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Dentistry/Jaw fracture differences

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QUESTION: My 19 year old son suffered a left angle minimally displaced complete fracture of left jaw in line with the back root of wisdom tooth (which is slightly through the gum tissue).  He did not receive treatment for a week.  He was wired closed with elastics by oral surgeon at school 1 week after the fracture.  He came home and was having intense ear pain and he had been set Class I on both sides (he is Class III on the right) so the Oral Surgeon at the teaching hospital released the elastics for 1-2 hours so he could realign his bite and reset the elastics in the right bite (this was 2 weeks after being set).  He was put in lighter elastics a week later (week 3 from original wiring) and then released last week(4 weeks since original wiring).  He did have an Xray at the 2 week point before the elastics were removed for the 2 hours (was healing well) but no Xray last week.  His bite is perfect and jaw opening is good. He is getting the arch bars removed this week.  He is still eating a pretty soft diet and is limiting heavy weightlifting (he previously lifted weights daily)until the arch bars are removed.

The oral surgeon from school called and said he should not have been taken out of elastics this soon and he is at risk of a non-union.  Now I am becoming scared.  How could I tell if there is a non-union or a fibrous union? Could this be corrected if there was a fibrous union?  My son is very anxious to get the arch bars off but he says other than cheeks being irritated by arch bars, no pain.  Any help is appreciated.

Thank you.

ANSWER: Jen- you cannot tell.  It is very important to have him properly evaluated by a board certified oral and maxillofacial surgeon.  Four weeks is too soon to release his bite.  Letting it go now could definitely cause a non-union and create major jaw problems.  Get him evaluated immediately to insure bone healing.

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QUESTION: He s being evaluated by a certified oral and maxillofacial surgeon at the teaching hospital.  My son already has been released from the elastics for the last week and is having the arch bars removed tomorrow by the head of the teaching department.  How would the oral surgeon know if there was bone healing?  What would be the length of time and should he go back in the elastics now?  I am taking him in the morning and my son is stating he wants the arch bars off so I don't even know how he would be evaluated.  Any help would be appreciated.

Answer
Jen - the surgeon, if he is knowledgeable, can gently stress the fracture site and in doing this he can determine if complete healing has occurred.  We all heal at different rates, but as a doctor with a lot of experience, I always waited a little longer to be sure that healing occurred.  

If the surgeon elects to remove the hardware, then he determines that your son has healed.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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