What is oral Surgery ?
Oral surgery refers to any surgical procedure performed on your teeth, gums, jaws or other oral structures. This includes extractions, implants, gum grafts and jaw surgeries. Oral surgery is usually performed by an oral and maxillofacial surgeon or a periodontist
Is oral surgery painful?
Patients' fears about pain following an oral surgery are well-founded. Removal of teeth, with the often necessary cutting of jaw bone, is one of the most painful surgical procedures that can be done to a human being.
How long does it take to recover from an oral surgery?
Typically, your oral surgeon will ask that you at least take about 48-72 hours to relax afterward so the treatment area is allowed to clot. After that, a patient should be able to return to normal physical activity. The soft tissue will usually fully heal in about 3-4 weeks.
What is the difference between dental surgery and oral surgery?
They are both capable of performing tooth extractions and other basic surgeries. However, Oral surgeons typically handle more complex surgeries and extractions—like wisdom teeth. In the case of simple tooth extraction or implant placement, you will likely have the option of seeing the dentist or an oral surgeon.
What does a maxillofacial surgeon do?
Maxillofacial surgery is a special type of dentistry. It involves operations to correct diseases, injuries and defects of your face, jaw or mouth. Maxillofacial surgeons are advanced specialists who diagnose and treat problems with: Bones and tissues of your jaw and lower face (maxillofacial area).
What to expect when getting oral surgery
The instructions for each type of surgical procedure is different, but it typically includes:
- Not eating for at least a few hours before the surgery
- Refraining from tobacco products and alcohol consumption
- Arranging transportation from the clinic
- Planning ahead so the patient can avoid strenuous activity during recovery
When are oral surgery procedures necessary?
Dentists recommend oral surgery procedures to their patients when the other treatment options they have tried have not been successful or if the problem that their patient has cannot be fixed using other dentistry techniques. Some of the conditions that require oral surgery procedures include:
What are the different types of Oral Surgeries?
Common oral surgery procedures
Here are some of the more common oral surgery procedures most people have to get at some point in their lives:
1. Dental implant installation
Implants are a popular way to replace missing teeth, and their installation requires oral surgery. The implant is a rod or screw that is surgically inserted into the patient's jaw. Most implants are made with titanium, but they are sometimes made with other materials, like zirconium.
A crown might be attached to the implant once it is placed depending on the type of implant used and how healthy the patient's jaw is. Others might have to wait up to six months for surrounding bone tissue to fuse with the implant.
2. Tooth extractions
At times, a patient needs a tooth extracted and a simple extraction will not get the job done. When this is the case, a surgical extraction is performed. This involves the oral surgeon making an incision into the patient's gums so the tooth can be reached and extracted. It can be performed under local or general anesthesia.
Common reasons a tooth might be extracted include severe tooth decay, damage or infection.
3. Bone grafting
This surgical procedure is performed when a person does not have sufficient jaw bone tissue. This can be the result of failing to replace a missing tooth or a dental condition that deteriorates jawbone tissue. Bone grafting is also performed when a patient wants implants but lacks the bone tissue needed to hold the oral prosthetic in place.
4. Corrective jaw surgery
Also called orthognathic surgery, this is used to fix a variety of minor and major dental and skeletal irregularities, like a misaligned jaw. The procedure can drastically improve the patient's ability to breathe, speak and chew properly.
5. Sleep apnea treatment
Surgery is sometimes needed to address sleep apnea. This condition leads to a person's airways becoming blocked during sleep. This leads to interruptions to their sleep cycle as their body wakes them up so proper breathing can be restored.
Surgery can be used to remove excess soft tissues that may be blocking a patient's airways. It can be used as a permanent solution for some types of sleep apnea.
6. Cleft Palate or Lip
Baby with cleft lip, maybe cleft palate also
Plastic surgeons usually perform cleft palate surgery on children, but maxillofacial surgeons with specialized training also can fix this facial defect that can cause problems with feeding and speech development. Babies with cleft palate have an opening in the roof of their mouth. Cleft lip refers to a turned-up front lip, and babies may have both a cleft palate and a cleft lip. A maxillofacial surgeon can repair these defects when a baby is around one year old.
