Palo Alto Oral Surgery

ASK THE DOCTOR

Preprosthetic Surgery

There are well over 40 million partially and completely edentulous patients in the United States who at one time or other require surgical treatment. When teeth are extracted, particularly due to infection of the gums (periodontal disease), there often are irregularities of the alveolar bone structure of the jaws. These irregularities are often painful and produce so-called “denture sores” beneath their dentures. At times small fragments of bone may pierce through these ulcerations of gum tissue. This can happen several months after extraction. The procedure to smooth out or trim the bone is called an alveoloplasty or alveolectomy, and is an office procedure. If the dentist happens to leave a small root tip behind because of its presence near the lower jaw nerve or fusion to the sinus wall of the upper jaw, this is not bad practice. Simply trying to excise these fragments might produce more serious surgical morbidity and side effects. If the wound is contaminated and reveals large amounts of infected tissue, then this abnormal tissue should be cleaned out and debrided. Radiographs(x-rays) are necessary to determine the character and quality of bone, pathological lesions present and the anatomy of the teeth that are to be removed. Looking for Cosmetic Dentistry Menlo Park? visit Dr. Marisa Walker

Implantology

For many years dental implants of varied sizes have been used in Dentistry to augment or replace hard and soft tissue components of the jaws. Implants have been shown to be “compatible” with the hard tissues and associated with responses that mimic the periodontal membrane attachment . This attachment is an element present around the normal tooth root structure. The dental profession has followed acceptable methods of biocompatibility testing and the products currently marked as dental implants do not cause serious harm to the patient.

Cooperation between the oral surgeon and prosthodontist or restorative dentist is also essential to ensure that the optimal number of locations of implants is agreed upon. This in turn will ensure optimal functional stress distribution, access for oral hygiene maintenance, and aesthetic considerations. It is clearly impossible to separate the quality of the implant anchorage from its subsequent loaded assignment. Therefore, it is presumed that the surgical skill that ensured a biomechanical anchorage is matched by the prosthodontic skill that maintains it.

The field of dental implantology is becoming more complex and requires an educational level and expertise far beyond a weekend course in Palm Springs. For those who are interested in getting involved with dental implants it behooves them to take not only didactic lectures but to participate in as many live mini-residency programs and hands -on workshops as possible. Once again, do question one’s background and training ,as well as, qualifications in this area.

Temporomandibular Joint Problems

The temporomandibular joint (TMJ) is the complex joint of the lower jaw which occasionally presents some diseases and dysfunction. In spite of extensive basic and clinical research, confusion continues regarding the differential diagnosis of temporomandibular joint disorders. This confusion arises to a large degree because we are dealing primarily with complaints of pain. The principal diagnostic challenge is to distinguish those patients whose signs and symptoms are caused by internal derangement from those whose disturbances are caused by myofacial pain and dysfunction; in other words, joint problems versus muscular disorders. The typical patient with joint derangement will have pain and mandibular dysfunction or both localized to the TMJ. The pain will be less in the morning and become worse during the day and with mandibular function. The affected joint(s) will be tender to palpation and painful when loaded. There will be minimal muscle tenderness. In contrast, the typical patient with a muscle disorder will have pain that is diffuse and poorly localized. The pain frequently will be worse in the morning. The patient generally sleeps poorly and is aware of clenching or grinding the teeth. Examination reveals diffuse masticatory muscle tenderness. The intra-articular problems usual emanate from a deformity, injury, or displacement of the “meniscus”, which is a supporting capsular disc that is suspended around the condylar head of the lower jaw (the ball part of the socket joint) and has a fluid media around it which lubricates and creates a ” shock absorbing” affect. If this suspension ligament is damaged through injury it may need repair. There are now arthroscopic procedures available to allow the surgeon to take a look into the joint interior just like any other joint such as the knee, which is common practice. Nevertheless, due to the small size and complexity of the joint, it is difficult to operate directly. It takes special training and skill to accomplish this. The oral surgeon would be a good place to start to develop a diagnosis and treatment plan. It may be suggested that you have an MRI (magnetic resonance imaging) radiographic study done. This less invasive than other diagnostic tests and provides a guide to whether there is capsular damage or displacement. Splint therapy may be recommended. This is an appliance that is fabricated in a laboratory and adapts to your teeth, used therapeutically to “rest” the joints for aid in repositioning a strained capsular disc. Since many TMJ patients appear to have stress problems as well, psychological counseling may be recommended.

