Introduction
Oral and Maxillofacial Surgeons care for patients with problem wisdom teeth, facial pain, and misaligned jaws. They treat accident victims suffering facial injuries, place dental implants, care for patients with oral cancer, tumors and cysts of the jaws, and perform facial cosmetic surgery. Their advanced training in anesthesia allows them to provide quality care with maximum patient comfort and safety in the office setting.
Treatment and Procedures
Among the conditions and symptoms treated by oral and maxillofacial surgeons are:
- Diagnosis and management of impacted teeth, tooth extraction and dentoalveolar surgery;
- Facial pain, including problems related to issues relating to temporomandibular joint disease;
- Diagnosis and treatment of oral cancers. Patients are encouraged to perform routine oral exams and to see their general dentist or an oral and maxillofacial surgeon annually for a professional examination.
- Pathologies in the maxillofacial region, including the performance of biopsies and other diagnostic tests and procedures required to diagnose the problem and develop an appropriate treatment plan;
- Diagnosis and treatment of obstructive sleep apnea, a condition affecting approximately 45% of the US population in which breathing ceases for a brief period of time. Often characterized by loud and frequent snoring, obstructive sleep apnea can lead to excessive daytime sleepiness, poor work performance and such cardiovascular disorders as hypertension, arrhythmias and congestive heart failure.
The oral and maxillofacial surgery residency enables oral and maxillofacial surgeons to perform a wide variety of procedures in both an office setting and a hospital environment. These four to six year residencies incorporate extensive training in anesthesia administration, including local anesthesia, nitrous oxide, intravenous sedation and general anesthesia, all of which the surgeon can appropriately, competently and safely administer in the oral and maxillofacial surgery office to meet the unique requirements of the patient and the procedure. Office-based surgery is often the most efficient and cost effective way to perform many procedures while maintaining maximum patient comfort and safety. Oral and maxillofacial surgeons are trained to perform the following treatments and procedures:
-
Reconstructive surgery to address hard and soft tissue injuries in the upper and/or lower jaws resulting from injury or trauma, tumor surgery or long-term denture wear.
-
Dental implant placement to replace a single tooth, several teeth or an entire mouthful of teeth. Dental implants offer a long-lasting, comfortable and functional alternative to conventional dentures.
-
Diagnosis and treatment of infections in the maxillofacial region, which can develop into life-threatening emergencies if not treated promptly and effectively.
-
Treatment and repair of injuries to the face, jaws, mouth and teeth caused by trauma. Oral and maxillofacial surgeons are experts in treating trauma, including fractures of the upper and lower jaws and orbits, and the cosmetic management of facial lacerations.
-
Surgical correction of oral and facial deformities caused by differences in skeletal growth between the upper and lower jaws; and congenital deformities like cleft lip and palate, which occur when all or a portion of the oral-nasal cavity does not grow together during fetal development.
-
Their surgical and dental background and their ability to reconstruct facial structures damaged through trauma, enable oral and maxillofacial surgeons to perform facial cosmetic procedures on an outpatient basis in the oral and maxillofacial surgeon’s office under local anesthesia, IV sedation or general anesthesia.
Dental Implants
Did you know that dental implants are frequently the best treatment option for replacing missing teeth? Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone.
A Solution of Choice for Replacing Missing Teeth
Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.
Twenty years ago, these patients would have had no alternative but to employ a fixed bridge or removable denture to restore their ability to eat, speak clearly and smile. Fixed bridges and removable dentures, however, are not the perfect solution and often bring with them a number of other problems. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking. Of even greater concern, fixed bridges often affect adjacent healthy teeth, and removable dentures may lead to bone loss in the area where the tooth or teeth are missing. Recurrent decay, periodontal (gum) disease and other factors often doom fixed bridgework to early failure. For these reasons, fixed bridges and removable dentures usually need to be replaced every seven to 15 years.
Before (left) and after a dental implant
Today there is another option for patients who are missing permanent teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your 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 never slip or make embarrassing noises that advertise the fact that you have “false teeth,” and never decay like teeth anchoring fixed bridges. Because dental implants fuse with the jawbone, bone loss is generally not a problem.