7. Facial Reconstruction
Doctors reviewing x-rays of head in hospital
Many types of trauma can break the facial bones or jaw, or knock out teeth. Maxillofacial surgeons can perform reconstructive procedures to restore the function and appearance of the face, jaw, and oral cavity following an accident. Depending on the extent of the injuries involved, facial reconstruction can require multiple surgeries over the course of months or even years. These surgeries often are performed under general anesthesia and may require staying overnight in the hospital.
8. Apicoectomy
Dental tooth model with cavity down to root
Oral and maxillofacial surgeons perform apicoectomies when a root canal procedure can’t be completed because the tooth’s root is hooked at the bottom, which prevents the root canal file from reaching the very tip of the root. Since the dental instruments cannot reach the very tip of the root, nerve material can’t be removed. This, in turn, can cause an infection. An oral surgeon performs an apicoectomy by removing the tip of the root and filling the space with inert material.
9. Biopsies
If you have a lesion in your mouth that looks suspect, we will perform a biopsy to check for oral cancer. We will remove a small piece of tissue and then send it to the lab for analysis.
10. Impacted Wisdom Teeth
These third molars are the last teeth to develop. While sometimes these teeth may erupt and not cause the patient any issues, more often than not these teeth either don’t fully erupt or aren’t properly aligned. This causes them to become impacted between the gums and the jawbone, which will also affect the health of surrounding teeth.
11. Craniofacial surgery
Used to correct congenital malformations like cleft palate or craniosynostosis (the premature fusing of bones in a baby's skull), or to repair traumatic fractures (include jaw fractures, cheekbone fractures, nasal fractures, eye socket fractures, and LeFort fractures of the mid-face)8 Lip reconstructive surgery: Used after the removal of skin cancer of the lip (typically squamous cell carcinoma, but also melanoma) to restore not only the appearance of the lips but their function9 Microvascular reconstructive surgery: Used to reroute blood vessels after the removal of a tumor in people with head and neck cancer10 Skin grafts and flaps: A procedure used after skin cancer surgery in which skin is either taken from another part of the body to replace resected tissues or partially removed and repositioned to cover an adjacent area of resection10
What are the risks associated with oral surgery?
Potential Risks
As with all surgeries, oral and maxillofacial surgery has risks. Even relatively common procedures like tooth extractions pose a risk of potentially serious complications.
In addition to the general risks of surgery (such as excessive bleeding, unfavorable scarring, post-operative infection, and an adverse reaction to anesthesia), oral and maxillofacial surgery poses specific risks, especially with regards to reconstructive surgery or in cases of facial trauma.
These include:
- Unintended changes in appearance
- Changes in jaw alignment and bite
- Changes in airflow through the nose and sinuses
- Injury of facial nerves, which may cause numbness, loss of facial muscle control, or unremitting nerve pain
- Alveolar osteitis: Also known as dry socket, this is caused when a blood clot doesn't form or is lost at the site of a tooth extraction before it has time to heal.
- Condensing osteitis: Bone inflammation in the jaw characterized by pain with movement
- Tissue necrosis (tissue death), usually caused by the severe restriction of blood flow to tissues following surgery2
Cosmetic procedures include:
- Blepharoplasty: Eyelid surgery
- Cheek augmentation: Cheek implants
- Genioplasty and mentoplasty: Aesthetic chin surgery
- Hair transplantation
- Neck liposuction
- Otoplasty: Reshaping of the outer ear
- Rhinoplasty (nose job)
- Rhytidectomy (facelift)
How to Prepare
The preparation for oral and maxillofacial surgery can vary depending on the condition being treated and the aims of the surgery. If oral and maxillofacial surgery is indicated, you will meet with your surgeon to review the pre-operative results and walk through the suggested procedure step-by-step.
To fully comprehend what's involved, do not hesitate to ask as many questions about not only the procedure but what to expect during recovery.
What to Wear
You may be asked to wear a hospital gown and surgical bib over your clothes when undergoing dental surgery. Wear something that is machine washable on the odd chance you get a spot of blood on your clothing.
Other surgical procedures, particularly those involving general anesthesia, will require you to undress and put on a hospital gown. The day of your procedure, wear something comfortable that you can easily take off/put back on.
Food and Drink
If undergoing general anesthesia or any form of sedation, you will need to adhere to certain food and drink restrictions prior to surgery.
