Oral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is a recognized international surgical specialty, and it is one of the nine specialties of dentistry recognized by the American Dental Association.
Oral Surgeons: Changing Lives with a Smile
Oral and maxillofacial surgeons are the only recognized dental specialists who, after completing dental school, are surgically trained in an American Dental Association-accredited hospital-based residency program for a minimum of four years. They train alongside medical residents in internal medicine, general surgery and anesthesiology and also spend time in otolaryngology (ear, nose and throat), plastic surgery, emergency medicine and other specialty areas. Their training focuses almost exclusively on the hard and soft tissue of the face, mouth and jaws, and their knowledge and surgical expertise uniquely qualify them to diagnose and treat the functional and esthetic conditions in this part of the body.
Conditions and Treatments
Your oral and maxillofacial surgeon has many years of education and hands-on training to provide treatment for a wide range of conditions.
Corrective Jaw Surgery
Corrective jaw or orthognathic surgery is performed in which the upper jaw, lower jaw and chin may be repositioned to correct minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth which can improve chewing, speaking and breathing. Difficulty chewing or biting food, excessive wear of teeth, a receding chin, a protruding jaw or sleep apnea may indicate the need for corrective jaw surgery.
Wisdom teeth are the last set of teeth to develop. Sometimes they emerge from the gum line, and the jaw is large enough to allow room for them, but more often than not, they fail to emerge and become impacted. When a wisdom tooth is impacted, it may need to be removed. Impacted wisdom teeth that are partially or fully erupted tend to be quite difficult to clean and are susceptible to tooth decay, recurring infections and even gum disease. The American Association of Oral and Maxillofacial Surgeons 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.
Cleft lip and cleft palate result when all or portions of the mouth and nasal cavity do not grow together properly during fetal development. The result is a gap in the lip or a split in the opening in the roof of the mouth. Until it is treated with surgery, a cleft palate can cause problems with feeding, speech and hearing. Oral and maxillofacial surgeons work as part of a team of health care specialists to correct these problems through a series of treatments and surgical procedures over many years.
Maxillofacial injuries or facial trauma encompass any injury to the mouth, face and jaw. 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 or combinations of these bones. These injuries can affect sight and the ability to breathe, speak and swallow. Because of this, the expertise of the oral and maxillofacial surgeon is indispensable. Avoiding injury is always best, so it is extremely important to use seat belts, protective mouth guards and appropriate masks and helmets for everyone who participates in athletic pursuits at any level.
Temporomandibular Joint Surgery
The temporomandibular joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet and allows the lower jaw to move and function. If you experience jaw pain, earaches, headaches, a limited ability to open or close your mouth, clicking or grating sounds, you may have Temporomandibular Disorder (TMD). TMJ treatment may range from conservative dental and medical care to complex surgery. If non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated which can involve either arthroscopy or repair of damaged tissue by a direct surgical approach.
Oral and maxillofacial surgeons recommend that everyone perform an oral cancer self-exam each month. If you notice white or red patches, an abnormal lump, chronic sore throat or hoarseness or difficulty chewing or swallowing, you should contact your oral and maxillofacial surgeon. They will remove a section of tissue to perform a biopsy and accurately diagnose the problem.
Dental implants are long-term replacements for missing teeth 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 and never decay. Because dental implants fuse with the jawbone, bone loss is generally not a problem.
Oral and maxillofacial surgeons have the ability to provide patients with safe, effective outpatient anesthesia including local anesthesia, nitrous oxide, IV sedation and general anesthesia. During their surgical residency, residents must complete a rotation on the medical anesthesiology service where they become competent in evaluating patients for anesthesia, delivering the anesthetic and monitoring post-anesthetic patients.
Traumatic Dental Injuries
While most traumatic dental injuries occur in children and teenagers, people of all ages can be affected, usually as a result of sports mishaps, automobile accidents, or bad falls. If you've experienced a traumatic dental injury it is important to visit your endodontist in order to determine any necessary treatment. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam.
Chipped or Fractured Teeth
Chipped teeth account for the majority of dental injuries. Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or "cap" may be needed to restore the tooth.
Injuries in the back teeth often include fractured cusps, cracked teeth, or a more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction.
Dislodged (Luxated) Teeth
During an injury, a tooth may be pushed sideways out of or into its socket. Your endodontist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury.
Children between seven and 12 years old may not need root canal treatment, since teeth are still developing. For those patients, your endodontist will monitor the healing carefully and intervene immediately if any unfavorable changes appear.
Knocked-Out (Avulsed) Teeth
If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently, avoiding touching the root surface itself. If it is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, the tooth should be placed back into its socket as soon as possible. The less time the tooth is out of its socket, the better the chance for saving it.
Once the tooth has been put back in its socket, your endodontist will evaluate it and will check for any other dental or facial injuries. If the tooth has not been placed back into its socket, your endodontist will clean it carefully and replace it. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your endodontist may start root canal treatment a week or two later.
A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. The closer the fracture is to the gum line, the poorer the long-term success rate. Stabilization with a splint is sometimes required for a period of time.
Traumatic Dental Injuries in Children
Chipped primary (baby) teeth can be aesthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted. This is because the replantation of a primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.
Children's permanent teeth that are not fully developed at the time of the injury need special attention and careful follow-up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your endodontist to stimulate continued root growth.
Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your endodontist to have the tooth examined or treated at regular intervals to ensure that root resorption is not occurring and that surrounding tissues continue to heal.
With any traumatic dental injury, time is of the essence. Contact your endodontist immediately.