Oral Surgery is the area of dentistry that deals with conditions of the teeth and jaws requiring surgical intervention including oral pathology, tooth extractions, wisdom teeth, TMJ disorders, cleft lip and palate, apicoectomies, and dental implants to name a few.

We can treat many conditions of the teeth requiring oral surgery, however, for complicated cases such as complicated wisdom tooth removal, impacted teeth, apicoectomies, and some TM J disorders a referral to an Oral and Maxillofacial Surgeon may be necessary. Oral & Maxillofacial Surgeons are specialists with advanced training and expertise in the diagnosis and treatment of various head and neck conditions and injuries.

Oral Pathology

An oral exam is routinely performed during the course of an initial comprehensive exam and regular check-ups. An oral cancer exam refers to the identification and management of diseases in 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.

Oral cancer is a general term used when referring to any type of cancer affecting the tongue, jaw, and lower cheek area. Oral cancer is on the rise (especially among men). The chances of survival are around 80% if an immediate diagnosis is made. Regular oral cancer screening and seeking immediate treatment when changes are first noticed might be a life and death decision.

Oral Examinations

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, a biopsy of the affected area needs to be analyzed by laboratory specialists. Definitive results are required to determine 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. If you are experiencing any pain or symptoms that cause you concern, we encourage you to contact us today to schedule an appointment.

Wisdom Teeth Examination

Panoramic or digital x-rays will be taken in order 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 a thorough examination can allow us to provide you with the best options for your particular case.

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.
• Disease.
• Infection.
• Tooth Crowding.

Extractions

There are many forms of dental treatment which can be used to save a tooth, including root canal therapy, crowns, and fillings. However, there are still some situations where it is necessary to extract one or more teeth to achieve better oral health and comfort.

In certain specific instances it may be optimum to remove the tooth rather than attempt another course of treatment:

Wisdom Teeth

When a person enters their later teenage years, additional teeth start to grow in at the back of their mouths, one on each side of the upper and lower jaw. In most cases, the jaw bone is not large enough to accommodate these additional teeth. Thus, when they do start to come in they often need to be removed. This is definitely not every case – some people retain their wisdom teeth all their lives. However, if the wisdom teeth begin to provide discomfort, the simplest handling is to remove them.

Impacted Teeth

An impacted tooth is one which remains fully or partially below the surface of the gums as it grows in. Such teeth can become infected and push against other teeth, creating inflammation or infections. Impacted teeth are removed for the overall health of the patient and to relieve the pain from the swelling and inflammation.

Crowded Teeth

There are times where teeth are too tightly crowded in a person’s mouth, and removing a tooth may simply make it easier to straighten or align the teeth. This would be done in combination with orthodontic treatment.

Non-Restorable Teeth

When teeth have severe bone loss or are severely decayed or broken in a way that cannot be repaired removing the tooth entirely may be the best treatment.

Health Concerns

We may also recommend a tooth be extracted simply for health purposes. If a tooth has severely decayed and becomes infected, it may be in the patient’s best interest to remove it entirely and have it replaced with a dental implant or a bridge.

Bruxism

Bruxism refers to an oral parafunctional activity which occurs in most humans at some point in their lives. The grinding of the teeth and the clenching of the jaw are the two main characteristics of this condition, which can occur either during the day or at night.

Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours. The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping. For sufferers, deep sleep or even naps, cause the reflex nerve control center in the brain to turn off, and the reflex pathways to become active.
Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally. This side to side action puts undue strain on the muscles and joints of the face and jaw. Ear ache, depression, headaches, eating disorders and anxiety are amongst the most common symptoms of bruxism; which often accompanies chronic stress, Alzheimer’s disease.

Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear. Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks and abrasive foods.

Here are some of the main reasons why bruxism should be promptly treated:

• Gum recession and tooth loss.
• Occlusal trauma.
• Arthritis.
• Myofascial pain – The grinding associated with bruxism can eventually shorten and blunt the teeth. This can lead to muscle pain in the myofascial region and debilitating headaches.

Treatment options

There is no single cure for bruxism, though a variety of helpful devices and tools are available including mouth guards. An acrylic mouth guard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep. Mouth guards should be worn on a long-term basis to help prevent tooth damage, damage to the temporomandibular joint and help to stabilize the occlusion.
Other methods of treatment include relaxation exercises, stress management education and biofeedback mechanisms. When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts and crown lengthening that can restore a pleasant aesthetic appearance to the smile.
Please ask us if you have questions or concerns about bruxism.