After more than 20 years of service, the vast majority of dental implants first placed by oral and maxillofacial surgeons in the United States continue to still function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice. If properly cared for, dental implants can last a lifetime.
Anatomy of a Dental Implant
A dental implant designed to replace a single tooth is composed of three parts: the titanium implant that fuses with the jawbone; the abutment, which fits over the portion of the implant that protrudes from the gum line; and the crown, which is created by a prosthodontist or restorative dentist and fitted onto the abutment for a natural appearance.
Many people who are missing a single tooth opt for a fixed bridge; but a bridge may require the cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime. Similarly, a removable partial denture may contribute to the loss of adjacent teeth. Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture.
Fixed bridges may require the shaping or cutting down of adjacent healthy teeth.
Bone is maintained by the presence of natural teeth or implants (a). Bone loss occurs with the loss of teeth (b).
Further, conventional dentures may contribute to the loss of bone in the area where teeth are missing. As illustration (a) indicates, the presence of natural teeth preserves the jawbone. When a tooth is missing, as in illustration (b), the bone may erode and weaken until it may be necessary for your oral and maxillofacial surgeon to graft bone to the area to strengthen it for placement of a dental implant. When a missing tooth is replaced by a dental implant, the fusion, or osseointegration, of the implant and bone provides stability, just as the natural tooth did.
If you are missing several teeth in the same area of your mouth, you may still enjoy the confidence and lifestyle benefits that come with dental implants. Your oral and maxillofacial surgeon will place two or more dental implants, depending on the number of teeth that are missing. Your replacement teeth will be attached to the implants to allow excellent function and prevent bone loss. The implants will serve as a stable support that tightly locks into your replacement teeth and dentures to prevent slipping and bone loss.
With an overall success rate of about 95% and almost 50 years of clinical research to back them up, dental implants are frequently the best treatment option for replacing missing teeth.
Dental Implants vs. Conventional Dentures
Implants can be used to replace one missing tooth so that the replacement looks and feels natural (a). Also, two or more implants can serve as a stable support for the replacement of many teeth (b).
Many patients who have selected dental implants describe a quality of life that is much more comfortable and secure than the lifestyle endured by those with fixed bridges or removable dentures. Dentures often make a person feel and look older than they are, cause embarrassment in social situations when they slip and click, and restrict the everyday pleasure of eating comfortably.
When they count the benefits they enjoy as a result of their dental implants, patients say their implants eliminate the day-to-day frustrations and discomfort of ill-fitting dentures. They allow people to enjoy a healthy and varied diet without the restrictions many denture wearers face. With a sense of renewed self-confidence, many people rediscover the excitement of an active lifestyle shared with family and friends and the chance to speak clearly and comfortably with co-workers. For all these reasons, people with dental implants often say they feel better… they look better… they live better.
Dental Implantation is a Team Effort
Dental implants combine the best of modern science and technology, including a team approach spanning several disciplines. A successful implant requires that all parties involved — the patient; the restorative dentist, who makes the crown for the implant; and the oral and maxillofacial surgeon, who surgically places the implant, follow a careful plan of treatment. All members of the implant team stay in close contact with each other to make sure everyone clearly understands what needs to be done to meet the patient’s expectations.
The team is organized as soon as the decision for placing a dental implant is reached. Following an evaluation that includes a comprehensive examination, x-rays and a consultation with the patient and members of the implant team, the oral and maxillofacial surgeon surgically places the posts, or implants, in the patient’s jaw.
When the implants have stabilized in the jaw, the restorative dentist prepares an impression of the upper and lower jaws. This impression is used to make the model from which the dentures or crowns are created.
The teamwork continues long after the implant and crown have been placed. Follow-up examinations with the oral and maxillofacial surgeon and restorative dentist are critical, and progress is carefully charted. Both the oral and maxillofacial surgeon and the restorative dentist continue to work together to provide the highest level of aftercare.
Are You a Candidate for Dental Implants?
Whether you are a young, middle-aged or older adult; whether you need to replace one tooth, several teeth, or all your teeth, there is a dental implant solution for you. With the exception of growing children, dental implants are the solution of choice for people of all ages, even those with the following health concerns:
Existing Medical Conditions. If you can have routine dental treatment, you can generally have an implant placed. While precautions are advisable for certain conditions, patients with such chronic diseases as high blood pressure and diabetes are usually successful candidates for dental implant treatment.
