Frequently Asked Questions

When a patient is facing oral or facial surgery, it’s normal to be apprehensive. At Park Avenue Oral & Facial Surgery, Dr. Ruben Cohen and his skilled team are here to provide you with the highest standard of surgical treatment. We also strive to help calm your fears and put you in a positive state of mind by providing you with the information you want and deserve as our valued patient.

Following are answers to some of the most frequently asked questions about oral and maxillofacial surgery. Of course, we’re always available for a consultation to answer any other questions you may have. We look forward to hearing from you soon.

What is an Oral and Maxillofacial Surgeon?

Oral and maxillofacial surgeons are unique among dental specialists in a number of ways. After completing four years of dental school, they go on to spend another four to six years in a hospital-based residency program for surgery. During their intense surgical residency, they receive training in general surgery, cosmetic surgery, facial trauma and reconstructive surgery, pathology and reconstruction, dermatology, emergency medicine, ICU training, and extensive general anesthesia training. They are the only health care specialists (aside from anesthesiologists) who are trained and can administer all levels of sedation -- including general anesthesia.

Oral and maxillofacial surgeons focus on treating problems related to the hard and soft tissues of the face, mouth, and jaws (the upper jaw is referred to as the maxilla). While they often work in a hospital, their practices are more often located in comfortable and accredited office settings (such as Park Avenue Oral & Facial Surgery).

Oral and maxillofacial surgeons provide a wide array of treatments and procedures – from tooth extractions and corrective jaw (orthognathic) surgery – to cleft lip/palate surgery, reconstruction surgery due to traumatic dental injury or facial trauma, dental implants, bone grafting, treatment for obstructive sleep apnea, TMJ and even oral cancers.

What are dental implants?

Dental implants are artificial tooth roots that provide a permanent base for fixed, replacement teeth. Compared to dentures, bridges and crowns, dental implants are a popular and effective long-term solution for people who suffer from missing teeth, failing teeth or chronic dental problems. Because they fit, feel and function like natural teeth, dental implants are considered to be today’s gold standard in tooth replacement.

Am I a candidate for dental implants?

Almost every person who is missing one or more teeth and is in good general health is a candidate for dental implant treatment. Dr. Cohen and his team can also optimize treatment for patients with diseases such as diabetes so they can benefit from dental implants. The quality and quantity of available bone is an important factor in dental implant treatment. Oral and maxillofacial surgeons can, even with significant bone loss, perform extraordinary procedures that add bone or create new bone to allow people who would not otherwise have been candidates for dental implants to have successful implant treatment.

Is it true that I can get dental implants in the same day/visit?

Yes, it is true – through a revolutionary procedure called Teeth-in-an-hour that we offer at Park Avenue Oral & Facial Surgery. This technology provides patients with fully functioning teeth on dental implants in a single procedure, which lasts about an hour. You can see more details about Teeth-in-an-hour on our website – or feel free to schedule a consultation where Dr. Cohen can explain it to you in person.

What exactly is the All-on-4 procedure for implants?

If you are missing most or all of your teeth, or are currently wearing dentures, the All-on-4 implant procedure could be an ideal solution. With All-on-4, we can replace your missing teeth with a full dental bridge supported by only four dental implants. With less implants needed, your overall treatment time and cost is reduced. All-on-4 also ensures greater stability in the bone, reducing the need for bone grafting surgery to increase the bone volume.

What’s the reason for bone grafting?

Bone grafting may be recommended because you have one or more missing teeth and have decided that you’re going to replace the teeth using dental implants -- and there’s been sufficient atrophy of the jawbone in specific areas that causes the bone structure to become weak. The atrophied bone is often a result of missing teeth in the first place, since once the teeth are not attached to the bone, the bone begins to atrophy. If this situation remains for a period of time, bone can atrophy to the point that the bone becomes weak and is unable to properly support an implant.

The good news is that once a bone graft procedure is performed, new bone is not only placed in the area where bone loss has occurred, but the graft stimulates new bone growth, which occurs around the graft, further strengthening the bone in the area. The grafted bone may be taken from another part of the body or may be ordered from a reputable bone bank.

Are dental implants usually covered by dental insurance?

Yes. Dental insurance plans are more frequently covering dental implants because they are realizing that implants are a cost-effective treatment option in the long term. However, policies do differ and the amount of the available benefits can be directly related to the amount of premiums paid. The best way to obtain an accurate cost for the implant treatment that’s right for you is to come into our office for a consultation. We’ll work hand-in-hand with you in order to maximize your insurance reimbursements for covered procedures.

Should wisdom teeth be removed even if they are not causing any problems?

Wisdom teeth, also referred to as third molars, can cause serious problems such as crowding, shifting other teeth, changing your bite, and contributing to loss of jawbone tissue. Wisdom teeth that are only partially erupted often trap food, causing decay and gum disease. Swelling and jaw pain are some of the most common early symptoms. The longer your wisdom teeth remain in your mouth, the more likely they are to cause harm, and the more difficult they are to remove. Because wisdom teeth erupt at different rates, a lot of damage can be done before you even begin to notice symptoms. We recommend calling us at the first sign of symptoms or before these symptoms even start to develop.

