Oral Surgeon Orange County: Oral and Maxillofacial Surgical Procedures

Wisdom teeth, or third molars, are the teeth located at the back of the mouth. These teeth are the last to erupt. They usually appear between the ages of 17 to 25; although, they appear much later in some cases.As they erupt at a later stage in a person’s life, there is no adequate space in the mouth for them to grow on. Thus, they end up growing improperly and becoming impacted. When left untreated, impacted teeth cause damage to nearby teeth, infection and even cysts or tumors.

In some cases, even if wisdom teeth are not impacted, they are still extracted as a preventative measure or a solution to symptoms such as persistent swelling and pain as well as decay or infection. In some cases, these molars are removed to prevent teeth overcrowding.Much like other procedures, prior to the extraction of the tooth, a thorough evaluation of the wisdom and surrounding teeth is done. In this process, x-rays will be taken to allow the surgeon to carefully study the tooth as well as determine if current or potential problems exist. To minimize the risks associated with this procedure, it is greatly recommended that wisdom teeth be taken out as early as possible.

This procedure is typically performed under local anesthesia and rarely requires an overnight stay. Prior to the release of the patient, post-operative care instructions will be given to ensure quick healing. In some cases, pain medications are prescribed to minimize the pain and swelling.

The All-On-Four TM procedure is an innovative method enabling patients to replace all their teeth on the upper or lower jaw with a complete set of functional teeth in a single procedure. The functional teeth are supported by four dental implants. This procedure is geared towards making tooth replacement more accurate, more efficient and minimally invasive. Furthermore, as this procedure enables patient to have a customized and natural-looking teeth, it is highly recommended for patients struggling due to loose-fitting conventional dentures.This is an alternative to traditional dental implants. It is recommended for patients who lack bone mass. With this procedure, oral surgeons are able to place dental implants without patients having to undergo extensive bone grafting. In the All-On-Four procedure, the removal of damaged teeth and the placement of dental implants can be done at the same time. Consequently, this results in lesser number of procedures and quicker healing time.Prior to performing the procedure, patients undergo a consultation and a comprehensive evaluation which includes x-rays. Also, impressions will be taken as these are necessary in the creation of the customized dentures.

On the day of the procedure, with the patient under anesthesia and sedation, the All-On-Four TM procedure is performed starting with the removal of any remaining teeth and followed by the placement of 4 dental implants. Then, the insertion of the new teeth is done. Once complete healing takes place and the implants have integrated with the natural bone, impressions will be taken and a new, stronger set of permanent teeth will be placed.Recovery time ranges from five to ten days. After the procedure, there may be bruising and swelling. These are expected to go away in a few days.

Dental implants are also used to resolve joint pain and bite problems brought about by the shifting of teeth into missing tooth space. They also help enhance or restore facial tissues. Getting implants involves several visits to the clinics and spans several months. The first step is basically a consultation which aims to determine whether the patient is a suitable candidate for implants. This thorough examination involves taking x-rays and impressions. The next step is the surgical procedure performed with the help of anesthetics. Here, the implant is placed into the jawbone, specifically on the site of the missing tooth. After the surgery, for three to six months, the implant bonds or integrates with the jawbone.

This is followed by the second phase where small “post” is placed to hold the artificial tooth in place. Then, the artificial tooth is attached to the post.To ensure that the dental implants last a lifetime, good oral hygiene and care instructions (provided by the surgeon) should be strictly followed by the patient. Regular dental visits are also integral in ensuring the success of the implants.

Hemisection is a procedure which aims to salvage half of a tooth. It involves cutting the tooth into half with one half having a root. Meanwhile, root amputation is the surgical removal of a root from a multi-rooted tooth such as the molars. Both of these procedures are performed in cases wherein at least one root is healthy or free of decay.These procedures, performed by an oral surgeon, begin with the exposure of deeper tooth structures. This is done with the surgeon creating a small incision on the gums.

For hemisection, the tooth is cut into two; the diseased half gets discarded while the healthy half is kept. For root amputation, removal of the diseased root/roots is done. Next, the treated tooth or area is cleaned thoroughly. Then, the incision is closed with sutures. A temporary filling is then placed to seal the crown and secure the tooth. Once full healing takes place, restoration of the tooth is done.

