Extractions & Preservation
Nonsurgical extractions
There are times when it is necessary to remove a tooth. Sometimes a baby tooth has misshapen or long roots that prevent it from falling out as it should, and the tooth must be removed to make way for the permanent tooth to erupt. At other times, a tooth may have so much decay that it puts the surrounding teeth and jaw at risk of decay, so your doctor may recommend removal and replacement with a bridge or implant. Infection, orthodontic correction, or problems with a wisdom tooth can also require removal of a tooth.
When it is determined that a tooth needs to be removed, your dentist may extract the tooth during a regular checkup or may schedule another visit for this procedure. The root of each tooth is encased within your jawbone in a "tooth socket," and your tooth is held in that socket by a ligament. In order to extract a tooth, your dentist must expand the socket and separate the tooth from the ligament holding it in place. While this procedure is typically very quick, it is important to share with your doctor any concerns or preferences for sedation.
Once a tooth has been removed, neighboring teeth may shift, causing problems with chewing or with your jaw joint function. To avoid these complications, your dentist may recommend that you replace the extracted tooth.
Oral Surgery
Oral and maxillofacial surgery is used to correct a wide spectrum of diseases, injuries, and defects in the head, neck, face, jaws, and the hard and soft tissues of the oral and maxillofacial region. A recognized international surgical specialty, it is also one of the specialties of dentistry recognized by the American Dental Association.
Oral Surgeons: Changing Lives with a Smile
Oral and maxillofacial surgeons are the only dental specialists who, after completing dental school, are surgically trained in an American Dental Association-accredited hospital-based residency program for a minimum of four years. They train alongside medical residents in internal medicine, general surgery, and anesthesiology; and also spend time in otolaryngology (ear, nose, and throat), plastic surgery, emergency medicine, and other specialty areas.
Their training focuses almost exclusively on the hard and soft tissue of the face, mouth, and jaws, and their knowledge and surgical expertise uniquely qualify them to diagnose and treat functional and aesthetic issues in this part of the body.
Conditions and Treatments
Your oral and maxillofacial surgeon has many years of education and hands-on training to provide treatment for a wide range of conditions.
Corrective Jaw Surgery
Corrective jaw or orthognathic surgery may reposition the upper jaw, lower jaw, and chin to correct minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. This can improve chewing, speaking, and breathing. Difficulty chewing or biting food, excessive wear of teeth, a receding chin, a protruding jaw, or sleep apnea may indicate a need for corrective jaw surgery.
Wisdom Teeth
Wisdom teeth are the last set of teeth to develop. Sometimes they emerge from the gum line, and the jaw is large enough to allow room for them, but more often than not, they fail to appear and become impacted. When a wisdom tooth is impacted, it may need to be removed.
Impacted wisdom teeth that are partially or fully erupted tend to be quite difficult to clean and are susceptible to tooth decay, recurring infections, and even gum disease. The American Association of Oral and Maxillofacial Surgeons strongly recommends that wisdom teeth be removed by the time a patient is a young adult in order to prevent future problems and to ensure optimal healing.
Cleft Palate
Cleft lip and cleft palate result when all or portions of the mouth and nasal cavity do not grow together properly during fetal development. The result is a gap in the lip or a split in the opening in the roof of the mouth.
Until it is treated with surgery, a cleft palate can cause problems with feeding, speech, and hearing. Oral and maxillofacial surgeons work as part of a team of healthcare specialists to correct these problems through a series of treatments and surgical procedures over many years.
Facial Trauma
Maxillofacial injuries or facial trauma encompass any injury to the mouth, face, and jaw. One of the most common types of serious injury to the face occurs when bones are broken. Fractures can involve the lower jaw, upper jaw, palate, cheekbones, eye sockets, or combinations of these bones.
These injuries can affect sight and the ability to breathe, speak, and swallow. Because of this, the expertise of the oral and maxillofacial surgeon is indispensable. Avoiding injury is always best, so it’s vital for anyone who participates in athletics, at any level, to use seat belts, protective mouthguards, and appropriate masks and helmets.
Temporomandibular Joint Surgery
The temporomandibular joint (TMJ) is located in front of the ear where the skull and lower jaw meet. It allows the lower jaw to move and function. If you experience jaw pain, earaches, headaches, a limited ability to open or close your mouth, clicking, or grating sounds, you may have Temporomandibular Disorder (TMD).
