Wisdom Teeth

Removal of Third Molars (Wisdom Teeth) and Other Problem Teeth

Wisdom teeth, or third molars, are the last teeth to develop and appear in your mouth. They come in between the ages of 17 and 25, a time of life that has been called the “Age of Wisdom.”

Wisdom teeth may not need to be extracted if they grow in completely and are functional, painless, cavity-free, disease-free and in a hygienic environment with healthy gum tissue. They do, however, require regular, professional cleaning, annual check-ups and periodic X-rays to monitor for any changes.

A tooth that doesn’t grow into the mouth completely or that is unable to break through the gums because there isn’t enough room is said to be “impacted.” An impacted wisdom tooth can damage neighboring teeth or become infected. Because it’s in an area that’s hard to clean, it can also invite bacteria that lead to gum (periodontal) disease. The oral bacteria that causes periodontal disease may also travel through the bloodstream and lead to infections and illnesses that affect the heart, kidneys and other organs.

In some cases, a cyst or tumor can form around the base of the impacted tooth. This may lead to more serious problems as the cyst can hollow out the jaw and damage surrounding nerves, teeth and other parts of the mouth and face.

Generally, wisdom teeth should be surgically removed when there are:

  • Infections and/or periodontal disease
  • Cavities that can’t be restored
  • Cysts, tumors or other pathologies
  • Damage to neighboring teeth

Dental Implants

More and more people are choosing dental implants as their best treatment option for replacing diseased or missing teeth. Your oral and maxillofacial surgeon is well-trained to surgically place the implant in your jawbone, where it will look and perform just like your natural teeth. Unlike fixed bridges or removable dentures, dental implants will not affect neighboring healthy teeth or lead to bone loss in the jaw. Most patients experience minimal if no disruption in their normal daily schedule with either surgery.  Even better, they regain the ability to eat virtually anything and can smile with confidence.

Dental implant surgery is, of course, surgery, and is best done by a trained surgeon. Your oral and maxillofacial surgeon has the specialized education and training in the complexities of the bone, skin, muscles and nerves involved, to assure you get the best possible results. Studies suggest that patients enjoy greater implant success rates when the surgery is performed by a dental specialist.​

If properly cared for, dental implants can last a lifetime.

Outcomes of implants and restorations placed in general dentist practices: A retrospective study by the Practitioners Engaged in Applied Research and Learning (PEARL) Network; Da Silva JD, Kazimiroff J, Papas A, Curro FA, Thompson VP, Vena DA, Wu H, Collie D, Craig RG; JADA 2014;145(7):704-713 10.14219/jada.2014.27

Corrective Jaw Surgery

Corrective Jaw surgery, also called orthognathic surgery, is performed by oral and maxillofacial surgeons to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. Some of the conditions where corrective jaw surgery may be helpful include:

  • Difficulty chewing, or biting food
  • Difficulty swallowing
  • Chronic jaw or jaw joint (TMJ) pain and headache
  • Excessive wear of the teeth
  • Open bite (space between the upper and lower teeth when the mouth is closed)
  • Unbalanced facial appearance from the front, or side
  • Facial injury
  • Birth defects
  • Receding lower jaw and chin
  • Protruding jaw
  • Inability to make the lips meet without straining
  • Chronic mouth breathing
  • Sleep apnea (breathing problems when sleeping, including snoring)

If corrective jaw surgery is appropriate for you, your oral and maxillofacial surgeon will work closely with your orthodontist and general dentist to develop a comprehensive plan that will realign your teeth and jaws, and improve your ability to breathe, eat and speak. Corrective jaw surgery and subsequent treatment may take several years to complete. Your oral and maxillofacial surgeon, orthodontist and general dentist understand that this is a long-term commitment for you and your family and will try to realistically estimate the time required for your treatment.

Oral, Head and Neck Cancer

Your oral and maxillofacial surgeon (OMS) is the expert for diagnosing and surgically treating cancer of the head, neck and mouth.

The inside of the mouth is normally lined with a special type of skin called mucosa. Healthy mucosa is smooth and pinkish-red in appearance. Changes in the appearance of the lips, cheeks, palate, and gum tissue around the teeth, tongue, face and/or neck should be reported to your dentist or oral and maxillofacial surgeon as they may be a warning sign for a disease process. The most serious of these is oral cancer.

