Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom". Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn't leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.
What is an Impacted Tooth?
A tooth becomes impacted when there is a lack of space in the dental arch and its growth and eruption are prevented by overlying gum, bone or another tooth.A tooth may be partially impacted, which means a portion of it has broken through the gum, or totally impacted and unable to break through the gum at all.
How Serious is an Impacted Tooth?
Impacted and partially impacted teeth can be painful and lead to infection.They may also crowd or damage adjacent teeth or roots. More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.
What Happens During Surgery?
Before surgery, your Oral and Maxillofacial Surgeon will discuss with you what to expect. This is a good time to ask questions or express your concerns. It is especially important to let the doctor know about any illness you have and medications you are taking. The relative ease with which a wisdom tooth may be removed depends on several conditions, including the position of the tooth and root development. Partially or totally impacted wisdom teeth may require a more involved surgical procedure.
Despite the considerable concern regarding impacted third molars, a recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation finds that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those third molars that remain impacted.
Must the Tooth Come Out if it Hasn't Caused Any Problems Yet?
Not all problems related to third molars are painful or visible. Damage can occur without your being aware of it. As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, partially or totally impacted wisdom teeth are more likely to cause problems as patients age. No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. It is estimated that about 85% of third molars will eventually need to be removed.
When Should I Have My Wisdom Teeth Removed?
It isn't wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process.The AAOMS/OMSF study strongly recommends that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing.The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.
Most wisdom tooth extractions are performed in the oral and maxillofacial surgery office under local anesthesia, intravenous sedation or general anesthesia.Your Oral and Maxillofacial Surgeon will discuss the anesthetic option that is right for you.
What Happens after Surgery?
Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by your Oral and Maxillofacial Surgeon can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.
Because the mouth is a region where changes can be easily seen, oral cancer can be detected in its early stages. Performing a selfexamination regularly will help in the early recognition and detection of oral cancer, and increase the chance for cure.
Factors That May Cause Cancer
Research has identified a number of factors that may contribute to the development of oral cancer.The most common are the use of tobacco and alcohol. Others include poor oral hygiene, irritation caused by ill-fitting dentures and rough surfaces on teeth, poor nutrition, some chronic infections and combinations of these factors. Studies have shown that the death rate from oral cancer is about four times higher for cigarette smokers than for nonsmokers. It is also widely believed in the medical field that the heat generated by smoking pipes and cigars irritates the mouth and can lead to lip cancer. Those at an especially high risk of developing oral cancer are over 40 years of age, heavy drinkers and smokers, or users of smokeless tobacco, including snuff. Perform a Self-Exam Monthly Oral and Maxillofacial Surgeons recommend that everyone perform an oral cancer self-exam each month. If you are at high risk for oral cancer - smoker, consumer of alcohol, user of smokeless tobacco, or snuff - you should see your general dentist or Oral and Maxillofacial Surgeon for an annual exam. Early Detection and Treatment Provide a Better Chance for Cure.
An oral examination is performed using a bright light and a mirror:
- 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 an oral cancer 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
See your Oral and Maxillofacial Surgeon if you have any of these signs. If the Oral and Maxillofacial Surgeon agrees that something looks suspicious, a biopsy may be recommended. A biopsy involves the removal of a piece of the suspicious tissue, which is then sent to a pathology laboratory for a microscopic examination that will accurately diagnose the problem. The biopsy report not only helps establish a diagnosis, but also enables the doctor to develop a specific plan of treatment.
The temporomandibular joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet. It permits the lower jaw (mandible) to move and function. TMJ disorders are not uncommon and have a variety of symptoms. Patients may complain of earaches, headaches and limited ability to open their mouth. They may also complain of clicking or grating sounds in the joint and feel pain when opening and closing their mouth. What must be determined, of course, is the cause.
What Causes TMJ Disorders?
Determining the cause of a TMJ problem is important, because it is the cause that guides the treatment. Arthritis is one cause of TMJ symptoms. It can result from an injury or from grinding the teeth at night. Another common cause involves displacement or dislocation of the disk that is located between the jawbone and the socket. A displaced disk may produce clicking or popping sounds, limit jaw movement and cause pain when opening and closing the mouth. The disk can also develop a hole or perforation, which can produce a grating sound with joint movement.There are also conditions such as trauma or rheumatoid arthritis that can cause the parts of the TMJ to fuse, preventing jaw movement altogether.
The Joint, the Muscles or Both are the Problem
Stress may trigger pain in the jaw muscles that is very similar to that caused by TMJ problems. Affected patients frequently clench or grind their teeth at night causing painful spasms in the muscles and difficulty in moving the jaw. Patients may also experience a combination of muscle and joint problems.That is why diagnosing TMJ disorders can be complex and may require different diagnostic procedures.