Gum Disease or Problem Teeth. Almost all implants placed in patients who have lost their teeth to periodontal disease or decay have been successful.
Currently Wearing Partials or Dentures. Implants can replace removable bridges or dentures, or they can be used to stabilize and secure the denture, making it much more comfortable.
Smokers. Although smoking lowers the success rate of implants, it doesn’t eliminate the possibility of getting them.
Bone Loss. Bone loss is not uncommon for people who have lost teeth or had periodontal disease. Oral and maxillofacial surgeons are trained and experienced in grafting bone to safely and permanently secure the implant.
Implant tooth replacement in children is usually deferred until their jaw growth is complete. There are, however, some instances when a dental implant may be appropriate, such as when it is part of the child’s orthodontic treatment plan. Your family dentist or orthodontist can guide you in this instance.
Corrective Jaw Surgery
Corrective jaw, or 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, which, in turn, can improve chewing, speaking and breathing. While the patient’s appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems.
Following are some of the conditions that may indicate the need for corrective jaw surgery:
- 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 or birth defects
- receding chin
- protruding jaw
- inability to make the lips meet without straining
- chronic mouth breathing and dry mouth
- sleep apnea (breathing problems when sleeping, including snoring)
Who Needs Corrective Jaw Surgery?
People who may benefit from corrective jaw surgery include those with an improper bite resulting from misaligned teeth and/or jaws. In some cases, the upper and lower jaws may grow at different rates. Injuries and birth defects may also affect jaw alignment. While orthodontics can usually correct bite, or “occlusion,” problems when only the teeth are misaligned, corrective jaw surgery may be necessary to correct misalignment of the jaws.
Evaluating Your Need for Corrective Jaw Surgery
Your dentist, orthodontist and Oral and Maxillofacial Surgeon will work together to determine whether you are a candidate for corrective jaw, or orthognathic, surgery. The Oral and Maxillofacial Surgeon determines which corrective jaw surgical procedure is appropriate and performs the actual surgery. It is important to understand that your treatment, which will probably include orthodontics before and after surgery, may take several years to complete. Your Oral and Maxillofacial Surgeon and orthodontist understand that this is a long-term commitment for you and your family.They will try to realistically estimate the time required for your treatment.
Corrective jaw surgery may reposition all or part of the upper jaw, lower jaw and chin. When you are fully informed about your case and your treatment options, you and your dental team will determine the course of treatment that is best for you.
What Is Involved in Corrective Jaw Surgery?
Before your surgery, orthodontic braces move the teeth into a new position. Because your teeth are being moved into a position that will fit together after surgery, you may at first think your bite is getting worse rather than better. When your Oral and Maxillofacial Surgeon repositions your jaws during surgery, however, your teeth should fit together properly.
As your pre-surgical orthodontic treatment nears completion, additional or updated records, including x-rays, pictures and models of your teeth, may be taken to help guide your surgery.
Depending on the procedure, corrective jaw surgery may be performed under general anesthesia in a hospital, an ambulatory surgical center or in the oral and maxillofacial surgery office. Surgery may take from one to several hours to complete.
Your Oral and Maxillofacial Surgeon will reposition the jawbones in accordance with your specific needs. In some cases, bone may be added, taken away or reshaped. Surgical plates, screws, wires and rubber bands may be used to hold your jaws in their new positions. Incisions are usually made inside the mouth to reduce visible scarring; however, some cases do require small incisions outside of the mouth. When this is necessary, care is taken to minimize their appearance.
After surgery, your surgeon will provide instructions for a modified diet, which may include solids and liquids, as well as a schedule for transitioning to a normal diet. You may also be asked to refrain from using tobacco products and avoid strenuous physical activity.
Pain following corrective jaw surgery is easily controlled with medication and patients are generally able to return to work or school from one to three weeks after surgery, depending on how they are feeling. While the initial healing phase is about six weeks, complete healing of the jaws takes between nine and 12 months.