Apicoectomy is one of the most common endodontic surgical procedures. It is performed in cases wherein infection or inflammation persists even after a root canal treatment or retreatment. The goal of this procedure is to treat the abscess or infection to preserve the tooth’s function as well as save it from extraction. Furthermore, having an infected or inflamed soft tissue surrounding the root of a tooth can be extremely painful. Hence, this procedure provides relief from this pain. Performed under anesthetics, apicoectomy involves the opening of the gum tissue for the surgeon to view the bone. At times, a small portion of the jawbone is removed to better expose the root.

Then, the infected or inflamed tissue and portion of the tooth’s root are removed. This is followed by sealing of the root canal with a filling material. Lastly, the gum is stitched back into place. Apicoectomy rarely requires an overnight stay. Much like other oral surgical procedures, pain and swelling are expected after the procedure. These can all be managed with the aid of medications. Full healing is expected to take place in a few months.

A frenectomy is an oral surgical procedure meant to remove frenum that is causing a problem. The frenum pertains to a fold of tissue in the mouth, like in between the upper two front teeth, under the tongue and on the sides of the gums. The frenum actually serves no vital purpose; hence, its removal doesn’t result in any loss of function in the mouth.There are many reasons why a frenectomy becomes necessary. One of these reasons is tongue tied or ankyloglossia. This is a case wherein a tight frenum under tongue hampers or limits the tongue’s movement. In other cases, the frenum prevents the permanent upper front teeth from coming out or causes a gap between these teeth.

This happens when the frenum is attached between the upper front teeth. Also, at times, a frenum prevents dentures from fitting properly. This typically happens on the sides of the upper or lower jaw.A thorough assessment is done for the dentist to evaluate if the condition may eventually get fixed even without surgery. If frenectomy is necessary, the dentist refers the patient to an oral and maxillofacial surgeon. The procedure is performed under anesthesia. Depending on the surgeon, a scalpel or a laser may be used to remove the frenum. A frenectomy lasts for about 10 to 15 minutes.

Soft tissue grafting is performed to add more tissue in some areas in the mouth. This procedure is done to enhance the appearance of a tooth, cover an exposed root, prevent further gum recession and stop the sensitivity in an affected area.

Gingivectomy and gingivoplasty are procedures meant to address problems involving gingivitis or periodontal disease. Gingivitis is a disease involving the inflammation of the gum tissue around the teeth. Caused by bacteria, gum disease may result in periodontitis when left untreated.

In gingivectomy, diseased or excess gum tissue and periodontitis-causing bacteria are surgically removed. On the other hand, gingivoplasty is an adjunctive procedure serving a cosmetic or functional purpose. Performed following a gingivectomy, gingivoplasty is the surgical reshaping of the tissues of the gum.

Crown lengthening is a surgical procedure which aims to expose more of the natural teeth by reshaping the bone or gum tissue. It is performed as a preparation for restorative procedures, particularly to ensure that a considerable portion of the tooth’s structure is exposed to securely hold the crown. Crown lengthening also serves an esthetic purpose in that it improves a “gummy smile”.

In this procedure, a small portion of the gum tissue around the teeth is removed. In some cases, removal of a small amount of bone may also be necessary to fully expose the teeth. Then, the gum is sutured into a new position – one that allows sufficient tooth exposure. As this procedure is performed with local anesthetic, patients do not have to worry about discomfort or pain during the procedure. The surgical site usually heals in about two to three months.

Bone grafting is a procedure which aims to replace lost bone tissue and promote the natural bone growth. Bones atrophy or shrink due to gum disease, previous extractions and injuries. One reason why bone grafting is performed is to strengthen and thicken an implant site.

This is necessary for implants to be stable or to be anchored firmly and to avoid the failure of implants. This procedure is also done to repair jaw defects brought about by tumor surgery, congenital defects or traumatic injuries.

A sinus lift is a type of bone grafting procedure performed on patients exhibiting bone loss on the upper jaw. For these patients, this procedure is a necessary prerequisite to a dental implant procedure. Basically, a sinus lift ensures the success and longevity of the dental implant.In this procedure, bone is grown on the floor of the maxillary sinus, just above the bony ridge of the gum which holds the teeth of the upper jaw. Following the growth of the bone in the maxillary sinus, dental implants can be placed securely on the new bone growth.As mentioned, sinus lift is for patients with significant amount of bone loss on the upper jaw. It is also recommended for those with a missing tooth in the back or upper jaw, those missing most of their upper teeth and those missing their teeth because of defects or conditions. Moreover, this procedure is a better alternative for patients who previously only had the option of wearing loose dentures (due to their condition).