The Role of the Oral and Maxillofacial Surgeon
When symptoms of TMJ trouble appear, an Oral and Maxillofacial Surgeon should be consulted. A specialist in the areas of the mouth, teeth and jaws, the Oral and Maxillofacial Surgeon is in a good position to correctly diagnose the problem. Special imaging studies of the joints may be ordered and appropriate referral to other dental or medical specialists or a physical therapist may be made.
Range of Possible Treatment
TMJ treatment may range from conservative dental and medical care to complex surgery. Depending on the diagnosis, treatment may include short-term non-steroidal anti-inflammatory drugs for pain and muscle relaxation, bite plate or splint therapy, and even stress management counseling. Generally, if non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated. Surgery can involve either arthroscopy (the method identical to the orthopaedic procedures used to inspect and treat larger joints such as the knee) or repair of damaged tissue by a direct surgical approach. Once TMJ disorders are correctly diagnosed, appropriate treatment can be provided.
Maxillofacial injuries, also referred to as facial trauma, encompass any injury to the mouth, face and jaw. Almost everyone has experienced such an injury, or knows someone who has. Most maxillofacial injuries are caused by a sports mishap, motor vehicle accident, on-the-job accident, act of violence or an accident in the home. If a person is unconscious, disoriented, nauseated, dizzy or otherwise incapacitated, call 112 immediately. Do not attempt to move the individual yourself. If these symptoms are not present but the injury is severe or you are uncertain about its severity, take the person to the nearest hospital emergency room as quickly as possible.
Injuries to Teeth, Mouth, Jaws and Facial Structures
At the hospital, the individual will most likely be seen by several medical personnel, one of whom will probably be an Oral and Maxillofacial Surgeon. Oral and Maxillofacial Surgeons, the surgical specialists of the dental profession, are specifically trained to repair injuries to the mouth, face and jaws. After four years of dental school, Oral and Maxillofacial Surgeons complete four or more years of hospital-based surgical residency training that may include rotations through related medical fields, including internal medicine, general surgery, anesthesiology, otolaryngology, plastic surgery, emergency medicine and other medical specialty areas. At the conclusion of this demanding program, Oral and Maxillofacial Surgeons are well-prepared to perform the full scope of the specialty, which includes emergency care for the teeth, mouth, jaws, and associated facial structures.
Treating Facial Injury
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 and combinations of these bones.These injuries can affect sight and the ability to breathe, speak and swallow. Treatment often requires hospitalization. The principles for treating facial fractures are the same as for a broken arm or leg. The parts of the bone must be lined up (reduced) and held in position long enough to permit them time to heal.This may require six or more weeks depending on the patient's age and the fracture's complexity. When maxillofacial fractures are complex or extensive, multiple incisions to expose the bones and a combination of wiring or plating techniques may be needed.The repositioning technique used by the Oral and Maxillofacial Surgeon depends upon the location and severity of the fracture. In the case of a break in the upper or lower jaw, for example, metal braces may be fastened to the teeth and rubber bands or wires used to hold the jaws together.
Patients with few or no teeth may need dentures or specially constructed splints to align and secure the fracture. Often, patients who sustain facial fractures have other medical problems as well. The Oral and Maxillofacial Surgeon is trained to coordinate his or her treatment with that of other doctors. During the healing period when jaws are wired shut, the Oral and Maxillofacial Surgeon prescribes a nutritional liquid or pureed diet, which will help the healing process by keeping the patient in good health. After discharge from the hospital, the doctor gives the patient instructions on continued facial and oral care.
Lacrosse: Hard plastic helmets resembling baseball batting helmets, with wire cage face masks, are manufactured for this sport.
Field Hockey: Oral and Maxillofacial Surgeons recommend that athletes participating in this sport wear mouth guards. Goalies can receive extra protection by wearing Lacrosse helmets.
Soccer: Soccer players should wear mouth guards for protection. Oral and Maxillofacial Surgeons advise goalies to also wear helmets.
Biking: All riders should wear lightweight bike helmets to protect their heads.
Scooters and Skateboarders: Bike helmets are also recommended for those who ride two-wheeled scooters and skateboards.
Skiing and Snowboarding: The recent surge in accidents among skiers and snowboarders has encouraged many safety conscious participants to wear lightweight helmets that will protect the maxillofacial area in the event of a fall or crash.
Horseback Riding: A helmet and mouth guard are recommended for horseback riding, particularly if the rider is traveling cross-country or plans to jump the horse.
Basketball, Water Polo, Handball, Rugby, Karate, Judo, and Gymnastics: Participants in these sports should be fitted with mouth guards.
A Word about Mouth Guards
New synthetic materials and advances in engineering and design have produced mouth guards that are sturdier yet lightweight enough to allow the wearer to breathe easily. Mouth guards can vary from the inexpensive "boil and bite" models to custom-fabricated guards made by dentists, which can be adapted to the sport and are generally more comfortable. A mouth protector should be evaluated from the standpoint of retention, comfort, ability to speak and breathe, tear resistance and protection provided to the teeth, gums and lips.
Jaw growth is a slow and gradual process. Occasionally, something may go wrong with this process and the upper and lower jaws may grow at different rates.
