Oral & Maxillofacial Surgeries

Oral & Maxillofacial Surgeons are specialists with advanced training and expertise in the diagnosis and treatment of various head and neck conditions and injuries. After four years of dental school, an Oral & Maxillofacial Surgeon completes four to six years of additional formal training in treating the craniomaxillofacial complex. This specialty is one of 9 dental specialties recognized internationally and by the American Dental Association (ADA).

An Oral Maxillofacial Surgeon can diagnose and treat a wide variety conditions. The following are just some of the many conditions, treatments and procedures oral and maxillofacial surgeon deal with on a daily basis:

 

  • Dental Implants
  • Bone Graft & Sinus Lift
  • Tooth Extractions & Impacted Teeth
  • Wisdom Teeth
  • Misaligned Jaws
  • Apicoectomy
  • Tumors, Cysts, & Biopsies
  • Sleep Apnea
  • TMJ, Facial Pain

Whether your dentist refers you to Arcadia Medi-Dental Group, you have pain or symptoms causing you concern, or you simply have questions you would like answered, please contact Arcadia Medi-Dental Group today at (626) 515-8090 to schedule an appointment. We are here to answer your questions and provide the treatment you deserve!

Bone grafting is often closely associated with dental restorations such as bridge work and dental implants. In the majority of cases, the success of a restoration procedure can hinge on the height, depth, and width of the jawbone at the implant site. When the jawbone has receded or sustained significant damage, the implant(s) cannot be supported on this unstable foundation and bone grafting is usually recommended for the ensuing restoration.

 

There are several major factors that affect jaw bone volume:

  • Periodontal Disease – Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
  • Tooth Extraction – Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following three years. Loss of bone results in what is called a “bone defect”.
  • Injuries and Infections – Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.

 

Reasons for bone grafts

Bone grafting is a highly successful procedure in most cases. It is lso a preferable alternative to having missing teeth, diseased teeth, or tooth deformities. Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone.

There are essentially two basic ways in which bone grafting can positively impact the health and stability of the teeth:

Jaw Stabilization – Bone grafting stabilizes and helps restore the jaw foundation for restorative or implant surgery. Deformities can also be corrected and the restructuring of the bone can provide added support.

Preservation – Bone grafting can be used to limit or prevent bone recession following a tooth extraction, periodontal disease, or other invasive processes.

Oral Examination

Initially, the dentist will thoroughly examine the affected area in order to assess the general condition of the teeth and gums. If periodontal disease is present or the adjacent teeth are in poor condition, these factors will be fully addressed before the bone grafting procedure can begin. The dentist will also recommend panoramic x-rays in order to assess the precise depth and width of the existing bone. On occasion, a CAT scan may be recommended to determine the bone condition. Depending on these results, the dentist may also anesthetize the area and explore into the gum in order to determine what kind and how much bone is required.

There are several types of bone grafts. Your dentist will determine the best type for your particular condition.

Autogenous Bone Graft – Harvested from the patient’s own body (usually from the posterior part of the lower jaw or the chin). This method is usually preferred because it produces the most predictable results.

Allograft Bone Graft – Cadaver or synthetic bone is used in this type of graft.

Xenograft – Cow bone is used in this type of graft.

The bone grafting procedure can often take several months to complete. Bone is typically harvested from your own body (or on rare occasions obtained from a “bone bank”) and added to the affected site. This bone will fuse with the existing bone and the migration of cells will cause firm adhesion and cell growth. Supplementing the jaw with bone will result in greater bone mass to help support and anchor the implant(s).

During the surgery, the dentist will numb the grafting and extraction sites using local anesthetic. A small incision will be made to prepare the site for the new bone and it will be anchored into place. On occasion, a synthetic membrane may be used to cover the new bone. This membrane prevents soft tissue and bacterial invasions, and encourages new bone growth. The surgery does not require an overnight stay, and you will be provided with comprehensive instructions for your post-operative care. A dentist, such as Dr. Natalie, will prescribe medications to help manage infection, discomfort and swelling.

TMJ – the temporomandibular joint – is located in front of your ear where the skull and lower jaw meet.

The TMJ is the most constantly used joint in the body. It allows your lower jaw to move and function.