A simple sinus lift procedure begins with the exposure of the jawbone. This is achieved by creating a small incision on the molars. Then, a small opening is made on the bone and the membrane lining the sinus is pushed outward. The opening or space is filled with bone grafting material (which may come from your own body, an animal or made from synthetic materials). Once the bone grafting material is placed, the incision is closed with sutures. Complete healing happens after several months when the bone integrates with the jaw. When this happens, the dental implants can now be placed.

Orthognathic surgery, or corrective jaw surgery, addresses cases involving minor and major skeletal and dental irregularities, particularly those that result in improper bite or misaligned jaws. Usually, these cases are corrected with orthodontics; however, there are cases wherein surgical correction is necessary. Simply put, corrective jaw or othognathic surgery is a procedure which aims to correct improperly positioned jaws. With this surgical procedure, facial appearance improves; the teeth also end up meeting correctly and functioning properly.Why is this procedure necessary? Orthognathic surgery is essential in that it helps eliminate problems brought about by having an improperly positioned jaw. Some of these problems are: difficulty closing lips comfortably, difficulty biting, chewing or swallowing and receding chin. Misaligned jaws also cause speech and breathing problems. It is also cited as a factor in sleep apnea, a condition involving breathing problems while sleeping.

In this kind of procedure, the regular dentist, orthodontist and oral and maxillofacial surgeon (OMS) work hand in hand to ensure the success of the treatment. Depending on the problem (open bite, protruding open jaw or receding open jaw), the OMS identifies the appropriate surgical procedure and performs the surgery. It is important to note that completely correcting the problem may entail several phases of orthodontic treatment and restorative surgery. Hence, the complete treatment process may take several years.

Oral and maxillofacial pathology involves diagnosing and treating diseases concerning the oral activity and adjacent areas of the head and neck like benign and malignant lesions. What situations prompt an oral pathology consultation? Changes in the appearance of the mucosa, a special type of skin lining the mouth, are warning signs of a possible pathological process or cancerous growth. These changes include: sore that bleeds easily and never heals, reddish or whitish patches in the mouth, lump or thickening of the mucosa, difficulty chewing or swallowing and chronic hoarseness or sore throat. Oftentimes, these changes in the oral region can be disfiguring and uncomfortable; however, they are rarely life threatening. Yet, it is important that proper examination be done to determine the cause of these symptoms, especially given the rise in the incidence of oral cancer.

Oral cancer refers to any type of cancer concerning the lower cheek area, tongue and jaw. It is generally treatable, especially when detected early. Fact is, as per the American Cancer Society, the five-year survivable rate for most oral cancers (which haven’t spread yet) is at 75% or higher. This is why it is greatly important to see an oral surgeon once the patient (or the dentist) notices suspicious changes in your mouth. It is important to note, however, that, sometimes, the aforementioned symptoms are due to other pathological problems and not oral cancer just like geographic tongue, hairy tongue and median palatal cyst.During an oral pathology consultation or oral cancer screening, the area or tissue in question undergoes thorough inspection. The dentist or hygienist, with the aid of a laser light, assesses the soft tissue for cellular changes indicative of oral cancer. Should changes be noted, a biopsy will be required; this means the surgeon will need to remove a small amount of tissue which will be sent in a laboratory for analysis. The result of the biopsy determines the next course of action. If the result indicates a malignant tissue, staging will be done before a treatment plan is made. In cases involving highly localized cancer, the tumor or lesion is, at times, removed in an outpatient setting. This is performed with the patient under local anesthesia and sedation. Meanwhile, more complicated or extensive cancer requires treatment in a specialized treatment facility.

Oral cancer screening should be done at least once a year. Furthermore, self-examination is greatly encouraged as it is an essential tool in catching oral cancer early. Everyone should regularly inspect their tongue, gums, lips and lymph nodes around the neck and jaw. These practices, though simple, can be life-saving!