While your family dentist or oral and maxillofacial surgeon will screen for oral cancers of other oral issues during your routine exams, it is important that you perform a monthly self-examination each month. Using a mirror and bright light:

  • Remove any dentures
  • Look and feel inside the lips and the front of gums
  • Tilt head back to inspect and feel the roof of your mouth
  • Pull the cheek out to see its inside surface as well as the back of the gums
  • Pull out your tongue and look at all of its surfaces
  • Feel for lumps or enlarged lymph nodes (glands) in both sides of the neck including under the lower jaw

When performing a self-examination, look for the following:

  • White patches of the oral tissues — leukoplakia
  • Red patches — erythroplakia
  • Red and white patches — erythroleukoplakia
  • A sore that fails to heal and bleeds easily
  • An abnormal lump or thickening of the tissues of the mouth
  • Chronic sore throat or hoarseness
  • Difficulty in chewing or swallowing
  • A mass or lump in the neck

Your mouth is one of your body’s most important early warning systems. Don’t ignore any suspicious lumps or sores. If you discover something, make an appointment for a prompt examination. Early treatment may well be the key to complete recovery.

Facial Trauma

Oral and maxillofacial surgeons are experts in treating and repairing facial injury and trauma, including fractures of the upper and lower jaws and the orbits surrounding the eyes, and facial lacerations. Their knowledge of how jaws come together (dental occlusion) is critical when repairing complex facial fractures, and their extensive soft tissue training, make them well qualified for the cosmetic management of facial surgeries.

The American College of Surgeons’ guidelines for optimal care in Levels I and II trauma centers, the centers that treat the most serious and complex facial trauma patients, recommend that an oral and maxillofacial surgeon be included as a member of the centers’ trauma team.

Many of the techniques that are standard in today’s hospital emergency rooms were developed by OMSs in combat hospitals during World War II, Korea, Vietnam and today’s international conflicts.

If you or a loved one suffer a facial or mouth injury that requires a trip to the emergency room, be sure to ask that an OMS is called for consultation. With their background and training, OMSs are the specialists most qualified to deal with these types of injuries. In some cases, they may detect an injury that might otherwise go unnoticed.

TMJ & Facial Pain

The temporomandibular joint (TMJ) is located in front of the ear where the skull and lower jaw meet. It permits the lower jaw to move and function.
TMJ disorders are not uncommon and may exhibit a variety of symptoms, such as earaches, headaches and limited ability to open the mouth. Diagnosing TMJ disorders can be complex and may require diagnostic procedures that include special imaging studies of the joints and appropriate referral to other dental or medical specialists.

Treatments for TMJ may range from conservative dental and medical care to complex surgery. Depending on the diagnosis, these may include short-term non-steroidal anti-inflammatory drugs for pain and muscle relaxation, bite plate or splint therapy, and even stress management counseling. If non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated.

Once TMJ disorders are correctly diagnosed, your oral and maxillofacial surgeon can provide appropriate treatment to relieve the problem.

Facial Reconstructive & Esthetic Surgery

Thanks to their surgical and dental background, oral and maxillofacial surgeons (OMSs) are uniquely qualified to perform cosmetic procedures involving. Oral and maxillofacial surgeons are extensively trained in surgical procedures involving skin, muscle, bone and cartilage that affect the functional and aesthetic aspects of the face, mouth, teeth and jaws. They have a profound understanding of the need for harmony between facial appearance and function. Following are some of the procedures that oral and maxillofacial surgeons may provide:

  • Cheekbone Implants
  • Chin Surgery
  • Ear Surgery
  • Eyelid Surgery
  • Facelift
  • Facial and Neck Liposuction
  • Forehead/Brow Lift
  • Lip Enhancement
  • Nasal Reconstruction
  • Skin Treatments
  • Botox® Injections
  • Chemical Peel
  • Dermabrasion
  • Laser Treatment
  • Injectable Fillers (Restylane®, Collagen, etc.)

With the development of advanced medical devices and biomaterials, many of these facial cosmetic procedures are now minimally invasive and can be performed in an office setting using local and/or intravenous anesthesia. Some procedures may require use of an outpatient or same day surgery center or hospital.

The information provided here is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is provided to help you communicate effectively when you seek the advice of your oral and maxillofacial surgeon.

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