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By the age of eighteen, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth or molar teeth are used to grind food up into a consistency suitable for swallowing.
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."
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, as wisdom teeth are the most commonly impacted teeth in 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. The location and impaction of the wisdom teeth can often create periodontal problems associated with teeth in front of them.
These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and can cause an infection. The result: swelling, stiffness, pain and illness. The location and impaction of the wisdom teeth can also often create periodontal problems with the teeth in front of them. 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. The removal of wisdom teeth can be performed in the office as an outpatient surgery under local anesthesia, nitrous oxide analgesia (laughing gas) or IV sedation to maximize patient comfort. Your oral surgeon has the training, license and expertise to provide various types of anesthesia for patients.
With an oral examination and x-rays of the mouth, your oral surgeon 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. Your oral surgeon has the training, license and experience to provide various types of anesthesia for patients to select the best alternative.
The removal of wisdom teeth can be performed in the office as an outpatient surgery under local anesthesia, nitrous oxide analgesia (laughing gas) or IV sedation to maximize patient comfort. Your oral surgeon has the training, license and expertise to provide various types of anesthesia for patients. These options as well as the surgical risks will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding, bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your post-operative kit will include postoperative instructions and a prescription for pain medication. If you have any questions, please do not hesitate to call us.
When restoration procedures such as root canal therapy, crowns, or fillings are not enough to save a tooth, or if there is periodontal disease present, it may need to be pulled, or extracted.
To make your experience very comfortable, tooth extraction procedures can be performed under various anesthetic options, including local anesthetic, nitrous oxide, or IV sedation.
Always before a tooth is extracted, the area surrounding the tooth is always numbed with a topical/and or injectable anesthetic. This will make the area feel numb, however, you still may experience pressure during the procedure.
Patients with extracted teeth sometimes need to take an antibiotic, and at the very least, take precautions following the procedure to ensure that infection doesn't occur.
Smoking, vigorous brushing and rinsing, and drinking liquids through straws are discouraged during the post-operative period because they hinder healing and may cause the wound to open. Cold compresses applied to the outside cheek near the extraction area can help reduce any swelling and promote faster healing.
A patient who has a tooth pulled experiences little or no discomfort, and only minor bleeding in many cases.
We recommend a soft food diet for the first couple of days, and it is important to keep the mouth clean to help the healing process.
Teeth replacement options can also be discussed by Dr. Smith.
Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth which look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence.
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 bone deterioration that occurs when teeth are missing.
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.
After the implant has bonded to the jawbone, the second phase begins. Your oral surgeon 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.
Using the most recent advances in dental implant technology, your dentist is able to place single stage implants. These implants do not require a second procedure to uncover them, but do require a minimum of six weeks of healing time before artificial teeth are placed. There are even situations where the implants can be placed at the same time as a tooth extraction - further minimizing the number of surgical procedures. Advances in dental implant technology have made it possible, in select cases, to extract teeth and place implants with crowns at one visit. This procedure, called "immediate loading," greatly simplifies the surgical process.
While your oral surgeon performs the actual implant surgery, and initial tooth extractions and bone grafting if necessary, the restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.
A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) is secured to the implants via a bar or ball in socket attachments.
There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a "partial" at night may be inconvenient, not to mention that dentures that slip can be uncomfortable and rather embarrassing.
If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If your mouth is not ideal for implants, ways of improving outcome, such as bone grafting, may be recommended.
The majority of dental implants and bone graft can be performed in the office under local anesthesia. We also use IV Sedation. IV sedation allows us to perform surgeries while the patient is in a relaxed state and unaware that the implant procedure is being done. This technique is very effective for people who are excessively nervous about surgery.
Once the implants are in place, they will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.
Over a period of time, the jawbone can atrophy or resorb after a tooth extraction, periodontal disease, missing teeth, oral pathology, trauma, or infection. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants.
