Pain Management

Recently there have been some concerns amongst our patients with regard to the management of pain through medications post-operatively.  These concerns fall on both sides of the argument where some people feel they haven’t been given enough pain medication and others don’t want pain medications at all.  This is a very tricky subject, not just for our patient’s but for us as physicians.  All of the doctors here at Pottstown Oral and Maxillofacial Surgery have faced situations where the management of pain either before or after surgery has been difficult.  One of the main reasons that we as a practice are concerned is the high abuse and addiction potential of these medications.  The statistics compiled by the National Institute of Drug Abuse are staggering.  Over 58 million people over the age of 12 have used prescription drugs non-medically at some point in their lives. The United States in particular comprises only 5% of the world population but consumes over 75% of prescription drugs. In Pennsylvania where our practice is located 4-5% of the population is abusing or has abused prescription drugs.

With these well researched statistics it concerns us as physicians when patients come to the office requesting pain medications.  One in twenty of these patients statistically is or could become addicted to the medications we are prescribing.  As a surgical office specifically we know our patients can have pain after surgery and we routinely write medications to help people manage their discomfort.  It should be said however that when you undergo surgery you should expect to feel some level of discomfort.  Pain medications are designed to help with your pain management, they do not improve your body’s ability to heal and they do not remove the underlying cause of the pain.  Only time and your body’s healing capacity will improve the situation.  You as a patient should also be doing everything in your power to optimize your body’s healing capacity.  Smoking and poor oral hygiene after the procedure cause delayed healing that can dramatically impact the pain you are experiencing.

Every case and every patient has a different pain tolerance and we try our best as physicians to determine what medication will be necessary based on the level of difficulty of the procedure and the patient’s history.  We know that pain and surgery are difficult things to deal with as patients and it can be frustrating if the pain continues for long periods of time or is more severe than expected.  In most but not all circumstances we will give you pain medication to manage your postoperative discomfort.  As with all medications it is important to take these as prescribed and not excessively to minimize the abuse potential and side effects.  Please know that none of our doctors are actually trying to keep you in discomfort or not be helpful.  What we are trying to do is help you without contributing to the level of addiction and prescription narcotic abuse that are a significant concern in our society.

What is Orthognathic Surgery?

Many children these days will at some point during their development are recommended for orthodontic treatment or braces.  Most of these patients will be routine cases for any orthodontist to handle.  A small percentage of these patients however will be evaluated for a significant malocclusion.  Occlusion is the way that your teeth come together.  People with significant malocclusion will be either one of two types.  Type 2 patients have a significant overbite, having the lower teeth positioned well behind the upper teeth.  Type 3 patients have a significant underbite which has the lower teeth positioned forward of the upper teeth.  Both of these conditions can be caused by overgrowth or undergrowth of either the upper jaw, lower jaw or both.  This condition is referred to as a skeletal malocclusion.  If these conditions are caught early by the orthodontist initial attempts to guide the bone growth of the face and jaws with appliances such as braces, headgear, retainers etc., can be attempted.  Once the majority of the skeletal growth is completed in the teenage years correction of the misalignment of the jaws may require surgery.

Surgery to reposition the facial bones, teeth and jaws is called orthognathic surgery.  This can be a life altering surgery for patients who cannot chew food properly or are concerned about their facial esthetics due to abnormal jaw position.  Many types of cosmetic smile and facial profile issues can be aided through orthognathic surgery.  Patients that show an excessive amount of gum tissue when smiling often suffer from a condition called vertical maxillary excess which can be surgically corrected.  Patients whose lower jaw and chin are pronounced may suffer from mandibular hyperplasia or maxillary hypoplasia which will cause a very flat or concave appearance to the face.  Patients with a weak chin may suffer from maxillary hyperplasia, mandibular hypoplasia or geniohypoplasia causing a convex appearance to the facial profile.  Finally patients with a significant asymmetry to the facial appearance can suffer from one of several developmental syndromes or conditions that limit the growth of one side of the jaws or may have significant overgrowth of one area of the jaw requiring recontouring or orthognathic surgery to correct.

All of these conditions can be managed through a joint effort between the oral surgeon and the orthodontist.  Several months of planning and workup of the conditions, planned procedures, diagnosis are done prior to any surgical intervention.  The surgery can be very involved and there is a significant recovery period after the surgery but for those patients that require the surgery the functional and esthetic outcomes are tremendous.  If you suspect a problem with you or your child, or if your orthodontist has discussed the possible need for surgery it may be a good idea to discuss your treatment with one of our surgeons here in Pottstown Oral and Maxillofacial Surgery Associates.