The majority of oral surgery performed in an oral surgery office revolves around the surgical repair and treatment of the supporting structures of teeth, namely the bony alveolar ridge. Extractions, removal of impacted teeth, cysts, tumors, repair of injuries to ridge, and reconstruction of ridge when it has become atrophic due to considerable bone loss, all involve dentoalveolar surgery.

At times people will call specialists for care of a fractured tooth. If the tooth is restorable, the oral surgeon will move the patient on to a general dentist for care. Oral surgeons are best trained in the diagnosis of diseases and injuries that affect the jaws.

Another common area seen in dentoalveolar surgery is the treatment of impacted teeth. By impaction we mean teeth that are partially or totally imbedded beneath the gum tissue and bone and don’t have the proper space to erupt fully into the mouth. The most common of all impacted teeth are the so-called “wisdom” teeth, or third molars. The second most common impacted teeth are the cuspid teeth or “eye” teeth. A large volume of courses of study have been done to point out the need for the early removal of impacted third molars in the teenage years around 16-17 years of age. Why? Most simply, at this age the root structure has not developed fully and radiographs can tell whether someone has enough room for them to enter the mouth and function normally. There are many serious side effects from surgery done on older patients who are “waiting for something to hurt.” If the roots begin to develop they can get hooked and anchored well into the jaw, particularly near main nerves and blood vessels that supply the jaws and teeth. The older patient may then develop postoperative numbness or altered sensations of the lips and tongue if the nervous tissue has been disturbed. It naturally takes longer to heal and recover from this kind of surgery as we get older.

Well, what about the other impacted teeth like the cuspids(eye teeth of upper jaw)? When one is approaching the early teens the cuspids should already be in position. An alert dentist will advise a young person to seek orthodontics if crowding occurs and if retained unerupted cuspids are present. These teeth can be exposed surgically at the young age of 10-13 and guided in with orthodontic treatment.

There is one other important matter when it comes to impacted teeth. Generally there is a developmental cyst surrounding the crown of the imbedded tooth. As the tooth erupts this cystic tissue becomes part of the gingival (gum) tissue that lines the oral cavity. However, when teeth are imbedded, this cyst has the potential of expanding with fluid within and cause considerable damage to the bone and adjacent teeth.

Make sure you have the benefit of good early treatment and special care. Most often one will receive sedation or twilight sleep or general anesthesia to provide ultimate comfort.

Often the oral surgeon is called upon to see patients who have sustained injuries to the hard and soft tissues of the face and jaws. This attention is not only given to the teeth and gum tissue that may be involved, but also contusions, lacerations, and fractures that occur in the facial and jaw bones. The oral surgeon is considered an expert in handling these injuries , but must be called upon immediately to be of some help. If one must resort to going to a hospital emergency room, than they should likewise call an oral surgeon or have the ER staff call for them. You must realize that Oral and maxillofacial surgeons are not in attendance at most hospitals , except some of the major teaching medical centers. However, they are active members of the hospital medical staff and can be contacted immediately by pager.

If you find that your bite is not the same, extreme sudden swelling has taken place, or you are having trouble opening your mouth, these may be signs of significant jaw injury. Likewise, infections spread very rapidly in the head and neck area and can be life threatening. If teeth are knocked out, try to replace them with help immediately. If this cannot be done , then place under the tongue of floor of the mouth, or better yet , place them in milk.

KEY POINT: call the oral surgery office for immediate attention. These teeth maybe reimplanted and stabilized at the office. The surgeons¹ office is usually equipped to do almost any surgical procedure with comfortable anesthesia moreso than the hospital ER.

KEY POINT: 3M company has a product that preserves avulsed teeth. This can be obtain from the oral surgery office for most schools, hospitals, daycare facililities, etc. Call our office or EMAIL if necessary.Oral and maxillofacial surgeons are likewise trained in facial cosmetic surgery today and are more than capable of handling facial lacerations. We are only a phonecall away.

Post Operative Instructions

1. DO NOT DISTURB WOUND: Keep fingers and tongue away from area. You may invite irritation and bleeding.

2. DO NOT RINSE MOUTH DAY OF SURGERY: Next day you may rinse gently with any mouth wash you desire, as long as you dilute with 50% water (half strength). Warm water with a quarter teaspoon of salt or baking soda is good. Three times a day is sufficient. A hot water bottle or heating pad may feel comfortable against the side of your face, but please restrict to 5 minutes at a time. Continue rinses for next week.

