Oral & Maxillofacial Surgery
Oral & Maxillofacial Surgeons are specialists with advanced training and expertise in the diagnosis and treatment of various head and neck conditions and injuries. After four years of dental school, an Oral & Maxillofacial Surgeon completes four to six years of additional formal training in treating the craniomaxillofacial complex. This specialty is one of 9 dental specialties recognized internationally and by the American Dental Association (ADA).
An Oral Maxillofacial Surgeon can diagnose and treat a wide variety conditions. The following are just some of the many conditions, treatments and procedures oral and maxillofacial surgeon deal with on a daily basis:
- TMJ, Facial Pain, & Facial Reconstruction
- Dental Implants
- Tooth Extractions & Impacted Teeth
- Wisdom Teeth
- Misaligned Jaws
- Cleft Lip & Palate
- Oral Cancers , Tumors, Cysts, & Biopsies
- Sleep Apnea
- Facial Cosmetic Surgery
Whether your dentist refers you to our office, you have pain or symptoms causing you concern, or you simply have questions you would like answered, please contact our office today to schedule an appointment. We are here to answer your questions and provide the treatment you deserve!
Cleft Lip and Cleft Palate
Cleft lip and cleft palate are two common but markedly different birth defects that affect about one in every 700 newborns. These developmental deformities occur in the first trimester of a woman’s pregnancy; cleft lip in week seven, and cleft palate in week nine. Cleft lip and cleft palate occur simultaneously in about half of all cases, and separately in approximately a quarter of all cases.
A cleft lip is essentially a separation of the two sides of the lip. In many cases, this separation will include the bone and gum of the upper jaw. A cleft palate occurs when the sides of the palate fail to “fuse” as the fetus is developing, which results in an opening in the roof of the mouth.
The cleft deformities are categorized according to their location in the mouth and the size of the defect.
- Unilateral Incomplete: A cleft on only one side of the mouth that does not extend as far as the nostril.
- Unilateral Complete: A cleft on only one side of the mouth that extends into the corresponding nostril.
- Bilateral Complete: Larger clefts affecting both sides of the mouth which each extend as far as the nostril.
- Microform Cleft: A mild case of cleft lip which may simply form a bump on the lip, or a small scar line extending toward the nostril.
Reasons for cleft lip and cleft palate correction
Cleft lip and cleft palate are highly treatable deformities, though it may take a whole team of different specialists to fully treat the condition. The prognosis for sufferers who receive corrective treatment is excellent; medically, physically, dentally, and emotionally. There are however, a series of risks for those who do not receive corrective treatment:
- Speech – Children born with either cleft deformity are likely to experience speech problems unless treatment is sought. Speech problems are detrimental to a child’s social and emotional development.
- Feeding – Babies with a cleft palate or a complete cleft lip have problems drinking milk. The gap means that liquids can pass from the mouth to the nasal cavity. This can be dangerous unless the child is fed sitting upright.
- Hearing Loss & Frequent Ear Infections – A cleft palate can cause the eustachian tubes (connecting the throat to the ear) to be incorrectly positioned. The fluid build up which results from this poor positioning can lead to painful middle ear infections. Severe and prolonged ear infections can lead to complete hearing loss.
- Dental Issues – Abnormalities in the upper jaw, gum, or arch can cause teeth to become impacted (unable to erupt) or absent completely. The shape of the mouth might not permit proper brushing which can lead to periodontal disease and tooth decay.
What does cleft lip and cleft palate treatment involve?
Initially, surgeons will work to close the cleft openings in the first six months of the child’s life. Unfortunately, this does not cure the dental problems that occur as a result of cleft lip and cleft palate defects. The dentist will perform a thorough examination of the teeth surrounding the deformity. Panoramic x-rays will generally be taken to allow the dentist to determine the best course of treatment.
The dentist may implant teeth to fill resulting gaps, and/or place braces on the teeth in order to correctly align the upper arch. These treatments will restore functionality to the jaw and improve the aesthetic appearance of the smile. Dental restoration work can generally be performed under local anesthetic and will not require an overnight stay.
If your child was born with any cleft deformity, we strongly encourage you to contact our office to schedule a consultation.
Corrective Jaw Surgery (Orthognathic Surgery)
Orthognathic surgery refers to the surgical correction needed to fix substantial abnormalities of the maxilla (upper jaw), the mandible (lower jaw), or both. The abnormality may be a birth defect, a growth defect, or the result of traumatic injuries to the jaw area.
Orthognathic surgery is generally performed by an Oral and Maxillofacial Surgeon to correct malocclusion (bad bite) in cases where routine orthodontic treatment has not or will not be effective. Orthognathic surgeries include the reconstruction of the mandible or maxilla, mandibular ramus, maxilla osteotomy, and mandibular osteotomy.