In most cases, you will be advised to stop eating at midnight on the night before your surgery. The next morning, you will be allowed a few small sips of water to take any morning pills, but nothing further.
If local or regional anesthesia is to be used, there may be no such restrictions. The only exception is if intravenous sedation is used alongside local or regional anesthesia. In such cases, the same food and drink restrictions apply.
What to Expect on the Day of Surgery
The expectations for oral and maxillofacial surgery are as diverse as the procedures used. With that said, there are some common elements involved in all of these procedures, and knowing more about them can help you prepare.
Before the Surgery
After you have checked-in and completed all of the necessary medical and consent forms, you will undergo pre-operative preparations. These preparations are largely directed by the type of anesthesia you are to undergo.
Local anesthesia: Procedures performed with local anesthesia, delivered either by injection or with nitrous oxide ("laughing gas"), may only require a review of your vital signs (temperature, heart rate, blood pressure) and a pre-operative dental exam with or without X-rays.
Regional block: Surgeries involving a regional block (an injection similar to local anesthesia that blocks nerve transmissions rather than numbing the skin) will also involve a pre-operative exam and review of vital signs.
Monitored anesthesia care (MAC): This form of sedation, sometimes used with local or regional anesthesia to induce "twilight sleep," is delivered via an intravenous (IV) line that has been inserted into a vein in your arm. You will also be connected to an electrocardiogram (ECG) machine to monitor your heart rate and a pulse oximeter to monitor your blood oxygen.
General anesthesia: The same procedures as MAC are used but often with a more extensive range of pre-operative blood tests, including a complete blood count (CBC), comprehensive metabolic panel (CMP), and arterial blood gas (ABG) test.
During the Surgery
Once you are prepped and the appropriate anesthesia has been administered, the surgery can begin. It may be open surgery (an invasive procedure involving a large incision), endoscopic surgery (also known as "keyhole surgery"), or minimally invasive open surgery (involving a small incision and minimal tissue damage).
The surgery may also be classified as being reconstructive (to repair or correct structural abnormalities) or aesthetic (used for cosmetic purposes).
After the Surgery
Once the surgery is complete, you are taken to a recovery room or the post-anesthesia care unit (PACU), where you will be monitored until you are fully awakened from the anesthesia. With local anesthesia, this usually takes 10 to 15 minutes or so. With general anesthesia, it generally takes around 45 minutes.
Once your vital signs have normalized and you are able to walk stably, you can usually be taken home by a friend or family member. Some procedures may require a hospital stay of one or several days.
In addition to wound care instructions, you may be given pain medications to help ease post-operative pain as well as oral antibiotics to help prevent post-operative infection.
Recovery
In the same way that oral and maxillofacial surgeries can vary, so too can recovery times. While most people can return to work and normal activity within a few days of a wisdom tooth extraction, for example, those who undergo orthognathic surgery may take months before they are fully recovered.
Certain factors can increase or decrease recovery times, including your general health before surgery, how well you care for your surgical wound, and whether you or not you smoke.
Follow the recommended dietary plan, whether it is a soft diet or liquid diet, and work with a dietitian if needed to ensure proper nutrition. Surgeons often recommend eating smaller meals and snacks rather than a full meal for the first week or so as eating too much may irritate the surgical site.
Some oral and maxillofacial surgeries will require your jaw to be wired. Because you'll be limited to a liquid diet, you will need to rinse your mouth thoroughly after brushing, as well as rinse with salt water several times a day to remove bacteria from the gums and prevent plaque buildup.
People who undergo soft palate surgery may experience changes in speech articulation that require speech therapy to correct.15 In fact, any surgery of the jaw, tongue, or soft or hard palate can affect speech, either temporarily or permanently. A speech pathologist can help determine what, if any, treatment is needed.
Damage to branches of the trigeminal nerve is common following maxillofacial surgery, most cases of which resolve on their own over time. Severe cases may require medications and other treatments to block the nerve pain.
Some oral and maxillofacial surgeries require extensive rehabilitation to restore nerve sensations or the function of facial muscles. Similarly, some scars can take months of ongoing care to minimize their appearance or prevent the development of thick, raised patches (hypertrophic scarring).