TMJ treatment may range from conservative dental and medical care to complex surgery. If non-surgical treatment is unsuccessful or there is clear joint damage, surgery may be indicated, which can involve either arthroscopy or repair of damaged tissue by a direct surgical approach.
Oral Cancer
Oral and maxillofacial surgeons recommend that everyone perform an oral cancer self-exam each month. If you notice white or red patches, an abnormal lump, chronic sore throat or hoarseness, or difficulty chewing or swallowing, you should contact your oral and maxillofacial surgeon. He or she will remove a section of tissue to perform a biopsy and diagnose the problem.
Implants
Dental implants are long-term replacements for missing teeth that an oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that fuses with the jawbone through a process called osseointegration, dental implants do not slip or decay. Because dental implants fuse with the jawbone, bone loss is generally not a problem.
Outpatient Anesthesia
Oral and maxillofacial surgeons possess the ability to provide patients with safe, effective outpatient anesthesia, including local anesthesia, nitrous oxide, IV sedation, and general anesthesia. During their surgical residency, residents must complete a rotation on the medical anesthesiology service, where they become competent in evaluating patients for anesthesia, delivering the anesthetic, and monitoring post-anesthetic patients.
Bone Grafting
Also called regenerative surgery, a bone graft is used to recreate bone and soft supporting tissues lost due to periodontitis. If you have periodontitis, you may be losing bone support around your teeth, and in order to avoid extractions, your periodontist may recommend regrowing the lost bone with a graft.
The goal of bone grafting is to encourage the body to rebuild the bone and other structures that attach a tooth to the jaw. First, your periodontist will separate the gums from your teeth in order to gain access to the roots and bone. The roots will be thoroughly cleaned, and the holes in the bone will be filled with a graft material that usually consists of your own bone. After this process is completed, your periodontist will put the gums back in place and stitch them together. Over the next few months, the grafted material will be encouraged to grow, which will fill in for lost bone and soft tissue.
Ridge Augmentation
A common use of bone grafting is for ridge augmentation. Ridge augmentation can recapture the natural contour of your gums and jaw after the loss of a tooth as a result of trauma, congenital anomalies, infection, or periodontal disease. Achieving an ideal amount of gum and bone as a support to surrounding restorations or implants may require hard and soft tissue reconstruction. After the loss of one or more teeth, your gums and jawbone may become indented where the tooth or teeth used to be. This occurs because the jawbone recedes when it no longer is holding a tooth in place. Not only is this indentation unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth, and this can create an area that is difficult to keep clean.
Ridge augmentation uses bone and tissue-grafting procedures to fill in the indented area of the jaw and gums, leaving you with a smooth gum line that coexists with your restoration or dental implant.
Root Canals
In the past, if you had a tooth with a diseased nerve, you would probably lose that tooth. Today, with a special dental procedure called root canal treatment, your tooth can be saved. Root canals are a relatively simple procedure involving one to three office visits. Best of all, having a root canal when necessary can save your tooth and your smile!
What is the purpose of a root canal?
A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory – to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
When a tooth is cracked or has a deep cavity, bacteria can enter the pulp tissue and germs can cause an infection inside the tooth. If left untreated, an abscess may form. If the infected tissue is not removed, pain and swelling can result. This can not only injure your jawbones, but it is detrimental to your overall health. Without the proper treatment, your tooth may have to be removed.
What are the signs that a root canal is needed?
Teeth that require root canal therapy are not always painful. However, signs you may need a root canal include severe toothache, pain upon chewing or application of pressure, prolonged sensitivity or pain in response to hot and cold temperatures, a dark discoloration of the tooth, and swelling and tenderness in the nearby gums. If you experience any of these symptoms, contact your doctor.
What happens during a root canal?
Root canal treatment involves one to three visits. During treatment, your general dentist or endodontist (a dentist who specializes in problems with the nerves of the teeth) removes the affected tissue. Next, the interior of the tooth will be cleaned and sealed. Finally, the tooth is filled with a dental composite. If your tooth had extensive decay, your doctor may suggest placing a crown to strengthen and protect the tooth from breakage. As long as you continue to care for your teeth and gums with regular brushing, flossing, and checkups, your restored tooth can last a lifetime.