Today, we 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 is either obtained from a tissue bank using cadaver (allograft) or animal bone (xenograft), or you own bone is taken from the jaw, chin, skull, hip or tibia. Your own bone is considered the best bone because it is vital bone, and can be used to graft large areas, but requires a second surgery site for grafting. Allograft and xenograft are convenient because they do not require a second surgery site. These grafts however, lack the potential to induce bone growth like your own bone can.
Socket Preservation: When a tooth or multiple teeth are extracted, the socket will often resorb and shrink in dimension over time. A socket preservation is a procedure in which an allograft or xenograft is placed into the socket to maintain the bony dimension to receive an implant in 3-4 months.
Ridge Augmentation: Overtime, the jawbone with missing teeth will often resorb. If implants are considered, they will often require the bone to be built back up to house the implant. Ridge augmentation is a procedure in which a bone graft is placed over the resorbed bone, and under the gum tissue. This can take anywhere from 3-6 months of healing, followed then by implant placement.
Sinus Lift: In the back upper jaw, there is an air filled space called the maxillary sinus. The maxillary sinuses are air-filled spaces behind each cheek in the back of the upper jaw. When the back upper teeth are removed, there is only a small amount of remaining bone separating the sinus from the mouth. Overtime, the sinus can increase in size while the jawbone in this area resorbs. If implants are being considered, and there is not enough existing bone, a sinus lift procedure is required. A sinus lift can be performed by making a window into the sinus and then adding bone along the sinus floor to create enough height to sufficiently house the implants. While implants are typically placed after 6 months of healing, in certain cases they can be placed at the same time as the sinus bone graft.
The maxillary sinus is an air-filled space behind the cheeks and in the back of the upper jaw. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.
There is a solution and it's called a sinus graft or sinus lift graft. The oral surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient's jaw and dental implants can be inserted and stabilized in this new sinus bone. However, there are certain cases in which implants can be placed at the same time as the sinus bone graft.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.
Sometimes prior to the fabrication and placement of a dental prosthesis such as dentures, certain oral surgery procedures may be needed. An ideally contoured jawbone ensures that the new dental prosthesis has the best fit and provides the maximum level of comfort, esthetics and function.
By performing pre-prosthetic procedures the oral surgeon can correct any bone or soft tissue conditions that might interfere with the placement of a dental prosthesis as well as create a better base of support for the new partial or full dentures.
Common pre-prosthetic surgical procedures include:
Alveoloplasty is a surgical procedure during which the jawbone is smooth and reshaped in areas where teeth have been lost or extracted. An alveoloplasty can be performed either during the actual extraction of the teeth or when necessary as a separate procedure. Oftentimes, during the extractions of the teeth to be replaced by a denture, the oral surgeon contours and shapes the bone to fit the future prosthesis.
Exostosis and tori reduction refers to the surgical procedures to remove benign bony bumps or prominences from the upper or lower jaws that may interfere with the placement and fit of a dental prosthesis. Once a sufficient amount of excess bone has been removed to allow the seating and fit of a dental prosthesis, the remaining bony surface is contoured and smoothed.
Sometimes removal of redundant tissue or excess gums in the mouth is necessary for the proper fit and function of a dental prosthesis. Hyperplastic tissue or extra folds of gum, lip, or cheek tissue that may have developed from a previous long-standing denture or other factors requires a surgical procedure to restore the normal soft tissue anatomy in preparation for the new dental prosthesis.
When teeth other than third molars (the wisdom teeth), fail to erupt, these teeth are referred to as impacted. Impacted teeth such as the canines (the most commonly impacted teeth), premolars, and molars are an infrequent occurrence. However, when these teeth fail to erupt, it is usually due to a lack of space or crowding in the mouth, or as a result of a positioning problem. This can create a functional as well as an esthetic problem during growth and development.
When a tooth remains impacted, it will often be diagnosed by a dentist or an orthodontist early in a child’s life. This typically happens in the early adolescent years, when teeth such as the canines and premolars are just beginning to erupt. Clinical examination and x-rays are often used to diagnose an impacted tooth. An oral surgeon can assist in uncovering the involved tooth to facilitate its eruption as well as to enable it to be brought into alignment by the orthodontist.
