Patient Resources
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What is an Oral and Maxillofacial Surgeon?
An oral and maxillofacial surgeon is a specialist in the field of dental and facial surgery trained in the surgical treatment of problems of the facial skeleton and associated soft tissues. The general scope of practice includes complex dental extractions, surgical preparation of the mouth for dentures or other dental procedures, grafting and prosthetic implant reconstruction of the teeth and jaws, diagnosis and treatment of pathologic lesions of the mouth and jaws, correction of dentofacial deformities and pain conditions, and the treatment of traumatic injuries to the teeth, jaws and facial skeleton. Some oral and maxillofacial surgeons have special training and interest in facial cosmetic surgery, cleft lip and palate repair, and correction of severe congenital and developmental craniofacial deformities. Much of the treatment provided by oral and maxillofacial surgeons is office-based with the use of intravenous sedation or general anesthesia for patient comfort and anxiety control. What are wisdom teeth and when do they need treatment?
Wisdom teeth are the 18-year molars, or third molars, erupting normally at the age of wisdom. Unfortunately, in the majority of cases, the third molars do not have sufficient space in the mouth for normal eruption and general maintenance to avoid problems in the later years of life. For this reason, wisdom teeth are usually removed to either prevent problems, which seem likely, or to treat existing problems associate with the teeth which include intermittent episodes of inflammation, decay, periodontal problems, or the inability to maintain adjacent teeth. Wisdom teeth are most predictably removed with the lowest complication rates prior to the age 20, but prophylactic removal of these teeth is reasonable prior to the age of 30 if benefits of removal outweigh the risks. What are the common complications associated with removal of wisdom teeth?
There are many potential complications with the removal of wisdom teeth. Most complications are very rare. The most common complications include soreness, bleeding and a condition commonly referred to as dry-socket. Dry socket is a condition where the blood clot is lost prematurely 3-5 days after an extraction resulting in painful, exposed bone. Fortunately, there is an office treatment, which can alleviate the pain immediately and easily. The more serious complications, but much more rare, are nerve problems resulting in altered sensation or numbness and sinus exposure. These potential problems are discussed in detail prior to proceeding with the treatment. How long is the recovery from surgical removal of wisdom teeth?
Typically, there is some soreness in the first 24 hours after extraction of the teeth, which should be controlled with pain medication. Careful diet and good oral hygiene is critical during the first 5 days after surgery. In normal recovery, pain should not be a problem after 2-3 days. The sockets will not be completely closed until 2-3 weeks after surgery and should be rinsed regularly until then. Smoking will sometimes dramatically increase the healing time and can increase pain during that time. What are dental implants?
Modern dental implants are titanium cylindrical bone anchors that are place and allowed to heal for long-term replacement of missing teeth. They can also be used for securing loose dentures. What are the advantages of dental implants over traditional options of tooth replacement or replacement?
The options for replacement of missing teeth include removable partial denture fabrication or bridgework. Dentures are a prosthesis, which is often not tolerated well, especially for replacement of very few teeth. Bridges require altering adjacent teeth in order to replace missing teeth creating margins, which are at risk for recurrent decay. The main advantage of dental implants over traditional methods of dental reconstruction is preservation of adjacent tooth structure. What is the difference in cost for implants versus other forms of restoration?
The cost for placement and restoration of a dental implant is very similar to that of a 3-unit bridge restoration. It can also be comparable to a complex root canal, buildup and crown restoration on a single tooth. What is bone grafting and why would it be necessary?
Bone grafting is the replacement of deficient bone in an area to provide necessary dimension to establish normal contours or for the purpose of implant placement. There are different types of bone grafts that can be used which include autogenous, or the patient’s own bone, or commercial prepared bone from cadaver source (allogeneic), bovine source (xenogeneic), or synthetic grafting materials. If a lesion of the oral tissues is detected, what is the usual course of treatment?
Lesions in the mouth are areas of tissue or bone change that are not normal. Many of these are benign and require little or no treatment. Some require complete removal and other modes of treatment should the lesion be identified as cancer or an aggressive benign tumor. It is essential to obtain an accurate diagnosis to make any treatment decision, or the decision not to treat. A biopsy is a minor procedure to obtain a small sample of the abnormal tissue and submit it to a laboratory for examination under a microscope. This examination takes only a few days. Sometime, if a lesion is small or behaves in a benign manor, it may be removed completely. What is the best course of action if a tooth is knocked loose or completely out of the mouth?
The most important action for a displaced or avulsed (knocked out) tooth is to try to replace it into the normal position in the socket. If the root is fractured, sometimes this is not possible. Displaced teeth should be pushed back into the socket with the fingers and held gently in place until it regains some stability. In the case and avulsed tooth, the tooth should be gently cleaned with clean water if visible environmental debris is present and pushed back into the socket and held until stable. Many times the tooth will find a secure fit and will be stable enough to heal. Dental evaluation and treatment is necessary as soon as possible. If the tooth cannot be found, it is essential to keep the tooth in something isotonic such as saline (salt water), milk, or one of the tooth saver kits available at pharmacies. It is imperative that the tooth be reimplanted within 2 hours of being avulsed. The quicker the tooth is replaced the more likely it will survive long-term. How are jaw and facial fractures treated?
Once a jaw or facial bone fracture is diagnosed by physical exam and x-rays, planning begins on the best timing and approach to reduce the bones back into their original position. The most important considerations are the accuracy of the bite and facial deformity. Reduction and fixation of the fractures can be done with closed techniques (wiring the teeth together in the normal bite to bring the fractured bones together) or open techniques (incisions made to directly visualize the fractures such that repair can be made with wires, plates and screws as necessary). Many times a combination of these approaches is necessary. Do all jaw and facial fractures need to be treated?
The majority of jaw fractures need to be treated with immobilization, which usually entails wiring the jaws together for a period of time. Some facial fractures are considered nondisplaced or minimally displaced and can sometimes heal without surgical intervention. If an unacceptable facial deformity exists, surgery is necessary for correction. What is orthognathic surgery and what conditions require this treatment?
Orthognathic surgery is the surgical correction of a congenital, developmental, or acquired deformity of the jaws. Correction entails surgical repositioning of the jaws for improved function of the bite. In improving occlusal (bite) function, often there is an improvement to facial balance and overall facial appearance. Temporomandibular joint function can often be improved a well, preventing the development of TMJ problems later in life. What is TMJ?
TMJ stands for “temporomandibular joint.” This abbreviation is often used in the context of temporomandibular joint dysfunction. The temporomandibular joint is very complex in anatomy and function. Problems associated with it can range from joint noises, locking, and pain. Problems can arise from the jaw muscles, tendons, and the joint disc. Diagnosis of the specific problem and cause is essential in successful management of TMJ problems. When is surgery necessary to treat TMJ disorders?
If a primary joint problem is identified that is not amenable to conservative measures and medications, surgery may be necessary. There are various procedures for treating temporomandibular joint problems ranging from joint injection to open joint arthroplasty to partial or complete joint replacement. |