3. FOOD: Keep taking nourishment. Try not to skip a single meal. Begin by heating liquid or soft things such as soups, soft-boiled eggs, fish, dairy products, ice-cream, or well-cooked cereals. As soon as possible get on to solid food. You will feel better, have more strength, less pain, and heal faster, if you continue to eat. Drink all the liquids you desire (coffee, tea, milk, etc.) at least 8 large glasses of water or fruit juices each day.

4. PAIN: Prescription for pain tablets will be given to you. Please follow directions on the bottle. You may need 1 or 2 pain tablets every 2, 3, 4, 5, or 6 hours. Take only what you need to be comfortable. Tylenol, Anacin, Advil, Bufferin, etc., usually are not strong enough to stop the pain, but may help pain if you try 2 or 3 tablets every 2 to 6 hours. You may try them if you wish. Be certain to drink at least 8 glasses of fluids during the day when taking the pain tablets.

5. ICE PACKS: An ice pack over the area of surgery for 15 or 20 minutes, then off for 30 or 40 minutes helps to prevent swelling, to prevent pain and to help stop excessive bleeding. Three or four times is sufficient for routine extractions. You may continue until bedtime for impacted wisdom teeth or several extractions. Ice packs are only effective for the first 24 hours following surgery. The next day you may switch to mild heat.

6. BLEEDING: TRY NOT TO SPEAK AND KEEP HEAD ELEVATED AT ALL TIMES:

(1) After your teeth were removed, two gauze sponges were placed on the wound and you were asked to keep your jaws closed tightly for 15 to 20 minutes. This was to help stop the bleeding and keep saliva away from the open tooth socket. You may discard the gauze sponges in 15 to 20 minutes.

(2) Should slight bleeding continue, fold two gauze sponges in half and place over the bleeding area and close your jaws tightly for 15 to 20 minutes to make pressure. This may have to be repeated 4 or 5 times. Slight oozing may continue into the next day.

(3) It also helps to stop bleeding if you will lie down, with the head raised on pillows. Apply your ice pack to that side of cheek. You may expectorate but do not swallow the blood as this will cause nausea. Do not become alarmed or excited. You may phone me. Use moistened tea bag (regular caffeinated, not herbal teas) compress.

7. NAUSEA: The swallowing of blood, the taking of pain tablets, not eating or the operation itself may cause you to feel nausea or upset to your stomach.

8. BONY EDGES: During the healing process, tiny sharp splinters of bone may work up through the gum. If annoying, please return to office for removal.

9. ELIMINATION: Active intestinal action is essential. Any mild laxative you desire is fine.

10. REPORT PROMPTLY: Any condition that appears unusual.

1. SWELLING: Swelling of some extant follows nearly every tooth extraction. This is Nature’s way of beginning the healing process. It does not mean infection has set in providing there is no prolonged fever, pain, etc. After the removal of impacted teeth or trimming of the bone, swelling is often quite severe. It is most marked on the 2nd or 3rd day, and begins to disappear on the 4th day.

2. STIFFNESS: Stiffness of the jaws is also Nature’s way of resting the bone which needs to be repaired, and usually relaxes about the 4th or 6th day. Warm mouth washes and heat (heating pad, hot water bottle, warm wet towel applied to operated area for 10 to 15 minutes 4 to 6 times a day will be comforting.

3. DISCOLORATION: Black and blue marks on the face are caused by bleeding internally into the checks or chin. This may appear first as a swelling but after the 2nd or 3rd day it may discolor the face yellow, black or blue. It will gradually disappear in a week or ten days. Heat applied to outside may be comforting, but will not greatly speed up the fading process.

CONTACT US

Disclaimer:

From the inception of this web site, we have been committed to providing you with accurate, up-to-date educational information, dealing with the most common situations occurring and related to oral surgery. The information provided on our site is intended to serve as a supplement to your knowledge base and is in no way to be considered medical advice.

We urge that you check with your oral surgeon, or other related health professionals before undertaking or choosing not to undertake any course of action and recommend that you always follow the advice and recommendations of your oral surgeon. Neither Imagicians, Inc., or any other contributors take responsibility for any consequence relating directly or indirectly to any information, recommendations, treatment, procedure, action or application of medicine by any person using the Palo Alto Oral Surgery Web site.