Oral Surgery (Dental extractions, Dis-Impactions, Cyst removal, Orthognathic surgeries)

Oral surgeries are common and include tooth extraction, gum grafts, jaw surgery, TMJ surgery, and more. Injuries may also warrant oral surgery. Your surgeon will discuss anesthesia options with you as well as risks, benefits, and complications of your particular surgery.

Impacted Teeth

Wisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or “impacted” between the jawbone and the gum tissue. Impacted wisdom teeth can result in swelling, pain, and infection of the gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, dentists recommend people with impacted wisdom teeth have them surgically removed.

It’s not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.

Extraction

Tooth extraction is the removal of a tooth from its socket in the bone. If a tooth has been broken or damaged by decay, your dentist will try to fix it with a filling, crown or other treatment. Sometimes, though, there’s too much damage for the tooth to be repaired. In this case, the tooth needs to be extracted. A very loose tooth also will require extraction if it can’t be saved, even with bone replacement surgery (bone graft).

Here are other reasons:

• Some people have extra teeth that block other teeth from coming in.
• Sometimes baby teeth don’t fall out in time to allow the permanent teeth to come in.
• People getting braces may need teeth extracted to create room for the teeth that are being moved into place.
• People receiving radiation to the head and neck may need to have teeth in the field of radiation extracted.
• People receiving cancer drugs may develop infected teeth because these drugs weaken the immune system. Infected teeth may need to be extracted.
• Some teeth may need to be extracted if they could become a source of infection after an organ transplant. People with organ transplants have a high risk of infection because they must take drugs that decrease or suppress the immune system.

Wisdom teeth, also called third molars, are often extracted either before or after they come in. They commonly come in during the late teens or early 20s. They need to be removed if they are decayed, cause pain or have a cyst or infection. These teeth often get stuck in the jaw (impacted) and do not come in. This can irritate the gum, causing pain and swelling. In this case, the tooth must be removed. If you need all four wisdom teeth removed, they are usually taken out at the same time.

If you expect to have treatment with intravenous drugs called bisphosphonates for a medical condition, be sure to see your dentist first. If any teeth need to be extracted, this should be done before your drug treatment begins. Having a tooth extraction after bisphosphonate treatment increases the risk of osteonecrosis (death of bone) in the jaw.

How it’s done:

• There are two types of extractions: A simple extraction is performed on a tooth that can be seen in the mouth. General dentists commonly do simple extractions. In a simple extraction, the dentist loosens the tooth with an instrument called an elevator. Then the dentist uses an instrument called a forceps to remove the tooth.
• A surgical extraction is a more complex procedure. It is used if a tooth may have broken off at the gum line or has not come into the mouth yet. Surgical extractions commonly are done by oral surgeons. However, they are also done by general dentists. The doctor makes a small incision (cut) into your gum. Sometimes it’s necessary to remove some of the bone around the tooth or to cut the tooth in half in order to extract it.

Most simple extractions can be done using just an injection (a local anesthetic). You may or may not receive drugs to help you relax. For a surgical extraction, you will receive a local anesthetic, and you may also have anesthesia through a vein (intravenous). Some people may need general anesthesia. They include patients with specific medical or behavioral conditions and young children.

If you are receiving conscious sedation, you may be given steroids as well as other medicines in your IV line. The steroids help to reduce swelling and keep you pain-free after the procedure.

During a tooth extraction, you can expect to feel pressure, but no pain. If you feel any pain or pinching, tell your doctor.

Dental Cysts
Dental or oral cysts are a fairly common occurrence in the mouth. In addition to cysts that grow along the gum line, this may also grow on the inside of the cheek, the tongue, as well as the floor of the mouth. A cyst is medically defined as a fluid filled sac or pouch, but can also appear as a growth of any kind, including an irregularly shaped patch of skin. Regardless, this should be removed and tested by your dentist or oral surgeon to ensure that growth is benign (harmless) as opposed to malignant (cancerous).

Several forms or types of cysts may develop in the mouth cavity. Oral cysts are also called dental cysts, as well as periapical, odontogenic or radicular cysts. Dental cysts are a very common form of an odontogenic cysts. In most cases, such cysts are caused by infections that result in the pulp or inner portion of the tooth becoming infected and causing resultant decay, as well as the development of fluid filled sacs or inflamed tissue. Fluids contained within such as sacs or cysts may be sterile or infected. If not treated, infectious fluids may be reabsorbed and spread infection to other locations in the body.

The most common types of oral cysts include:

• Periapical cyst- also known as a radicular cyst, these are the most common of odontogenic cyst types. The tooth becomes infected, leading to death of pulp tissues. Infected matter and toxins may escape through the apex (bottom most portion) of the tooth, leading to infection of surrounding tissues as well as the development of cysts caused by skin or gum tissue caused by lack of adequate blood supply.
• Keratocyst- This cyst is often difficult to diagnose, and results pertaining to content must rely on laboratory tests. They are rather aggressive and can be tricky to remove, as the cyst can grow into bone formations of the jaw.
• Dentigerous cyst – this type of cyst is the second most common, and develops within a dental follicle in close proximity to or surrounding an unerupted tooth. These type of cysts are commonly found around the third molars. These cysts can grow and alter positioning of teeth, but most do not cause symptoms or pain and often go unnoticed.
• Primordial cyst – this type of cyst develops instead of a tooth and is one of the rare forms of oral cysts.

Common Treatment for Cyst Removal (Cyst Operations)

• The most common and beneficial treatment for cysts is excision or removal of the cyst. Before removing the cyst, the dentist or oral surgeon generally performs a biopsy, which involves the removal of a small portion or piece of tissue from the questionable cyst. The tissue sample is then sent to a laboratory where examination and analysis will be performed.
• Cysts in mouth commonly form around the wisdom teeth, around impacted wisdom teeth, and in the pulp of teeth, and while the cyst itself might be benign, or harmless, dentists and oral surgeons most frequently suggest their removal before surrounding tissues or bone structures are damaged.
• Cyst operations are generally performed under local anesthesia, meaning the patient is awake during the procedure. In most cases, cysts are removed quickly and efficiently in under an hour. Large cysts require more detailed or extensive surgery, which may or may not require bone reconstruction.

Orthognathic cosmetic surgeries
Corrective jaw or orthognathic surgery is performed by an oral and maxillofacial surgeon (OMS) to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient’s appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems.

Following are some of the conditions that may indicate the need for corrective jaw surgery:

• Difficulty chewing, or biting food
• Difficulty swallowing
• Chronic jaw or jaw joint (TMJ) pain and headache
• Excessive wear of the teeth
• Open bite (space between the upper and lower teeth when the mouth is closed)
• Unbalanced facial appearance from the front, or side
• Facial injury
• Birth defects
• Receding lower jaw and chin
• Protruding jaw
• Inability to make the lips meet without straining
• Chronic mouth breathing
• Sleep apnea (breathing problems when sleeping, including snoring)