What are impacted teeth and wisdom teeth? Each tooth is formed within your jawbones. As it develops, it travels upwards or downwards, and erupts into its appropriate place in your dental arch. This is normal and except for mild discomfort when a tooth is erupting, all will be well. If the tooth travels in the wrong direction, if its progress is blocked by another tooth, or if it is stuck in dense bony structures of your jaw, the tooth becomes impacted. This is sometimes the case with wisdom teeth.
Decay can occur even though an impacted tooth or wisdom tooth is not visible in the mouth, bacteria normally present in the mouth can often reach the crown of an impacted tooth. When decay does occur, there is no way for a dentist to fill such a cavity and severe pain will result.
Infection can occur around the crown of the tooth. With any infection that is unchecked, it may spread to the face, neck or throat tissues with the potential of general body illness.
Resorption of other teeth or the bone supporting them can occur. This has to do with the pressure the impacted tooth or wisdom tooth produces by pressing on those good teeth that have erupted. This pressure may injure the roots of good teeth or it may crowd the other teeth and affect your ability to chew food normally.
What is the operation like? The removal of an impacted tooth or wisdom tooth is a minor surgical operation, lasting 5 to 30 minutes. It often requires incision of the gum, cutting the tooth and probably some removal of bone too. The oral surgeon may provide anesthesia options of nitrous oxide (laughing gas), intravenous sedation, or general anesthesia to make the procedure more relaxing for you.
You will have some swelling and discomfort. Your surgeon will detail other potential complications. You may experience some stiffness in your jaw. There may even be some slight discoloration of the skin. Detailed instructions and medications for home care will be given to you by the surgeon to speed your recovery and minimize difficulties. Healing speed will depend upon the ability of your body to generate tissue.
Must the tooth come out if it hasn’t caused trouble yet? The main problem is that no one can tell when an impacted tooth or wisdom tooth will cause you trouble. About the only thing that can be said is that trouble probably will arise and when it does, it will arrive unexpectedly and at inconvenient times. By waiting, trouble may arise first, then the tooth cannot be removed until the infection or other complications have been treated. This means loss of more time and added expense along with some added risk. It’s best to have impacted teeth and wisdom teeth removed before trouble begins. It is far easier to have impacted teeth or wisdom teeth out when you are younger as well.
Injuries to the face may often result in fractures to the facial bones, the upper jaw (maxilla) or the lower jaw (mandible). Common causes include motor vehicle accidents, interpersonal violence, sports injuries, and falls. Many fractures are diagnosed and referred by emergency rooms to the oral and maxillofacial surgeon, some people present directly.
Cheekbone fractures commonly have a relatively pain free depressed appearance. The area under the eye may initially be swollen but later appear flat. A step in the edge of the eye socket can sometimes be felt. Sometimes there is limitation in jaw opening. On occasion visual disturbances may accompany this injury including bleeding in the lateral white of the eye. These injuries are best treated by either early intervention or delayed intervention of several days, sometimes surgically and sometimes nonsurgically for the less intense injuries. Suspicion of any such injury should be professionally evaluated.
Injuries to the upper jaw may range from severe, when the entire mid-face is disjoined from the skull, to a more simple injury involving only the tooth-bearing segment of the mid-face. Bite is often disturbed and feels spongy. Often times the front teeth do not come together in this type of injury, resulting in the back teeth seeming too long. There is usually pain and swelling. Repair may be surgical, with immediate ability to chew restored, or by wiring the teeth together with a temporarily impaired eating ability. Suspicion of any such injury should be professionally evaluated.
Injuries to the lower jaw may involve the joint, neck of the lower jaw, angle, or body. The bite usually feels different and numbness may be associated in the lip. Sometimes bleeding in the tissue of the floor of the mouth is present, and usually there is pain and swelling. Repair may be surgical, with immediate ability to chew restored, or by wiring the teeth together with a temporarily impaired eating ability. Suspicion of any such injury should be professionally evaluated.
Failure to treat broken facial bones or jaws may result in failure to heal, inability to chew and function, infection, or jaw joint problems, and further difficulty to repair by delaying treatment.