Unequal jaw growth - a cause for concern
One or both jaws may grow too much or too little. The resulting abnormality may interfere with proper teeth alignment, speaking and chewing. The tongue and lips may be forced to move awkwardly during speech and swallowing in an attempt to compensate for the jaw malrelationship. There may be a speech defect or excessive mouth breathing. An improper bite may threaten the long-term health of the gums and teeth. The jaw joint (TMJ) can also be adversely affected by a jaw malrelationship. In addition, jaws of different sizes that don't match can affect appearance.
When unequal jaw growth is the source of the problem, corrective jaw surgery may be necessary. Orthodontic treatment (braces or other appliances) may also be needed to allow the teeth to align properly. Corrective jaw surgery involves moving all or part of the upper and/or lower jaw into a more favorable position. For example, the entire jaw can be moved backward if it's too large. The goal of treatment is to improve function and restore facial balance.
Some people have facial abnormalities involving just the upper face, cheek bones and nose. These can also be surgically corrected. The bones are repositioned so the facial features are more symmetrical. This is usually accompanied by the return of normal breathing, speaking and eating patterns. After the jaws are moved into their new position, rubber bands or wires attached to the teeth may be used to fasten the jaws together during healing. Alternatively, rigid internal fixation with miniature screws and plates may be used to allow you to open and close your jaws sooner after corrective surgery.
Take a closer look
Take a closer look at your bite and appearance. Does your chin stick out? Does it recede? Do your teeth fit together properly? Do you have "buck" teeth? Are your teeth straight? If you suspect there's cause for concern, have your oral and maxillofacial surgeon examine your face and bite.
FACIAL COSMETIC SURGERY
Facial cosmetic surgery has long been the solution of choice for the correction of physical malformations resulting from aging, disease, injury and birth defects. In recent years, however, a growing number of men and women of all ages are choosing facial cosmetic surgery to improve their appearance and reduce the signs of aging.
Is Cosmetic Surgery for You?
Thanks to the development of advanced medical devices and biomaterials, many of today's facial cosmetic procedures are 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. Because of their surgical and dental background, Oral and Maxillofacial Surgeons are uniquely qualified to perform cosmetic procedures that involve the functional and aesthetic aspects of the face, mouth, teeth and jaws. Extensive education and training in surgical procedures involving soft tissue (skin and muscle) and hard tissue (bone and cartilage) finely attune the Oral and Maxillofacial Surgeon to the need for harmony between facial appearance and function. Following are some of the procedures available to you.Your Oral and Maxillofacial Surgeon may perform other surgeries not listed here. Make an appointment to discuss your personal situation.
Nasal Reconstruction (Rhinoplasty) can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip.
Cheekbone Implants (Malar Augmentation) create the appearance of higher, more prominent cheekbones and better facial balance.
Chin Surgery (Genioplasty) increases or reduces the length and projection of the chin.
Ear Surgery (Otoplasty) is usually done to set prominent ears back closer to the head, or to change the shape or reduce the size of large ears.
Eyelid Surgery (Blepharoplasty) removes fat and excess skin from the upper and lower yelids, and can be done alone or in conjunction with other facial surgery procedures such as a
facelift or browlift.
Facelift (Rhytidectomy) provides a more youthful appearance by tightening facial skin, muscles and removing excess skin. A minifacelift is a minimally invasive technique involving only small incisions.
Facial and Neck Liposuction can help sculpt the face by removing excess fat. Neck liposuction is often performed in conjunction with such procedures as genioplasty and corrective jaw surgery.
Forehead/Brow Lift is often done in conjunction with blepharoplasty to improve brow positioning, minimize frown lines and reduce forehead wrinkles.
Lip Enhancement can reshape the upper and lower lip to give a more aesthetic or youthful appearance. Augmentation of the lips is accomplished using various materials that help "plump" the lips, creating fullness and decreasing vertical lines.
Several techniques exist for treating skin that is wrinkled, scarred or otherwise damaged.The amount of improvement varies and depends upon the initial condition of the patient's skin and the procedure. Botox® Injections can reduce the signs of aging by reducing the muscle activity and wrinkles of the eyebrow and forehead. It is especially effective in reducing frown lines.
Chemical Peel involves the application of a solution that causes the wrinkled or damaged top layers of skin to peel, revealing new, healthier skin after healing.There are several types of chemical peels: a light peel to remove superficial wrinkles, a medium depth peel, and a deep peel for more severe conditions. Dermabrasion smoothes surface irregularities to produce a more uniform appearance. Laser Through the use of a special laser, the outer layers of the damaged or wrinkled skin are removed.The new skin appears healthier and smoother, giving a rejuvenated, more youthful appearance.
Injectable Fillers (Restylane®, Collagen, etc.) are synthetic or naturally occurring materials that are placed with small needles to plump wrinkles, furrows or grooves in the skin.The results are instantaneous although the duration varies with the material chosen.