Dental Procedures

You may have a problem, injury, or illness that is most appropriately treated by an oral and maxillofacial surgeon. Oral and maxillofacial surgeons care for patients who experience such conditions as problem wisdom teeth, facial pain, and misaligned jaws. They treat accident victims suffering facial injuries, offer reconstructive and dental implant surgery, and care for patients with tumors and cysts of the jaws and functional and esthetic conditions of the maxillofacial areas.

Oral and maxillofacial surgeons are dental specialists who treat conditions, defects, injuries, and esthetic aspects of the mouth, teeth, jaws, and face. After training that includes a four-year graduate degree in dentistry, they complete a minimum four-year hospital surgical residency program.

Like the first day of school or the start of a new job, it is normal to be anxious about a new event in your life. In all likelihood you have never experienced outpatient surgery, and much of your anxiety is simply a fear of the unknown, as well as a concern that upcoming procedures are going to hurt.

The truth is that modern technology makes it possible for you to safely undergo complex surgery in the office with little or no discomfort. Oral and maxillofacial surgeons also have specialized knowledge in pain control and advanced training in anesthesia. They receive extensive schooling in the medical and dental aspects of anesthesia, and clinical experience in anesthesia techniques ranging from local anesthesia to sedation and general anesthesia. Your oral and maxillofacial surgeon will help you decide which type of anesthetic will best help avoid discomfort and relieve your anxiety.

Before surgery, your oral and maxillofacial surgeon will review with you the type of anesthetic to be used, as well as the way you’re likely to feel during the operation, and what you can expect during recovery. Your surgeon will provide answers to questions you have regarding your operation to help you understand what to expect and help alleviate your anxiety. Afterwards, your surgeon can prescribe medications to make you as comfortable as possible when you get home.

Before, during and after surgery, your oral and maxillofacial surgeon truly shares your concern for your well being. Beyond that, though, your oral and maxillofacial surgeon also has the training, the knowledge and the experience to make your visit as pleasant and comfortable as it possibly can be.

Most people start getting their third molars (also called wisdom teeth) when they reach their late teens or early twenties. In many cases, the jaws are not large enough to accommodate these teeth and they remain either under the gums or partially erupted (known as impacted).

Serious problems can develop from partially blocked teeth such as infection and possible crowding of and damage to adjacent teeth. More serious complications can develop when the sac that surrounds the impacted tooth fills with fluid and enlarges to form a cyst, causing an enlargement that hollows out the jaw and results in permanent damage to the adjacent teeth, jawbone and nerves. Left untreated, a tumor may develop from the walls of these cysts and a more complicated surgical procedure would be required for removal.

No one can tell when your impacted molar will cause trouble, but trouble will probably arise. When it does, the circumstances can be much more painful and the teeth can be more complicated to treat. After evaluating your x-rays, your dentist can often predict if the wisdom teeth are going to cause trouble later on. If so, your dentist will recommend their removal rather than wait for trouble to occur.

Removal is easier in younger patients. Roots are not yet fully developed and the bone is less dense. In older patients, removal before complications develop is key to shorter recovery and healing time and minimizing discomfort after surgery.

Dental implants are a great option for patients who are missing natural teeth. They are secure anchors for artificial replacement teeth and eliminate the instability associated with dentures and the unnecessary cutting down of adjacent teeth needed to make a bridge.

Dental implants are made of materials that are compatible with human bone and tissue. The implants are surgically placed directly into the jawbone. Small posts are then attached to the implants, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth. Based on patient needs, a single tooth, a partial bridge or a full set of replacement teeth are fitted to the implants and locked in place over the protruding posts.

In appearance and in function, implants are the closest thing to natural teeth and a good alternative to conventional dentures.

Jaw growth is a slow and gradual process. Occasionally, 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 speech defect or excessive mouth breathing.

When unequal jaw growth is the source of the problem, corrective jaw surgery (orthognathic surgery) may be necessary. Corrective jaw surgery involves moving all or part of the upper and/or lower jaw into a 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.

* Parts taken with permission from educational materials provided by the American Association of Oral and Maxillofacial Surgeons.

Periodontal disease, or gum disease, is the leading cause of tooth loss in adults. It is a disease of the gums and bone, which support the teeth. Gum disease is generally painless. In fact, many people are not even aware that they have gum disease. Unfortunately, if gum disease is not treated, it can lead to abscesses (pus pockets) or even tooth loss. The best way to determine if you have gum disease is to ask a dentist or periodontist.