There are several classifications of malocclusion (the improper coming together of teeth) which may require orthognathic surgery:
- Class I Occlusion –This malocclusion means that the lower anterior incisors sit directly behind the upper anterior incisors when the patient bites down. This is considered less destructive than Class II and Class III malocclusions.
- Class II Malocclusion – This is identified when the lower anterior incisors lie significantly behind the upper anterior incisors during the biting process; in some cases hitting the soft tissue behind the upper incisors. This is commonly referred to as an overbite and can cause discomfort, bone damage, excessive wear of the front teeth, and tooth loss.
- Class III Malocclusion – This is commonly known as an underbite and occurs when the lower anterior incisors and lower jaw are positioned beyond the upper teeth, making the lower jaw much more prominent than the upper jaw.
Reasons for orthognathic surgery
The malocclusion of the teeth can create greatly destructive forces among the five powerful muscles that control the closing and opening of the jaw. These muscles generate a tremendous force when clenching, grinding or chewing. Misalignment can seriously damage the function and aesthetic appearance of the teeth in many ways if left untreated, such as:
- Tooth Wear – In the case of an overbite, the pressure and wear on the teeth is not spread evenly. This can also lead to TMJ, migraine headaches, and tooth loss.
- Chronic Jaw, Muscle Pain & Headache – The misalignment of the teeth alters the way the facial muscles interact. In some cases, the meniscus cartilage which acts as a buffer between the jawbones can be painfully damaged.
- Loose Teeth – When uneven pressure is continually exerted in unintended places or soft tissue is damaged by an overbite, adjacent teeth may become loose in their sockets which causes pain and reduces proper function.
- Tooth Sensitivity – As teeth become damaged by constant use, the enamel becomes thinner and the nerves are less protected. This lack of protection can lead to sharp pains when hot or cold foods are eaten.
- Difficulty Swallowing, Chewing, or Biting Food – Each can be associated with muscle pain and/or poor alignment of the upper and lower jaws.
What does orthognathic surgery involve?
When the dentist identifies a patient as a candidate for orthognathic surgery, a complete photographic analysis is initially undertaken. This includes panorex x-rays, cephalometric x-rays, models, impressions, and radiographs. Your oral & maxillofacial surgeon, your orthodontist and your dentist will work together and consider how the corrective surgery will impact both proper jaw function and the aesthetic appearance of the entire face.
Generally, orthodontic braces are necessary to align the arches and straighten the teeth prior to the surgery, and additionally, retainers may be used after the surgery. During maxillary surgery, the upper jaw is moved and may be secured in position using tiny plates, wires, rubber bands and screws. Surgery on the mandible is performed using bone grafts to align the lower jaw into the correct position. Orthognathic surgery generally requires a general anesthesia and a good deal of aftercare. Pain medication will be prescribed as necessary, and you’ll be given post treatment advice for your recovery. You may also be provided with a modified diet (if required).
An oral exam is routinely performed by the dentist during the course of an initial comprehensive exam and regular check-ups. An oral cancer exam refers to the identification and management of diseases pertaining to the maxillofacial and oral regions.
The soft tissue of the mouth is normally lined with mucosa, which is special type of skin that should appear smooth in texture and pink in color. Any alteration of the color or texture of the mucosa may signal the beginning of a pathologic process. These changes may occur on the face, neck, and areas of the mouth (e.g., gums, tongue, lips, etc.). The most serious of these pathologic changes (which may or may not be painful) is oral cancer, but there are also many other common pathologic problems.
Geographic Tongue – Also known as Benign Migratory Glossitis or Erythema Migrans, is a condition where the tongue is missing papillae (small bumps) in different areas, and a map-like appearance can develop. This condition is usually seen as red well defined areas on or around the sides of the tongue. The red patches (which can look like an unsightly rash) may come and go from hours to months at a time and cause increased sensitivity to certain substances.
Median Palatal Cyst – This cyst is of developmental origin and is essentially a fluid filled skin sac. It usually appears in the middle of the palate and may cause substantial discomfort.
Hairy Tongue – An overgrowth of bacteria or a yeast infection in the mouth which can cause the tongue to appear hairy and black. This condition is usually a result of poor oral hygiene, chronic or extensive use of antibiotics, or radiation treatments to the head or neck. It is often also seen in HIV positive patients and those who are intravenous drug users. Hairy Tongue may or may not require treatment.
Treatment of Pathological Diseases
In the majority of cases, the pathological changes experienced in the oral region are uncomfortable and disfiguring, but not life threatening. However, oral cancer is on the rise (especially among men) and the chances of survival are around 80% if an immediate diagnosis is made.