Treatment of jaw fractures in simpler cases may be accomplished in the office with local anesthesia and intravenous sedation. Very little discomfort or memory is associated with such a procedure. More serious fractures require treatment in a hospital operating room, under general anesthesia. Some treatments allow immediate return to chewing function, while others require the jaws to be wired together for several weeks while the bones heal.
Medications for comfort, oral hygiene, and prevention of infection will be given as well as routine care and diet instructions.
So you need a biopsy?
The oral cavity and head include more growths than any other part of the body, as such, a constant vigil is necessary to look for abnormal tissue, which could have serious effects. The oral and maxillofacial surgeon provides an important link for evaluating and treating these lesions. Often times the biopsy, becomes the most important step in determining whether the growth is benign or malignant in nature.
Perhaps you have noticed something which needs evaluation: a swelling, lump, non healing sore in the mouth or on the face; color change in the skin, white flat areas on the lip, persistent cracking of the lip or scaling. Maybe it’s a wartlike growth. Sometimes a denture may become poor fitting from a more subtle swelling in the jaws. Sometimes the dentist may notice something within the x-rays of the bone around your teeth. Perhaps your physician or dermatologist has recommended a mole, growth or salivary gland be evaluated with a biopsy. All these cases may involve the oral and maxillofacial surgeon to evaluate and possibly biopsy this unusual growth.
A detailed history of this special lesion is taken. Radiographs and sometimes other studies such as CAT scans or MRI are obtained to evaluate growths if deeper within the head or mouth. A thorough examination of the affected area will be made. Sometimes special stains are used within the mouth to help evaluate the seriousness of abnormal tissue. Your medical history will also be reviewed. A discussion of the possibilities will be made at the evaluation/consultation appointment with treatment recommendations made. The biopsy is the removal of a piece of tissue, or if small, the entire abnormal area.
The tissue removed during the biopsy is then sent to a pathologist. The pathologist prepares the tissue for examination under the microscope and then determines what is going on within the growth by the type, pattern and nature of the cells seen under the microscope. The pathological diagnosis is then made and communicated to the surgeon who interprets what has happened clinically. Appropriate further treatment or observation can then be planned.
So if you’ve got a bump, lump, growth, or tumor, don’t ignore it!
What are dental implants? Implants are fixtures that are placed into and fuse with the bone of the jaw. The highly reliable fixtures we use today are the result of years of development. They can be conservatively placed with minimal alteration of the existing jawbone. Replacement teeth are then attached to the implants.
Why consider an implant? When teeth are lost, there is often change in appearance and a decrease in a person’s ability to chew or speak. Single teeth can be replaced with an implant, thereby sparing the adjacent teeth from being altered to affix a conventional bridge. Even with well-made dentures, some people cannot chew, speak or laugh without dislodging their dentures. Others develop sore spots where loose dentures rub against tissue. Implants improve the stability and retention of dentures significantly. It is possible with implants to eliminate dentures completely and return to the improved function of full mouth crown and bridgework. With implants, people with partial dentures have the option of a stable fixed bridge.
Anyone healthy enough to have a tooth extracted is probably healthy enough to receive an implant.
What is the procedure like? Many implants are as simple as having a tooth extracted. The placement of an implant is a minor surgical operation. It requires an incision in the gum and the placement of a fixture in the bone. The incision is then closed with sutures. Your oral surgeon may provide anesthesia options of nitrous oxide (laughing gas), intravenous sedation, or general anesthesia to make the procedure more relaxing for you. The operation takes from 30 to 90 minutes, depending upon the complexity of the procedure. Once the surgery is complete, it takes three to four months for the implanted fixture to fuse to the bone. In most cases, you can wear your own denture, or temporary replacement tooth, during the healing period so there is little disruption of business or social activities. After the healing period, the surgeon will uncover the implant and your dentist will attach the final denture, bridge, or false tooth.
What should I expect after the operation? Detailed instructions and medications for home care will be given to you by the oral surgeon to speed your recovery and minimize difficulties. You can expect some swelling and discomfort. Some people experience stiffness of their jaw and slight discoloration of the skin. Your surgeon will detail other potential complications.