Gum disease is caused by dental plaque (bacteria) present on the gum tissues surrounding the teeth. In the early phase, plaque that is not removed from around the teeth can cause a condition called gingivitis. Gingivitis is a condition that results in red gums that often bleed easily. Gingivitis can be eliminated through professional tooth cleaning and improved oral hygiene.

If gingivitis is not properly managed, it can progress into a much more serious condition called periodontitis. Bone loss around the teeth is the primary sign of periodontitis or periodontal disease. Active periodontitis causes destruction of the supporting tissues of the teeth including the bone and gum tissue. If not treated properly, excessive bone loss around teeth can cause teeth to become loose or lost. There are many different treatments for periodontal disease including root planing (deep cleaning), gum surgery, antibiotic therapy, tissue regeneration procedures and bone grafting. Treatment must be customized for each patient based on the severity of the disease and careful analysis of individual risk factors.

A Periodontist is a dental specialist who focuses on treating diseases of the supporting structures of the teeth including the gums and jawbone. Following graduation from dental school, the periodontist receives an additional two to three years of graduate training to become a dental specialist. In addition to the diagnosis and treatment of gum disease, many periodontist have received extensive training in dental implants.

Gum disease is classified as a chronic disease. Chronic means forever. Gum disease does not have a permanent cure. However, it can be successfully treated and through proper follow-up care, your teeth can be maintained for a lifetime.

Warning signs for gum disease include red and bleeding gums, loose teeth, moving teeth, bad breath and receding gums. In many cases, there are no obvious signs that you have gum disease. The best way to determine if you have gum disease is to have a periodontal exam performed by a dentist or periodontist. Gum disease is diagnosed by examining the condition of your gums and studying dental radiographs (x-rays).

There are many exciting new treatments for managing gum disease. There are new treatments that may help bone grow back around infected teeth. There are also new medications that can be placed in the gum around the teeth to eliminate the bacteria that cause active gum disease. Many incredible tools for battling gum disease are currently under development.

Periodontist often work with your dentist to make your smile look nicer. The appearance of short teeth, "gummy smiles" and uneven teeth can often be improved through a surgical procedure called "periodontal plastic surgery." Many beauty pageant contestants including winners of the Miss America and Miss Hawaii pageants have been through these remarkable procedures.

When teeth are missing and there are teeth on either side of the space a bridge can replace the missing teeth. When there has been the loss of a tooth or teeth and there is a tooth on either side of the open space, replacement teeth can be attached to two crowns constructed for the 2 teeth on either side of the open space. This is called a bridge because it bridges the open space.

When a tooth is lost 5 or more other teeth may drift so it is essential to place a replacement tooth as soon as possible. The space left from missing teeth may cause one of several problems. Teeth may drift into the space changing your bite, this changed bite may result in sore jaws, gum disease, or decay (due to more difficult hygiene).

A Denture is a set of false teeth. Dentures have been around for many years. The earliest form of denture was introduced more than 2,000 years ago. Today, dentures are of better quality and are more comfortable than ever before. Modern dentures can be made of acrylic, fiberglass, metal, or a combination of these materials. A denture is generally made to replace missing teeth that are not possible to replace by a fixed bridge. Replacing missing teeth has substantial benefits for your health and your appearance. A fixed bridge is superior to a removable denture because it is anchored more securely is less bulky, and places less stress on the underlying gums. It easier to chew food and speak naturally. However, there are situations when it is technically not possible to make a bridge.

A complete denture, also called a full denture, replaces all the natural teeth and provides support for cheeks and lips. Without this support, sagging facial muscles can make a person appear older. Complete dentures can be either "conventional" or "immediate" according to when they are made and when they are inserted into the mouth. A partial denture replaces some teeth. Conventional dentures are made and inserted after the remaining teeth are removed and the tissues have healed. Healing may take several months. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient's jaws during a preliminary visit. An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly.

Years ago, teeth with diseased or injured pulps were extracted. Today, endodontic treatment ­also known as a root canal-- gives dentists a safe and effective means of saving teeth. Endodontics is the area of dentistry concerned with the prevention, diagnosis, and treatment of disorders of the dental pulp (the tooth¹s soft core).

Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development. The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth¹s growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it. All teeth have only one pulp chamber, but teeth with more than one root will have more than one canal.

An Endodontist is a dental specialist with special training in endodontic procedures. To become specialists, they complete dental school and an additional two or more years of advanced training in endodontics. They perform routine as well as difficult and very complex endodontic procedures, including endodontic surgery. Endodontists are also experiences at finding the cause of oral and facial pain that has been difficult to diagnose.

Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, a blow to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, the tooth and surrounding tissues become infected and it can cause pain and swelling or lead to an abscess. Even in the absence of pain, certain byproducts of a diseased pulp can injure the bone that anchors your tooth in the jaw. Without endodontic treatment, your tooth will eventually have to be removed. Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. Sometimes, there are no symptoms.

Treatment usually requires from one to three appointments. During these treatments, your dentist or endodontist removes the diseased pulp. The pulp chamber and root canal(s) of the tooth are then cleaned, shaped, filled and sealed to prevent recontamination of the root canal system. Root canal therapy is usually a relatively painless procedure.

Endodontic treatment can often be performed in one or two visits and involves the following steps:

1. The endodontist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, the endodontist places a small protective sheet called a "dental dam" over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
2. The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.
3. After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called "gutta-percha." The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. Your dentist will remove the temporary filling before the tooth is restored.
4. After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function. If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth.

You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings. Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment fails to heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this happens, another endodontic procedure can save the tooth.

New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover very narrow or curved canals that could not be treated during the initial procedure.

Most teeth can be treated. Occasionally, a tooth can¹t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn¹t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. And, when endodontic treatment is not effective, endodontic surgery may be able to save the tooth.

The most common endodontic surgical procedure is called an apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after endodontic treatment, your endodontist may perform an apicoectomy. In this procedure, the endodontist opens the gum tissue near the tooth to expose the underlying bone, and the infected tissue is removed. The very end of the root is also removed, and a small filling may be placed to seal the root canal. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day.

When the pulp of a tooth is damaged, the only alternative to endodontic treatment is extraction of the tooth. To restore chewing function and to prevent adjacent teeth from shifting, the extracted tooth must be replaced with an implant or bridge. This requires surgery or dental procedures on adjacent healthy teeth and can be far more costly and time-consuming than endodontic treatment and restoration of the natural tooth.

There are many disadvantages to losing a tooth. When a tooth is removed and not replaced, the teeth next to the empty space begin to shift from their normal position. This may cause teeth to become crooked or crowded, which decreases chewing and biting efficiency. Crowded or crooked teeth may be more prone to dental disease because they are harder to keep clean than properly aligned teeth. As a result, other teeth may be lost if the missing tooth is not replaced.

A replacement tooth (an implant or a bridge) is usually more expensive than endodontic treatment and involves more extensive dental procedures on adjacent teeth.

Endodontic treatment can safely and comfortably save a tooth that otherwise would have to be removed. In fact, root canal therapy is successful approximately 95% of the time. Remember, a healthy restored tooth is always better than an artificial one.

* Parts taken with permission from educational materials provided by the American Association of Endodontists and the American Dental Association.

 

There is a two-part answer to this question:
First, if anything looks funny or something unusual happens to your child's mouth/teeth, please have your child examined by a pediatric dentist or a family dentist.

Here are a few examples:

1. Primary (baby) teeth erupt by 9 months of age
2. If child falls and injures any baby teeth
3. If gums bleed often with no apparent reason
4. If chalky white area cannot be removed by brushing
5. If baby teeth erupt and line up in an unusual manner
6. Any funny looking spots on teeth or inside mouth appear

Second, all children should be seen for a visual examination by age two (even if they need to sit in their parent's lap.)

To delay attending to obvious area of decay on a child of 2 years to 4 years old is to ask for big trouble in many cases. If the decay has progressed deep inside the tooth, the pulp (nerve) will abscess and your child will develop a tooth, gum, and bone infection. This can cause pain, swelling, fever, malaise as well as disturbances in the enamel of the permanent teeth forming in your child jaws.

The ugly steel caps are very ugly, but very strong. There are ways of putting a tooth colored covering on the steel crown and thereby improve the looks. There are also plastic (composite) tooth colored crowns, which are very esthetic, but not quite as durable as the metal caps.