PROCEDURES

• Reddish patches or whitish patches in the mouth
• A sore that fails to heal and bleeds easily
• A lump or thickening on the skin lining the inside of the mouth
• Chronic sore throat or hoarseness
• Difficulty in chewing or swallowing

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

We would recommend performing an oral self-examination monthly and remember that your mouth is one of your body's most important warning systems. If you discover anything unusual, please call us for a consultation. If indicated, we will schedule a biopsy. This painless procedure is done in office where a sample of tissue is removed and sent to a pathologist. The pathologist will examine it under a microscope and obtain a diagnosis. This diagnosis will lead to a treatment plan that may range from simple observation to further treatment. Do not ignore suspicious lumps or sores.  Please contact us so that we may help.

What are Dental Implants?

The implants themselves are tiny titanium posts which are inserted into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. They are surgically placed into the jawbone. The bone bonds with the titanium, creating a strong foundation for artificial teeth. Small posts are then attached to the implant which protrude through the gums. These posts provide stable anchors for artificial replacement teeth. Implants also help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.

The Surgical Procedure

For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet during this time. At the same time, your dentist is forming new replacement teeth.

After the implant has bonded to the jawbone, the second phase begins. Our doctors will uncover the implants and attach small posts which will act as anchors for the artificial teeth. These posts protrude through the gums. When the artificial teeth are placed these posts will not be seen. The entire procedure usually takes six to eight months. Most patients experience minimal disruption in their daily life.

Among the bones of the face are the upper and the lower jaws. These contain the teeth and enable proper chewing, swallowing and speech. Along with the other facial bones, they give the bony support to the soft tissues of the face that allows for pleasing aesthetic contours. Function and appearance are so closely related in this area that it is often difficult to separate the two. If a person has a deficiency or excess in the jaws, it may cause chewing, expiratory or aesthetic problems. This can be corrected by repositioning the misaligned structures. This type of surgery is called ortho (straight) gnathic (jaw).

Orthognathic surgery is needed when jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics, and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

Who Needs Orthognathic Surgery?

There are many people who can benefit from orthognathic surgery. Jaw growth is a gradual process and in many instances the upper and lower jaws will grow a different rates. This will result in retruding, protruding or narrow jaws. This disharmonious alignment will cause improper bite that will affect chewing, speech, and aesthetics. At times these problems can be evident at birth while at other times they develop during growth. Trauma at any age can also alter jaw relationships.

While orthodontics (braces) can correct bite problems, only if the teeth are involved, surgery is required if the jaw bones need to be realigned. This will not only increase proper function, but enhance aesthetics as well. Surgery can be done at almost any age and can be combined with cosmetic procedures if required or desired.

Difficulty in the following areas should be evaluated:

• difficulty in chewing, biting or swallowing
• speech problems 
• chronic jaw or TMJ pain 
• open bite 
• protruding jaw 
• breathing problems

Any of these can exist at birth or may be acquired after birth as a result of hereditary or environmental influences or, trauma to the face. Before treatment begins, preliminary records such as dental models, x-rays and pictures are obtained. Tracings and measurements of the above in conjunction with the clinical examination will enable the doctor to arrive at a diagnosis. This diagnosis will determine which areas will need surgery and how this will take place. It is during the pre-operative phase where you are encouraged to ask questions and become fully involved with the treatment planning. Patient understanding is a very important and vital part of this process.

Technology and Orthognathic Surgery

During this phase, your surgeon will work closely with your dentist and orthodontist to coordinate treatment. Mock surgery will be performed on the models and x-ray tracings to educate you about the procedure and give you an approximate idea of the final results. When you are comfortable with the aspects of your care, you and your dental team will make the decision to proceed with treatment.

Commonly Asked Questions

Q: Will the surgery hurt?
A: No. All of the surgery is done with general anesthesia so you will not feel or remember anything.

Q: Will there be any scars?
A: No. The jaw surgery is done inside the mouth so there is no facial scarring.

Q: Will my mouth be wired closed?
A: Maybe. Depending on the type of procedure, you may not be wired closed at all or you may need closure from two to six weeks.

Q: What can I eat?
A: You will be placed on a liquid diet. We have many recipes and booklets that will ensure your good health. We will also have you consult with a nutritionist if we feel that it is necessary.

Q: How long will I be in the hospital?
A: Anywhere from same day surgery up to two days post-operatively.

Q: Will it hurt afterwards?
A: Some discomfort is to be expected but we will give you adequate pain medication to make you comfortable, both while in the hospital and when you are at home.

Q: Will I be swollen?
A: Yes. Although you will be given medicine to lessen swelling, some is to be expected in the first week. Most of the swelling is gone within two weeks..

Q: When can I resume my daily routines?
A: Usually a one week recuperative period is required followed by gradually increasing your activities until you feel back to normal.

Q: Will I need antibiotics?
A: Yes. Even though infection is rare, antibiotics are given during and after surgery to lessen its occurrence.

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.

We now have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance. The bone graft procedures are referred to as:

• Sinus Lift Procedure
  This procedure involves elevating the sinus membrane and placing the bone graft onto the sinus floor, allowing implants to be placed in the back part of the upper jaw.
• Ridge Augmentation
  In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase the ridge height and/or width.
• Nerve Repositioning
  The inferior aveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw.

These procedures may be performed separately or together, depending upon the individual's condition. There are several areas of the body which are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee.

These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.

However, the average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your Third Molars, also known as "wisdom teeth."

Why Should I Remove My Wisdom Teeth?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly, and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Oral Examination

With an oral examination and x-rays of the mouth, our doctors can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid- teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Our doctors have the training, license and experience to provide various types of anesthesia to allow patients to select the best alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques.

• Facial lacerations
• Intra oral lacerations 
• Avulsed (knocked out) teeth 
• Fractured facial bones (cheek, nose, or eye socket) 
• Fractured jaws (upper and lower jaw) 

Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a "hands on" experience and an understanding of how the treatment provided will influence the patient's long term function and appearance. 

The Nature of Maxillofacial Trauma

There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries account for many. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bony injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

Soft Tissue Injuries of the Maxillofacial Region

When soft tissue injuries such as lacerations occur on the face, they are repaired by "suturing". In addition to the obvious concern of providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat, injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). Our doctors are well-trained oral and maxillofacial surgeons and are proficient at diagnosing and treating all types of facial lacerations.

Bone Injuries of the Maxillofacial Region

Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient. When an arm or a leg is fractured, a "cast" is often applied to stabilize the bone and allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. However, certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small "plates and screws" at the involved site. This technique of treatment can often allow for healing and prevents the necessity of having the jaws wired together. This technique is called "rigid fixation" of a fracture. The relatively recent development and use of "rigid fixation" has profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. Importantly, the patient's facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is "hidden".

Injuries to the Teeth and Surrounding Dental Structures

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth which have been displaced or "knocked out". These types of injuries are treated by one of a number of forms of "splinting" (stabilizing by wiring or bonding teeth together). If a tooth is "knocked out", it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to "wipe the tooth off", since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

The proper treatment of facial injuries is now the realm of specialists, well versed in the emergency care, acute treatment and long term reconstruction and rehabilitation of the patient.