This is what he explained to us:  Orthodontists and Oral Surgeons can help many children and adults when they work as a team to treat problems with the growth and position of the jaws and teeth.  The most common problem they work on is when children have an adult tooth that can't come out because it's stuck way up in the jaw bone.  The oral surgeon performs a little operation so that the orthodontist can put a brace on the teeth to help pull the adult tooth down.  This is very common and happens a lot.

     Sometimes a child has too many teeth to fit in a little mouth.  The orthodontist aligns the teeth properly and uses appliances that expand the inside of the mouth. Then the oral surgeon does an operation to change the bones in the jaw so that the whole mouth works properly and the person's face is balanced normally. 

   Some children don't have a problem with their teeth but they have a problem with their jaws not developing properly.  This effects the way they look and bite. These problems may make it difficult or painful to eat certain foods.  The way the teeth meet in the mouth may effect the way a person makes sounds and effect their speech.  Their teeth are aligned by the orthodontist before the oral surgeon can perform an operation on their jaws.  The orthodontist sets the stage and the oral surgeon finishes the job.  The jaws can be moved backward, forward, or up or down with surgery.  Surgery can also change the way the bones in the face grow.

     Just like building a building, orthodontists and orthognathic surgeons look at the face and the jaw and try to decide what the balance should be to put the face in just the right position.  They decide by taking panoramic x-rays  that show the bones of the whole face and head.  Information from the x-ray is then transferred to a computer so that the oral surgeon can use computer software to draw different plans to  for correcting the problem and then choose the best plan that the patient's face look great and function properly.

     Dr. Sachs showed us some examples of the tracings on x-rays of a few of his patients.  Look at the pictures below to see examples of how specific cuts in jaw bones are used to change faces with different problems.  These pictures are from a pamphlet published by the American Association of Oral and Maxillofacial Surgeons called a Patient's Guide to Orthognathic Surgery. 
 

    When there are space problems and jaw problems, it can take a whole year to plan for jaw surgery.  The surgery usually takes one hour, but sometimes it takes a few hours.  The patient stays in the hospital for a day after the surgery.  Sometimes they use little rubber bands on the teeth to hold them in just the right position.  Sometimes the surgeon has to wire the jaw closed.  It's like having a cast to hold the jaw really tight for 2 months.  Sometimes metal plates and screws are used to hold the changes in the jaw bones very rigidly until the face heals completely.  The patients have to be on special liquid diets until the healing is finished and life becomes normal again. Most of Dr. Sach's patients need a nutritious liquid diet while their jaws heal.  If you would like to see some recipes used by Dr. Sach's patients  click here 
 

Q:  Do you like working with orthodontists?
A:   Orthodontists are very good thinkers.  They are like engineers because they are used to working with forces and moving things.  Oral surgeons are good doers.  The combination is excellent.

Q:   Do you enjoy your job?
 A:  Sure I enjoy my job.  Of course, sometimes it's frustrating if kids don't keep their mouth clean when they have braces.

Q:   What was your toughest assignment?
A:   The toughest assignment was learning how to perform this type of surgery because when I was a student all of this was not discovered.  Over the last 25 years, we learned, step by step, different operations.  We didn't start getting the best result until we realized that we had to let the orthodontists do their work.  The orthodontists learned that they couldn't get a great result unless they worked with oral surgeons as a team.  When we started to work together, then we could really help a lot of people.

Q:   Did you wear braces as a kid?
A:   No, I didn't.

Q:   What made you decide to be an oral surgeon?
A:    When I was a student in dental school, I worked in an oral surgery clinic in a hospital.  I helped the oral surgeons there and assisted them in the operating room.  Once I saw how interesting and rewarding the work could be, I decided to become an oral surgeon.

Q:   Do you think oral surgeons were needed more when you were a kid or now?
A:   I think they are needed more now because now we can do many more types of operations and help more people.

Q:   Which problem is the most difficult problem you see often?
A:   We work with children who are born with a facial defect called a cleft  palate.  They are born with a jaw that is not fully developed.  We have to rehabilitate them so they can eat properly and look normally.  This is a challenging problem that orthodontists and oral surgeons work on together.

Q:  Do you see more kids than adult patients?
A:   Most of the patients I see are teenagers.  I see about 20% children, 60% teenagers and 20% adults.  Most of the children I see have birth defects. Most of the teenagers I see have problems with the growth or development of their jaws. Most of the adults I see were not lucky enough to have treatment for their jaw problems when they were young, and now they have problems such as pain, loose teeth, or other problems.  The adults have to start over as if they were kids, with braces and jaw surgery.

Q:  Do children born with birth defects have problems with the way their face grows?
A:   That is a very good question.  Usually children with birth defects also have problems with the growth of their facial bones and mouth.  There is a new special area where orthodontists and oral surgeons work together to increase the growth of the jaw.  The oral surgeon does an operation so that the orthodontist can use a special appliance that slowly pulls the jaw down and makes it grow more normally.  It's very hard to pull the jaws forward with surgery on some patients with birth defects.  With this special appliance, there is a lot of growth in only six to eight weeks.  The surgery is from the inside out so there aren't any scars on the face.

Q:   What are some of the usual problems you work on?
A:   We do corrective jaw surgery, rehabilitate car accident victims, treat infections in the jaw, we remove bad growths in the bone, we remove wisdom teeth, impacted teeth, baby teeth if there is not enough room in the mouth and we treat birth defects such as cleft palates.

Q:  What is the first hard food kids want after having their jaws wired closed for two months after surgery?
A:   French Fries.