Oral cancer is a general term used when referring to any type of cancer affecting the tongue, jaw, and lower cheek area. Since it is impossible for the dentist to decisively diagnose a pathological disease without taking a biopsy sample of the affected area, seeking immediate treatment when changes are first noticed might be a life and death decision. For less serious problems, there are several options available, such as:
- Antibiotics – In the case of a bacterial infection or persistent soreness, the dentist may prescribe a dose of antibiotics to return the mucosa to its natural state. This will alleviate soreness and discomfort.
- Diluted Hydrogen Peroxide – When poor oral hygiene is causing changes to the soft tissue, the dentist may prescribe a diluted hydrogen peroxide mouthwash. This will kill more bacteria than regular mouthwash and improve halitosis (bad breath).
- Oral Surgery – If the patient has cysts or abnormal non-cancerous growths, the dentist may decide to completely remove them. This can improve comfort levels, alleviate breathing problems, and make speech substantially easier depending on the location of the cyst.
During the course of a regular check up, the dentist will thoroughly inspect the soft tissue of the mouth and take serious note of any changes. If there are cell changes present, the dentist will take a biopsy of the affected area and send it away to be analyzed by laboratory specialists. When definitive results are obtained, the dentist can decide on the best course of treatment.
Oral Cancer Screenings
An oral cancer screening is usually performed during a comprehensive or recall (check-up) exam. Screening is painless and only takes a few minutes. The dentist or hygienist will use a laser light to assess the soft tissue for cell changes that might be indicative of oral cancer. If such cell changes are present, a small biopsy will be taken and sent to a laboratory for review. If the biopsy indicates that oral cancer is present, an excision (removal) will generally be performed.
Platelet Rich Plasma (PRP)
Platelet Rich Plasma or PRP is a by-product of blood that is exceptionally rich in platelets. PRP has long been used in hospitals to accelerate the body’s own healing process, but it is only fairly recently that advances in technology have allowed this same technique to be used in the dental office.
The blood platelets perform several essential functions in the body, including blood clot formation and the release of growth factors that help to heal wounds. These growth factors stimulate the stem cells to produce new host tissue as quickly as possible, which is why platelet rich plasma is so effective in the post-treatment healing process.
There are several ways in which PRP can be used in clinical dentistry:
- Bone Grafting For Implants – This includes closure of a cleft lip and cleft palate deformities, sinus lifts, ridge augmentation, and both inlay and onlay grafts.
- Bone Repair – PRP can be used in facial trauma reconstruction, repairing of defects due to tooth removal, or the removal of growths and cysts.
- Fistula Repair – This includes the repair of fistulas between the mouth and the sinus cavity.
Reasons for platelet rich plasma treatment
Platelet rich plasma application is now widely used to expedite the post-procedure healing process and is completely safe. Since the blood used will come from the patient’s own body, disease transmission is not a factor. Almost all patients report a much greater degree of comfort immediately after their procedure. There are also several more distinct advantages of PRP:
- Lower Infection Risk – PRP is smeared thickly on the wound after the procedure by the dentist and actually seals the wound away from infectious agents, lowering the risk of problems.
- Accelerated Healing – The saturation of the wound with PRP helps increase tissue synthesis due to its growth factors, and this in turn results in faster tissue regeneration. Speedier healing decreases the risk of later infections, complications, and discomfort.
- Safety and Convenience – Disease transmission is non-issue since the blood is harvested from the patient’s own blood supply. The amount of blood needed is small and can be collected during a routine outpatient procedure.
What does platelet rich plasma treatment involve?
The dentist will initially assess if your candidate for PRP treatment. Patients with blood clotting disorders will be unable to take advantage of this treatment. A small (about 2 oz) sample of your blood will be collected during a scheduled outpatient treatment. The blood will be placed into a centrifuge to separate the plasma from the red blood cells. A second centrifuge will be used to concentrate the platelets which contain the growth factor
Immediately after suturing the wound, the dentist will apply the PRP to the surgical area in a high concentration. This will expedite your healing and decrease the amount of discomfort following the surgery. The dentist will provide aftercare instructions pertaining to the surgery and a prescription for pain medication as required.
If you have any questions about treatment with platelet rich plasma or would like to find out if you are a candidate and can benefit from this treatment, please contact our office today to schedule an appointment.
Wisdom Teeth Extractions
Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.
In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors.
There are several types, or degrees, of impaction based on the actual depth of the teeth within the jaw:
- Soft Tissue Impaction: The upper portion of the tooth (the crown) has penetrated through the bone, but the gingiva (gum) is covering part or all of the tooth’s crown and has not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.
- Partial Bony Impaction: The tooth has partially erupted, but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.
- Complete Bony Impaction: The tooth is completely encased by jawbone. This will require more complex removal techniques.
Reasons to remove wisdom teeth
While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:
- Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
- Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
- Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
- Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn’t universally accepted by all dental professionals, and it has never been validated by any scientific studies.
Wisdom teeth examination
As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital x-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems. The x-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.
What does the removal of wisdom teeth involve?
Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.