Temporomandibular joint disorder (TMJ) affects the temporomandibular joint, located in front of the ear where the skull and lower jaw meet, jaw muscles and facial nerves. It affects an estimated 10 million Americans. It is also noted to be more prevalent in women than in men.In some cases, symptoms of TMJ disorder are just limited to the jaw joint. These symptoms include pain and clicking or popping of the jaw, limited jaw movement and lockjaw. As the condition progresses, patients may also feel persistent headache and pain in the jaw, neck and face. This disorder likewise affects oral health in that it may result in chipped teeth, receding gums and chronic clenching and grinding of the teeth. Suffice to say, this disorder, with its symptoms and side-effects, can negatively impact one’s way of living. Hence, it needs to be treated.To properly treat TMJ disorder, the source of the problem needs to be determined first. The diagnosis of TMJ disorder is complex; it requires the expertise of an oral and maxillofacial surgeon (OSM). Oftentimes, the practice is to initially recommend the most conservative treatment option.

This treatment option usually involves conservative therapy and/or orthodontic treatment. In conservative therapy, the focus is on allowing the body to heal naturally. This non-surgical method typically employs relaxation techniques, stress management counseling, anti-inflammatory medications and/or splint therapy. In some cases, TMJ disorder is resolved with the aid of orthodontic treatments and restorative procedures.Meanwhile, if the condition persists even after conservative approaches, surgical procedures are recommended. Surgical treatment of TMJ disorder may involve repairing damaged tissue or arthroscopy, a method similar to orthopedic procedures utilized in the inspection and treatment of larger joints like the knee.

Oral and maxillofacial surgeons are usually called on to treat injuries which result in displaced or knocked out tooth or fractures in the supporting bone. In cases involving a knocked out tooth, it is essential to re-insert the tooth in an hour or two. Doing the procedure at a later time deliberately decreases the chances of successfully putting back the tooth in place. It is also important for the knocked out tooth to be handled properly. To ensure its survival, it should be placed in a glass of milk. Other dental specialists like endodontists and restorative dentists may be called in to aid in the re-insertion process and ensure the success of the procedure. If the knocked tooth cannot be re-inserted, using dental implants is the next alternative.

Maxillofacial traumas may be the result of vehicular accidents, sports injuries, accidental falls and interpersonal violence among others. These traumas may range from teeth injuries to severe facial skin and bone injuries. Listed below are the different classifications of maxillofacial injuries and how they are usually treated.

Ridge modification is a procedure that involves the treatment of upper and lower jaw deformities. Periodontal diseases, injuries, wearing dentures, traums or developmental problems are some of the causes of the jaw deformity. This defect poses problems for dental implant placement. In addition, it may result in an unappealing indentation in the jaw line close to the missing teeth which can be challenging to clean. Generally, ridge modification is performed to improve the function and appearance of the mouth. Also, it increases the chances of success of the dental implants.

In ridge modification, the defect is exposed by lifting the gum away from the ridge. This is followed by the filling of the defect with bone grafting materials. This is basically done to regenerate lost bone. Then, the incision is closed. After a few months (4 to 12 months), when the area is fully healed, the dental implant will be placed. In some cases though, the implant is placed during the ridge modification procedure.

Bone injuries usually involve fractures. Treating maxillofacial bone injuries is similar to treating other bones in the body. In determining the best treatment option for the injury, factors such as the patient’s age and general health, location of the fracture and severity of the injury are taken into consideration.Just like fractures in other body parts, facial fractures also need to be stabilized. In fractures of the upper and/or lower jaw, this is done by wiring the jaws together. Meanwhile, other types of jaw fractures are best stabilized with the aid of small plates and screws which are surgically placed.

When it comes to bone injuries in the maxillofacial region, the goal of the treatment or procedure is not just to treat the injury but to address the problem without causing major changes in the patient’s facial appearance. This is why, in these procedures, the number of incisions is kept to a minimum as much as possible. Moreover, the incisions made are usually small to make them inconspicuous when they heal.

Soft tissue injuries are injuries involving the facial skin, gum, lip and tongue. Injuries (typically lacerations) involving these areas are treated with sutures. Here at 7 Day Dental, our specialists take extreme caution to ensure that the suturing procedure leads to the best cosmetic outcome.

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