How long will an implant last? Most implants in our use have a 98% success, measured at eleven years. We hope for 15 to 25 years. The most important factor is how well you take care of the implant. If you follow the oral hygiene program recommended by your dentist, it can last as long as other conventional dental restorations, such as crowns and bridges. Research shows that there is little chance the implant will be lost once it has fused to the bone. The secret to implant longevity is good regular care.
The most common form of oral cancer is lip cancer. Lip cancer is largely related to changes brought to lip by excessive exposure to sun. Often in the initial stages there is an initial weakening of the line between the red vermilion of the lip, with the white skin below the lip. As this progresses, small scaling areas may form, which are characteristic of hyperkeratosis. As these reactive changes progress, dysplasia occurs where there could be chronic fissuring or chronic plaques or scale like areas on the lip. Dysplasia represents a premalignancy that if left untreated will advance to lip cancer. Frank lip cancer is often noted in its advanced forms by severe ulceration.
It is important with initial changes that a biopsy be performed on the lip. A biopsy takes a small segment of the abnormal tissue and the pathologist examines this under the microscope. He is able to determine what the cells are doing and inform the clinician as to what condition is present on the lip. When these changes represent dysplasia, where the very mildest forms of lip cancer, a lip shave is often performed. A lip shave will remove the vermilion of the lip from the corner of the mouth to the opposite corner. New pink tissue is advanced from inside the mouth to create the red margin of the lip. With more advanced changes a wedge of tissue is often removed from the entire lower lip. Most of these surgeries are very cosmetic with minimal disfigurement. It is important though, that all cases of lip cancer be captured early so that the simplest of surgeries can be used to cure the problem. Lip cancer is fairly easily treated with 97% of the cases cured. If your lip is abnormal, consider having it evaluated today with a biopsy by an oral and maxillofacial surgeon.
What is orthognathic surgery? Orthognathic surgery is surgery performed on the bones of the jaws to change their positions. Orthognathic surgery is corrective facial surgery where deformities of the jaw exist. It may be indicated for functional, cosmetic, or health reasons. It is surgery commonly done on the jaws in conjunction with orthodontic treatment, which straightens the teeth.
How do I know if I need orthognathic surgery? Facial imbalances are often present and sometimes recognized by the untrained eye. People with large jaws, or chins, or small jaws or chins, teeth which don’t fit together, eyeballs which appear bulging, and flat cheekbones are examples of facial characteristics that may be improved by orthognathic surgery. Sometimes the differences are so subtle that only a trained specialist can recognize them. The orthodontist or oral maxillofacial surgeon recognizes the need for surgical repositioning of segments of facial bones or teeth. An evaluation by such a specialist will often easily determine if you are a candidate for this type of surgery.
Will I have to have orthodontics? In most cases where the jaws are being moved, comprehensive orthodontic movement of the teeth may be necessary to prepare the teeth for optimal occlusion or biting positions. Following surgery there is often a short period of orthodontics for subtle and fine detailing of the tooth positions.
What is the surgery like? Some minor orthognathic surgery procedures can be done in the surgeon’s office, but most often they are done in the hospital. Surgery usually lasts three to four hours during which time you will be completely asleep. While you are asleep, incisions are made on the inside of your mouth to expose the bones to be cut. The procedures are then carried out. Screws are used to hold the bones and the teeth are not usually wired together at all. The incisions are closed with sutures, and you are ready for recovery.
How long does recovery last? The length of recovery in the hospital may vary from one to three days following surgery. During the week following surgery, activities should be limited. All strenuous activities and heavy exercise should be avoided the first month after surgery. Swelling is common, and a brief period of facial discoloration is possible. Often orthognathic surgery is easier to recover from than the extraction of impacted wisdom teeth.
What if I don’t have the surgery? Facial and dental imbalances have influences on function, health, and appearance. Not treating a functional problem may prevent you from being able to bite and chew your food, close your lips together, and to speak clearly. The health of the teeth, gums and particularly the jaw joint (TMJ) may be in jeopardy if surgery is not done. While not often a primary reason for orthognathic surgery, the appearance of your face may be made to look more balanced or normal. One’s facial appearance can influence one’s quality of life in many ways.
Livingston District Dental Society
P.O. Box 587, Brighton, Michigan 48116