What is jaw reconstruction?

Jaw reconstruction, or orthognathic surgery, is performed to correct developmental growth abnormalities of the jaws and facial bones. Patients with these abnormalities usually present with a malocclusion (the abnormal alignment of the upper and lower teeth). These problems can affect not only chewing but speech and the overall health of the individual as well as the esthetic appearance of the face. Surgical treatment is usually conducted in combination with orthodontics. The surgery is performed under general anesthesia. During the surgery, the jaws are moved to the correct position, not only to improve the patient's occlusion, but to restore normal facial appearance as well.

What are the different treatment options for sleep apnea?

There are both non-surgical and surgical treatment options for obstructive sleep apnea (OSA). The most common non-surgical option is the CPAP machine, which increases air pressure in your throat and helps you breathe more easily during sleep. However, some OSA patients find CPAP to be cumbersome and uncomfortable -- and can’t get used to wearing the mask at night. In those cases, an oral appliance is often recommended. The oral appliance is a custom night guard that works by moving the jaw forward, which increases the size of the upper airway, subsequently reducing the air resistance that leads to snoring and sleep apnea.

Surgical options to treat OSA are usually recommended only if the patient has tried both the CPAP machine and oral appliance – without success. Some common surgical options include UPPP (Uvulopalatopharyngoplasty), genioglossus suspension, hyoid suspension, and for severe cases, maxillomandibular advancement.

If you suffer from any of the symptoms of OSA -- which may include snoring, episodes of no breathing, insomnia, excessive daytime sleepiness and fatigue, depression, dry mouth and weight gain -- it’s important to see a physician to have a sleep test performed. OSA not only affects the quality of your life, but can also be fatal if left untreated.

What is oral and maxillofacial pathology?

Oral and maxillofacial pathology is the specialty that deals with the identification, nature and management of diseases affecting your oral and maxillofacial regions. Oral and maxillofacial surgeons diagnose and manage patients with diseases, including cysts, benign and malignant tumors, soft tissue, and severe infections of the oral cavity and salivary glands. The reconstruction of the mouth and face following the removal of tumors represents the ability of the oral and maxillofacial surgeon to return patients to optimum levels of appearance and function.

What kind of a physician or surgeon treats cleft lip and palate in a child?

An oral and maxillofacial surgeon plays an important role in the carefully orchestrated, multiple-stage correctional program for both cleft lip and palate patients. The goal is to help restore the jaw and facial structures, leading to normal function and appearance. Care and treatment must consider function, appearance, nutrition, speech, hearing, and emotional and psychological development.

Cleft lip surgery is usually performed by the time a baby is three months old. A cleft palate often requires multiple surgeries over the course of 18 years, with the first surgery typically performed by the time a child is about 12 months old. The initial surgery creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones.

What are the treatment options for TMJ?

Restoring your jaw’s alignment and reducing the pain you are experiencing from TMJ disorders may require several types of treatments to reduce muscle tension, regain a stable bite, or rest and heal your jaw joint.

The treatments may range from conservative dental and medical care to more extensive procedures and surgery. Depending on your physician’s diagnosis, your TMJ treatment may include short-term, non-steroidal anti-inflammatory drugs for pain and muscle relaxation, bite plate or splint therapy, Botox injections, and even stress management counseling or physical therapy.

The first step to treating your TMJ requires a thorough examination, including medical history, and digital x-rays. There’s no simple prescription for TMJ problems and no single cause, so the approach is as individual as you are.

What can be done to ensure the safety of sedation dentistry for pediatric patients?

Parents have every right to be concerned about sedation dentistry for their children, not because sedation dentistry itself is dangerous, but because there are physicians who are not qualified or certified to administer sedation – and/or do not enforce the safety guidelines that are in place. At Park Avenue Oral & Facial Surgery, we encourage every parent to ask the prospective doctor the following questions to help assure that their child will be in the best hands possible.

  • Will the sedation be performed by an oral surgeon, dental anesthesiologist, or medical anesthesiologist?
  • Ask if a medical anesthesiologist can come do the sedation in the dentist’s office. If they do offer this as an option, it’s usually a good sign that the office is indeed compliant with state requirements.
  • Ask to confirm that the procedure will be done in an AAAASF-accredited facility.

AAAASF provides accreditation for medical and dental offices. It sets the ideal (or minimum) standard of care required in an outpatient setting to provide anesthesia services. No office should offer anesthesia services without being accredited. It would be like a hospital operating without an accredited operating room. If the facility is not accredited, immediately seek another provider. This cannot be stressed enough. Ask the dentist if he or she has hospital privileges, and also ask if you can have your child’s procedure done in hospital if you are more comfortable with that.