Enjoy the Benefits
Corrective jaw surgery moves your teeth and jaws into positions that are more balanced, functional and healthy. Although the goal of this surgery is to improve your bite and function, some patients also experience enhancements to their appearance and speech. The results of corrective jaw surgery can have a dramatic and positive effect on many aspects of your life. So make the most of the new you!
Treating and Preventing Facial Injury
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 911 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.
Oral and Maxillofacial Surgeons Treat 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.
Don’t Treat Any Facial Injury Lightly
While not all facial injuries are extensive, they are all complex since they affect an area of the body that is critical to breathing, eating, speaking and seeing. Even in the case of a moderately cut lip, the expertise of the oral and maxillofacial surgeon is indispensable. If sutures are needed, placement must be precise to bring about the desired cosmetic result. So a good rule of thumb is not to take any facial injury lightly.
Prevention — The Best Policy
Because avoiding injury is always best, oral and maxillofacial surgeons advocate the use of automobile seat belts, protective mouth guards, and appropriate masks and helmets for everyone who participates in athletic pursuits at any level. You don’t have to play at the professional level to sustain a serious head injury. New innovations in helmet and mouth and face guard technology have made these devices comfortable to wear and very effective in protecting the vulnerable maxillofacial area. Make sure your family is well-protected. If you play the sport, make the following safety gear part of your standard athletic equipment.
Football: Helmets with face guards and mouth guards should be worn. Many of the helmets manufactured for younger players have plastic face guards that can be bent back into the face and cause injury. These should be replaced by carbon steel wire guards.
Baseball: A catcher should always wear a mask. Batting helmets with a clear molded plastic face guard are now available; these can also be worn while fielding.
Ice Hockey: Many ice hockey players are beginning to wear cage-like face guards attached to their helmets. These are superior to the hard plastic face masks worn by some goalies, as the face guard and the helmet take the pressure of a blow instead of the face. For extra protection, both face and mouth guards — including external mouth guards made of hard plastic and secured with straps — can be worn.
Wrestling: More and more high school athletic associations require wrestlers to wear head gear. A strap with a chin cup holds the gear in place and helps steady the jaw. Recently, face masks have been developed for wrestlers, who should also wear mouth guards.
Boxing: Mouth guards are mandatory in this sport. A new pacifier-like mouth guard for boxers has been designed with a thicker front, including air holes to aid breathing.
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.
There are five criteria to consider when being fitted for a mouth protector. The device should be:
- fitted so that it does not misalign the jaw and throw off the bite;
- lightweight;
- strong;
- easy to clean; and
- should cover the upper and/or lower teeth and gums.
By encouraging sports enthusiasts at every level of play to wear mouth guards and other protective equipment, oral and maxillofacial surgeons hope to help change the “face” of sports.
In the event a facial or mouth injury occurs that requires a trip to the emergency room, the injured athlete, his parent or coach should be sure to ask that an oral and maxillofacial surgeon is called for consultation. With their background and training, oral and maxillofacial surgeons are the specialists most qualified to deal with these types of injuries. In some cases, they may even detect a “hidden” injury that might otherwise go unnoticed.
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.
Common Procedures
Cosmetic Chin Surgery
Before
After*
Cosmetic Ear Surgery
Before
After
Facelift & Forehead Brow Lift
Before
After
Nasal Reconstruction
Before
After*
* procedures done in conjunction with corrective jaw surgery
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 eyelids, 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 mini facelift 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.
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.
Conclusion :Facing the Facts
Facial cosmetic surgery may refine, enhance and/or rejuvenate existing features. It will not give you a new face or a new life. How much or how little change is realized depends on the individual and the extent of the surgical procedure. Your age, health, skin texture, bone structure, healing capacity and personal habits, such as smoking or alcohol consumption, are all factors that may affect the results of your surgery.
Each procedure outlined here entails a reasonable recovery period during which you may experience some swelling, bruising and discomfort. These are part of the normal healing process.
If you are interested in learning more about these procedures and determining whether you are a candidate for cosmetic surgery, please schedule a consultation with your oral and maxillofacial surgeon.
Ref: The American Association of Oral and Maxillofacial Surgeons (AAOMS)
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation.
