Oral Surgery

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Oral and maxillofacial surgery is a specialty of dentistry concerned with the diagnosis and surgical treatment of congenital or acquired diseases, dysfunction, defects or injuries of the mouth, jaws, face, neck and associated regions.

Some of these issues are:

When Teeth Are Lost

When a tooth must be extracted due to trauma, bone loss, or other reasons, implants can be placed into the bone if you are determined to be a good candidate for implants. Please see our tooth fractures page to see the different types of fractures that occur with teeth.

Impactions

The wisdom teeth, or third molars, are the most frequently impacted teeth because of a lack of space in the jaw. In most cases, wisdom teeth that do not erupt into proper alignment should be extracted. Please see our wisdom teeth page to see the different types of impactions that can occur.

Jaw Alignment

Oral surgery can correct cases where the jaw bones are underdeveloped or overdeveloped. Cases, where the upper and/or the lower grow too much or too little can be surgically corrected.

TMJ – Temporomandibular Joint

Otherwise known as the TMJ, this joint in front of the ear where the lower jaw pivots is a common problem area. Problems with this joint can cause headaches and pain that never goes away. Lesser cases can be corrected with medication, therapy, and splints. However, a more serious case would require reconstruction of the joint.

Biopsy

When there is a suspicious growth or appearance of the tissue in the mouth, a biopsy will be performed to determine the origin of the lesion.

Facial Trauma

Oral surgery can help in cases of facial trauma that results from accidents or facial genetic malformation of the jaw and face.

Oral Cancer Exams & Biopsies

Any visit to our office includes an oral cancer exam. However, you are the most important factor in an early diagnosis of a change you notice in or around your mouth. You should look for the following:

A sore or lesion in the mouth that does not heal within two weeks.

A lump or thickening in the cheek.

A white or red patch on the gums, tongue, tonsil, or lining of the mouth.

A sore throat or a feeling that something is caught in the throat.

Difficulty chewing or swallowing.

Difficulty moving the jaw or tongue.

Numbness of the tongue or other areas of the mouth.

Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.

These symptoms may be caused by other, less serious problems, but they also indicate the possible presence of oral cancer. After the physical examination of your mouth, if we find any areas that are suspicious, we may recommend a biopsy. This is simply taking a small portion of the suspicious tissue that is sent to an oral pathologist for examination under a microscope.

Vertical Impactions

The lower tooth, in the image to the left, is partially vertically impacted. This means that part of the tooth is above the bone and visible in the mouth, and part of it is submerged in the bone. This tooth could still erupt properly as the tooth next to it is not in its way.

The upper tooth is fully vertically impacted. This means that the entire tooth is submerged in the bone.

If no tooth movement is shown after a few years, then we know that the teeth are impacted and should be considered for removal. This tooth could still erupt properly as the tooth next to it is not in its way.

Distal Impactions

The lower tooth, in the image to the left, is partially distally erupted. This means that part of the tooth is above the bone and visible in the mouth, part of it is submerged in the bone, and it is tilted distally, which means it is tipped toward the back of the mouth. This tooth will not likely erupt properly due to a lack of space toward the back of the jaw. These teeth typically need to be removed because the bacteria that gets under the gum tissue is almost impossible to clean, which then causes an infection.

The upper tooth is fully distally impacted. This means that the entire tooth is submerged in bone and is tipped toward the back of the mouth. These teeth can be observed for a few years, but it is best if they get removed, especially if other teeth need to be removed.

Horizontal Impactions

Both of the teeth in the image to the left are horizontally impacted. This means that the teeth are perpendicular to where they should be. These teeth will not erupt properly since there is no place for them to go, and there is almost no chance that they will be guided into the proper position in the mouth.

These teeth typically need to be extracted. They can be observed for a few years, but it is best if they get removed, especially if other teeth need to be removed.

Pericoronitis

Pericoronitis is a common problem that occurs around an erupting wisdom tooth that typically does not have enough room, and it most commonly occurs on lower wisdom teeth. It literally means inflammation around the crown. A piece of gum tissue appears over the biting surface of the tooth, which is very difficult to clean. Debris collects under the flap, and when the debris is not removed, the gum becomes inflamed. The gum can also become inflamed if the top tooth catches the flap of tissue during chewing. In most cases, pericoronitis is treated with an antibiotic for a few days, and when the infection has decreased, the wisdom tooth is removed.

Fractured Cusp

Vertical Furcation

Split Root

Vertical Root

Oblique Root

This is the most common type of fracture, and it has the best long-term prognosis. In this type of fracture, a part of the tooth can completely break off, and occasionally, no pain is felt after the tooth fractures.

Treatment for this type of fracture is to place a crown on the tooth. If the fracture extends into the middle part of the tooth, root canal therapy would be required in addition to a crown.

A vertical furcation is when a tooth has a vertical crack that extends vertically into or toward the furcation, which is the place where the tooth splits into two or more separate roots. The nerve is almost always involved in a vertical furcation crack. The tooth rarely separates into two pieces because the tooth is held in position by the surrounding bone.

The prognosis for this type of crack is fair, but it depends on how deep the crack extends into the internal aspect of the tooth. The options are to treat the tooth with a root canal followed by a build-up, post, and crown or to extract the tooth.

A split root fracture, known as a subgingival oblique fracture, can be restorable, but it depends on where the fracture ends. Subgingival means below the gumline. If the fracture is not too far below the gumline, the tooth can be restored with a procedure called crown lengthening followed by a crown. The tooth might also require root canal treatment. If the fracture is too far below the gumline, it is unrestorable and requires extraction.

These types of fractures occur for various reasons, such as biting down on very hard foods or foreign objects, the presence of a previous filling in the tooth, and a tooth that had root canal therapy that was not treated with a crown.

Vertical root fractures are not a very common type of fracture and it usually occurs with teeth that have had root canal therapy. If the fracture is very short in length, the tooth can possibly be saved by performing an apicoectomy. This involves gaining access to the root tip within the bone and removing the part of the root that is fractured. The only other option is an extraction.

Oblique Root Fractures are fractures that are limited to the roots of teeth, and the crown portion is intact. The fractured root is generally entirely below the gumline and usually entirely in bone.

If the fracture is close to the crown, the tooth is usually unrestorable. The tooth might be able to be treated with endodontic therapy and root amputation if the remaining roots are strong and healthy, but the overall prognosis is poor.

If the fracture is close to the tip of the root, the tooth could be restored with root canal therapy. The root canal cannot be performed on the fractured root tip, and the body tends to resorb the untreated piece. The prognosis for this procedure is fair to good, and regular exams are recommended to check how the body responds to the treatment.

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Dr. Kao and our friendly staff are dedicated to making every visit to our dental office a great experience. We provide expert dental care with a personal touch in a comfortable setting.

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