Expose and bond is a procedure performed by the oral surgeon to enable the procedures necessary to align the tooth. Once the impacted tooth is identified, the oral surgeon performs a procedure to uncover the tooth and bond an orthodontic bracket to its surface. A chain is then attached to the patient’s braces. The expose and bond procedure can be performed in the clinic by the oral surgeon under various anesthetic options to make the patient very comfortable and relaxed.
After an expose and bond procedure, healing typically takes 1-2 weeks.
The orthodontist will then periodically adjust the chain to bring the impacted tooth into the mouth and to align it in the proper position.
We recommend a soft food diet for the first couple of days following the procedure. It is important to keep the mouth clean to promote the healing process.
In some cases a tooth that has had a root canal, which did not sufficiently heal or has become re-infected, is not a candidate for endodontic retreatment. For these teeth a minor surgical procedure that treats the infection from the root-end of the tooth, that is known as an apicoectomy, may be indicated. An apicoectomy is an excellent next step procedure to preserve a previously treated tooth, eliminate a dental infection, and to restore the health of the surrounding tissues. It is most useful in cases where fractures or hidden canals still cause pain or infection around a treated tooth, as well as when an endodontic retreatment procedure is not recommended as it will further weaken and jeopardize the tooth.
An apicoectomy may be performed under local anesthesia. An apicoectomy is typically a straightforward procedure during which an incision is made in the gum tissue at the involved tooth. This is to expose the inflamed or infected tissue surrounding the root tip of the tooth. Once uncovered, the damaged tissue in the area is removed along with a few millimeters of the tooth’s root tip. A biocompatible filling material is then placed in the end of the remaining portion of the root to seal it and prevent any possibility of reinfection. The gum tissue flap is put back into place and sutured to complete the procedure.
Post-surgical discomfort is generally mild and you may have some swelling in the area. Most patients return to their normal activities very quickly. If needed, apply a cold compress to reduce discomfort and swelling after the procedure. The appropriate pain medication will be prescribed or recommended. If your discomfort does not respond to medication, or other symptoms that concern you develop, please call our office.
Prior to undergoing an apicoectomy the doctor will discuss all the risks and benefits of the procedure. If during the course of an apicoectomy any significant fractures or are discovered in the tooth that changes the prognosis, you will be immediately advised.
The mouth is a complex structure consisting of hard tissues, such as the teeth and bone, as well as soft tissues, including the mucosa (cheeks, lips, and gums) and the tongue. Although it is rare, there are times when these tissues exhibit abnormal growth and development that can produce lesions or pathology in the oral cavity or surrounding areas. In other situations, certain oral tissues may undergo a change in tissue structure, due to a disease like cancer, and develop irregular growths or lesions. This is why routine dental care, including screenings for oral cancer are so important.
If during the course of a dental checkup or oral cancer screening a suspicious lesion or growth is discovered, patients are often referred to an oral surgeon for further evaluation and care. Abnormal findings on either dental x-rays or during the course of a dental exam prompting this referral may include the presence of an ulceration or a sore that does not heal, or evidence of a bump growing in either the jawbone, the gums, or the neck. The oral surgeon will perform a comprehensive exam on this patient and do a tissue biopsy, as well as order additional studies as needed to confirm the diagnosis.
If an individual on their own notices any suspicious growths, ulcerations, or unusual bumps anywhere in their mouth or in the head and neck region, it is important that they have them promptly evaluated. They should not hesitate to contact the dentist or oral surgeon with any concerns.
Sedation offers individuals with general anxiety about going to the oral surgeon, or fears about a specific oral surgery procedure, the opportunity to have a stress free and more comfortable experience. Utilizing safe and controlled sedation techniques prior to the procedure, the patient is eased into a state of complete relaxation. This eliminates any discomfort, pain, and preoperative anxiety that may be associated with a particular visit. With sedation, patients typically feel more at ease post-operatively as they have little or no memory of the actual moment-to- moment oral surgery procedure.