  • Who will provide the preoperative evaluation of my child, including a review of their past medical history such as allergies, current prescription medications and previous illnesses and hospitalizations?
  • What is the recommended time that my child should be without food or drink prior to the procedure?
  • Will any sedation medication be given to my child at home prior to their coming to the office? If so, how should they be monitored until they arrive in the office?
  • What training and experience does the sedation/anesthesia provider have in providing the level of sedation or anesthesia that is planned for the procedure? Does this training and experience meet all of the standards of the ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists?
  • Does the staff assisting in the procedure have current training in emergency resuscitation procedures, such as Basic Life Support for Healthcare Providers, and other advanced resuscitation courses as recommended by the ADA Guidelines? Is this training regularly renewed?
  • Does the state dental board require a special sedation/anesthesia permit or license that allows for the sedation/anesthesia provider to administer this specific level of sedation or anesthesia in the dental office?

The fact is that there are many pediatric dental treatments and procedures that require a calm and relaxed patient – and avoiding proper dental care early on may very well cause serious health issues down the road. Again, we urge every parent to do their due diligence for the safety of their child and their own peace of mind.

What do I do if my child has had an accident and his/her tooth has been entirely knocked out – and it’s outside of your regular hours?

Call us as soon as possible for any facial and dental trauma. If you’re calling after regular office hours, ask that the doctor be contacted. To preserve the tooth until you can see us, put it in a glass of milk. We may be able to replace and stabilize the tooth. If that’s not possible, we will discuss other treatment options.

What is gum grafting?

When recession of the gums occurs (“gingival recession”), the body loses a natural defense against both bacterial penetration and oral trauma. Performed by an oral and maxillofacial surgeon, gum reconstruction using gum grafting or gingival grafting techniques becomes an option when a patient suffers from gingival recession. The combination of modern medicine and technology makes most gum grafts rather quick, painless, and minimally invasive.

What are the benefits of 3D imaging?

The Planmeca 3D imaging system provides oral and maxillofacial practices with state-of-the-art technology to help diagnose potential issues more accurately and provide treatment with unprecedented confidence. Unlike a traditional spiral CT scanner, the 3D system utilizes cone beam CT technology and provides precise, crystal-clear digital images while minimizing your exposure to radiation.

The 3D system also enables the practice to perform a wider range of diagnoses and treatments, helping to reduce multiple visits.

What are the benefits of dental stem cells?

Aside from being the most convenient stem cells to access, dental stem cells have significant medical benefits in the development of new medical therapies. Using one’s own stem cells for medical treatment means a much lower risk of rejection by the body and decreases the need for powerful drugs that weaken the immune system, both of which are negative but typical realities that come into play when tissues or cells from a donor are used to treat patients.

Further, the stem cells from teeth have been observed in research studies to be among the most powerful stem cells in the human body. Stem cells from teeth replicate at a faster rate and for a longer period of time than do stem cells harvested from other tissues of the body. Stem cells in the human body age over time and their regenerative abilities slow down later in life. The earlier in life that your family’s stem cells are secured, the more valuable they will be when they are needed most.

Why would I seek an oral and maxillofacial surgeon for aesthetic enhancements?

An oral and maxillofacial surgeon is actually among the most qualified physicians to perform aesthetic enhancements of the face. The specialty as a whole is specifically focused on the entire facial structure encompassing a unique knowledge of both its function as well as its appearance. An oral and maxillofacial surgeon has spent years looking at structural facial balance while studying its impact on the overlying soft tissues. The oral and maxillofacial surgeon has an in-depth understanding of the muscles involving function in addition to facial expression -- and has surgically operated in this area of the human body for their entire career.

It’s important to remember that oral and maxillofacial surgeons are also trained to become experts in all aspects of pain and anxiety control, including general anesthesia, deep sedation, and conscious sedation. Much of their training focuses on ambulatory anesthesia and airway management, preparing them to administer safe and effective anesthesia services in the dental office and other ambulatory settings.

What aesthetic treatments are offered by an oral and maxillofacial surgeon?

An oral and maxillofacial surgeon (like Dr. Cohen) has had extensive training in facial cosmetic surgical procedures and understands the fine balance between facial appearance and function. The aesthetic treatments offered by an oral and maxillofacial surgeon include:

  • Chin surgery (genioplasty)
  • Cheek implants or removal of fat around cheekbones to enhance this area
  • BOTOX
  • Dermal fillers
  • Mandibular angle implants

For details on all of our aesthetic treatments, please visit the Facial Aesthetics tab on our website.

Why should I choose Park Avenue and Oral & Facial Surgery?

Park Avenue Oral & Facial Surgery is one of the premier Oral and Maxillofacial Surgery practices in New York City. Ruben Cohen, D.D.S. -- a Diplomate of the American Board of Oral and Maxillofacial Surgery -- was named in 2017 & 2018 by The New York Times Magazine as one of the top 20 oral surgeons and “Super Specialists” in New York City – selected by his peers.

At Park Avenue Oral & Facial Surgery, we offer the highest standard of service and excellence in treatment in New York City. Patients always come first at our comfortable, accredited and state-of-the-art facility. From your first phone call to your final follow-up visit, our skilled team will make your surgical experience as seamless as possible. We believe in what we do, and our commitment to you will be evident.

Still have questions? Please feel free to call our office today. Our team will be happy to assist you!