does not affect the appearance or function of the lips. The numbness subsides on the upper lip relatively quickly.
  • Nausea – Feeling nauseous and vomiting are common after effects of general anesthesia.
  • Jaw joint stiffness – This may take place for several months. The best way to overcome this is to exercise the muscles more by chewing.

The risks that may occur in the long run includes: 

  • Permanent numbness – In the case of the lower lip, it may take six months or less to recover from the numbness. In very rare cases, patient experiences permanent numbness or altered sensation after the surgery due to a damaged nerve.
  • Infection of plates – The plates that were used to secure the new position of the jaw underneath the gums may become infected, especially if patient is a smoker. In such cases, the plates are removed.
  • Relapse in the position of the jaw – As the muscular force that caused the misalignment in jaw is still present, there is a small chance that the jaw and teeth may move back towards their original position.

However, it is not common for these long term risks to occur. For majority of the patients who undergo jaw surgery, the benefits significantly outweighs the risks.

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Hi Lisa, 

Thanks for the D2D. The cost of a jaw surgery in Singapore costs upward of $10,000. This excludes fees for pre and post orthodontics, anaesthetist, operating theatre, hospital admissions. 

Jaw surgery is a highly technical procedure practiced by oral & maxillofacial surgeons.

The exact fee varies depending on the following factors:

  • Complexity of patient’s condition – a double jaw surgery will have higher fees than a single jaw surgery
  • Amount of experience of surgeon – an oral surgeon who has more years of experience would have seen and done more cases of jaw surgery
  • Public healthcare institute or private dental practice – surgeon fees in private dental practices may be higher than those in public healthcare institutes
  • Hospital charges – the number of days patient needs to be hospitalised and whether the hospital is public or private will play a part
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Hi George,

Thanks for the D2D. As jaw surgery is a surgical procedure, Medisave can be used to cover part of the fees. The amount that can be claimed is from $5,000 onwards, depending on the complexity of the procedure and subject to the Medisave withdrawal limits.

During your consultation with your oral surgeon, he/she will be able to advise the amount that can be claimed based on your condition. The amount that can be claimed is based on the Table of Surgical Codes that is published by Ministry of Health.

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Hi Petrina, 

Thanks for the D2D. It is important to first find out the underlying cause of the lisp before suggesting any treatment option.

The most common type of lisp is frontal lisp, where the tip of the tongue protrudes between the front teeth and obstructing the airflow. There is also palatal lisp, where one rolls their tongue too far back and touches the roof of the mouth and dental lisp, where the tip of the tongue pushes against the teeth.

Common causes of lisp include tongue placement and tongue tie. If it is due to tongue tie, a jaw surgery is not needed and a minor tongue tie surgery would do.

You are recommended to bring your child to a paedodontist/oral surgeon so that he/she can do a thorough dental condition to advise the possible treatment option.

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Hi Feng Jiao, 

Thanks for the D2D. Not proceeding with a jaw surgery does not bring about any risks per se, however it means that you may continue to face certain functional difficulties associated to a protruding jaw (underbite) such as:

  • Inefficient biting and chewing
  • Worn down tooth enamel, increasing susceptibility to tooth decay, sensitivity and other dental issues
  • Chronic headaches and temporomandibular joint disorder
  • Affected speech clarity 

Aesthetically, you may also find that your jaw/face is imbalance or your chin seems more prominent. Some people find that it affects their appearance and hence their confidence. 

I have encountered patients who have a prominent chin but do not want to proceed with jaw surgery for various reasons too. The important thing is that you make an informed decision.

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Hi Philip, 

Thanks for the D2D. Yes, you will need to be hospitalised for at least a night after your jaw surgery.

The exact duration of your stay depends on the extent of surgery and your personal speed of recovery. In most cases, patients tend to be discharged after two to three days.

Hospitalisation is needed as you need time to recover from the general anaesthesia and you will have difficulty eating or drinking right after the jaw surgery. You will be on intravenous (IV) drip for at least a day after the surgery. The IV drop will provide you with the nutrients and medication you require. 

During your hospital stay, your oral surgeon will monitor your condition regularly and advise when you can be discharged.

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Hi Chai, 

Thanks for the D2D. Listen to your orthodontist and oral surgeon, they know your dental condition and are the best people to guide you along the process.

During the pre- and post-surgery orthodontic treatment, maintain good oral hygiene so that there are no additional dental issues. If you are wearing Invisalign, be disciplined in wearing your aligners for the recommended time so that your treatment can progress in a timely manner. If you are a smoker, it is best to stop smoking.

A few weeks before your jaw surgery, do prepare yourself mentally and physically. It is important to have a positive attitude to make the whole experience a more positive one. Arrange for your loved ones to be with you during the first few days after surgery.

Physically, rest more before the surgery. Refrain from taking drugs with aspirin as there may be undesirable side effects that may affect your surgery. It is good to check with your oral surgeon before you consume any type of medication.

As you’ll be hospitalised, bring along items for your stay, comfortable clothing for day of discharge and lip balm. On the day of surgery, you’ll need to fast (no food and drink) for five to six hours before the procedure.

For things to take note of during the recovery process after the jaw surgery, refer to this question: “What is the recovery process like after a jaw surgery?" 

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Hi Dahlia, 

Thanks for the D2D. Jaw surgery is generally a safe procedure and serious complications arising from the surgery are not common. You can refer to this question: “What are the risks of jaw surgery?”, for the list of short and long term risks of a jaw surgery. 

Immediately after the surgery, bleeding, swelling, soreness and numbness is expected. These are not complications.

Bleeding in the mouth (operation site) or nose may be observed for up to two weeks. Swelling and bruising should take about one week before it starts to reduce. If you feel that there is excessive bleeding or your discomfort is persistent, do let your oral surgeon know.  

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Hi Yong Jia, 

Thanks for the D2D. If you are already visiting a dentist, you may ask him/her for a recommendation for a Dental Specialist in Oral & Maxillofacial surgery (oral surgeons).

Oral surgeons are dentists who underwent further training for procedures that are related to the mouth, teeth, face and jaws (e.g. dental implant placement, jaw surgery). 

Alternatively, recommendations from friends and family are a good way to start. You may also take advantage of the internet to search for an oral surgeon. Important things to look out for will be his/her training and qualifications and the number of years of experience in treating similar conditions.

As a successful jaw surgery requires the close cooperation of an oral surgeon and orthodontist, you may want to look for group dental practices that have both specialists. This will save you time and effort in travelling to different dental clinics for your dental appointments. 

The best way to gauge if the oral surgeon is suitable for you is to go for a consultation. That is when you can communicate with him/her and ask any questions you may have.

Observe if the oral surgeon answers your question patiently, go through the possible treatment options with you and explain the benefits and risks (if any) of each treatment carefully.

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