Oral and Maxillofacial Surgeons are the experts in outpatient sedation. There are many anesthetic options to make you as comfortable as possible during your surgical visit. Local anesthetic is always provided during any procedure.
The choice of which type of sedation is most appropriate for an oral surgery procedure depends on the specific needs of the individual. In choosing the most appropriate method of sedation, the oral surgeon considers the patient’s medical history and their level of anxiety. Types of sedation for oral surgery patients include nitrous oxide sedation, oral conscious sedation, and IV sedation.
Commonly referred to as “laughing gas,” nitrous oxide is used as a mild sedative to reduce anxiety and allow a level of relaxation during a procedure. Nitrous oxide is inhaled through a small mask over the nose. It is administered for the duration of the procedure and is turned off as the procedure is coming to an end. The effects of this method of sedation wear off very quickly.
Oral Sedation means that you will be given a prescription for an oral medication prior to you appointment. Taken at the recommended time before your appointment, this medication allows you to fully relax by the time your procedure begins. When receiving oral sedation, a patient must have an escort on the day of the procedure to drive them to and from the oral surgeon’s office.
IV Sedation involves a sedative that is administered intravenously, or directly into a vein. It is indicated when deeper sedation is required. This type of sedation can be quickly modified to your state of consciousness and can be continued as long as necessary for the procedure.
IV Sedation requires an empty stomach. Patients receiving this type of sedation will be instructed as to how many hours prior to their surgical procedure they should stop eating or drinking. In addition to this, patients receiving IV sedation will need to have an escort present for the appointment and to be able to drive them home when the appointment is completed.
Oral and Maxillofacial Surgeons are highly skilled specialists trained to provide treatment for all types of facial trauma including the emergency management of dental and maxillofacial injuries, as well as any required facial reconstruction procedures.
Oral and maxillofacial trauma can range from dental injuries or lacerations in and around the mouth to more complex and severe damage to the soft tissues and many bones of the face and skull. These injuries are often caused by motor vehicle accidents, assaults, sports or work related injuries, falls, or other mishaps involving direct physical trauma to the mouth and face.
Dentoalveolar Injuries refer to injuries involving the teeth and the bone surrounding the teeth. These injuries can include teeth that have been dislodged with or without a segment of the surrounding bone, or an avulsion, which means that a tooth has been completely “knocked out” of its socket. Treatment of these injuries requires they be treated without delay to reposition and stabilize the involved teeth and/or bone in the correct anatomical positions.
While the Oral and Maxillofacial Surgeon can provide the initial treatment for this type of a traumatic injury, the involved teeth should be followed and assessed by the general dentist or the endodontist for any long-term effects to the teeth, the surrounding bone, or the occlusion, as well as to perform any necessary procedures to restore these teeth.
Soft tissue injuries of the Maxillofacial region include lacerations within the mouth (intra-oral) and facial lacerations. The diagnosis and treatment of soft tissue injuries involves repairing the injury to achieve the best cosmetic result, and as possible to maintain function and sensation in the involved area.
Fractures of the upper or lower jaws, fractures to the orbit of the eye, the cheekbone, and nasal fractures are common facial injuries involving the bones of the face that are treated by an Oral and Maxillofacial Surgeon.
Facial bone fractures are treated in much the same way as fractures of other parts of the body. The goals are to restore alignment, achieve bony union, prevent any infections from developing, reestablish function, and to maintain normal facial appearance. Treatment considerations for facial fractures may include the health and age of the patient, the location of the injury, as well as the degree of severity of the fracture and the associated damage.
While the bones in the face cannot be put in a cast like the treatment of limb fractures, other methods of stabilization are employed by the Oral and Maxillofacial Surgeon to allow effective and complete healing of the involved bones. Certain jaw fractures may require a surgical procedure and stabilization. This may involve the placement of small plates and screws at the affected site, or the temporary wiring of the jaws together.