Symptoms may include:

 

  • Difficulty opening and closing the mouth
  • Jaw and cheekbone pain
  • Pain or a tired jaw when eating
  • Earaches or ringing in the ears
  • Headaches
  • Popping or clicking sounds when opening and closing the mouth
  • Changes in bite
  • Pain behind the eye
  • Problems moving the jaw side to side or forward
  • Pain when touching the TMJ area or jaw muscles
If the TMJ is impaired, a condition called Temporomandibular Disorder (TMD)results.

 

 
 

Diagnosing TMJ disorders can be complex and may require different diagnostic procedures.

If non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be needed.

Treatments may include:

 

  • Short-term use of non-steroidal anti-inflammatory drugs for pain and/or muscle relaxation
  • Bite plate or splint therapy
  • Stress management counseling

 What to expect when you have wisdom tooth surgery

Before Surgery

  • Your surgeon will discuss the procedure and tell you what to expect.
  • Wear loose, comfortable clothing with short sleeves or sleeves that can be rolled up.
  • Check with your surgeon if you can eat or drink anything in the hours before your surgery.
  • Arrange for someone to accompany you on the day of surgery.
 

After Surgery

  • Do follow your surgeon’s post-surgical instructions.
  • Do use an icepack during the first 24 hours to help reduce swelling.
  • Do apply moist heat if your jaw is sore and you are unable to open your mouth as wide as usual after the first 48-72 hours.
  • Do eat soft foods and drink fluids during the first two days.
  • Do take it easy, knowing you can resume normal activities within a relatively short period of time.
  • Do be sure to avoid disturbing blood clots when brushing your teeth.
  • Don’t use a straw for at least 24 hours. The pressure created by the suction may dislodge blood clots.
  • Don’t rinse your mouth vigorously until clotting is complete. Your surgeon may recommend gentle salt water rinses to aid healing.
  • Don’t smoke. It may disturb blood clots and healing.
  • You may be prescribed medications to help with discomfort
Follow these instructions properly, and promptly discard any leftover medications.

 

When to contact your surgeon
If there is excessive bleeding or any other concerning symptoms after you return home, contact your oral and maxillofacial surgeon immediately for instructions.
 

What Is Sedation Dentistry?

Sedation dentistry uses medication to help patients relax during dental procedures. It’s sometimes referred to as “sleep dentistry,” although that’s not entirely accurate. Patients are usually awake with the exception of those who are under general anesthesia.

The levels of sedation used include:

  • Minimal sedation — you are awake but relaxed.
  • Moderate sedation (formerly called “conscious sedation”) — you may slur your words when speaking and not remember much of the procedure.
  • Deep sedation — you are on the edge of consciousness but can still be awakened.
  • General anesthesia — you are completely unconscious.

What Types of Sedation Are Used in Dentistry?

The following types of sedation are used in dentistry:

  • Inhaled minimal sedation. You breathe nitrous oxide — otherwise known as “laughing gas” — combined with oxygen through a mask that’s placed over your nose. The gas helps you relax. Your dentist can control the amount of sedation you receive, and the gas tends to wear off quickly. This is the only form of sedation where you may be able to drive yourself home after the procedure.
  • Oral sedation. Depending on the total dose given, oral sedation can range from minimal to moderate. For minimal sedation, you take a pill. Typically, the pill is Halcion, which is a member of the same drug family as Valium, and it’s usually taken about an hour before the procedure. The pill will make you drowsy, although you’ll still be awake. A larger dose may be given to produce moderate sedation. This is the type of anesthesia most commonly associated with sedation dentistry. Some people become groggy enough from moderate oral sedation to actually fall asleep during the procedure. They usually can, though, be awakened with a gentle shake.
  • IV moderate sedation. You receive the sedative drug through a vein, so it goes to work more quickly. This method allows the dentist to continually adjust the level of sedation.
  • Deep sedation and general anesthesia. You will get medications that will make you either almost unconscious or totally unconscious — deeply asleep — during the procedure. While you are under general anesthesia, you cannot easily be awakened until the effects of the anesthesia wear off or are reversed with medication.

Regardless of which type of sedation you receive, you’ll also typically need a local anesthetic — numbing medication at the site where the dentist is working in the mouth — to relieve pain if the procedure causes any discomfort.