Other Oral Surgery Procedures Surgery of the Gums (Periodontal Surgery) Most people are aware of how important it is to take good care of the gums with proper hygiene and regular checkups. In spite of attentive care to the gums, the gums surrounding teeth recede very slowly as we age. Gum recession can be accelerated greatly where there is a defect in the gum tissue from over-aggressive brushing or from periodontal (gum) disease. Unfortunately, as gum tissue recedes, so does the bone surrounding the tooth, leaving the tooth with less bone to anchor it into the jaw. Once roots are exposed by recession, the teeth may appear less attractive (this is how the expression "long in the tooth" came about) and the exposed root surfaces may also be quite sensitive to hot or cold foods or to the touch. This condition is corrected by replacing the gum tissue using a gingival grafting procedure. This will repair the defect and help to prevent additional gum and bone recession. During this procedure, we take gum tissue (gingiva) from your palate and graft it over the exposed root. This can be done for one tooth or several teeth, and it not only treats the functional problems with recession, but also evens out the contours of your gum line, leaving a more pleasing esthetic appearance. Before gum tissue grafting After gum tissue grafting A different type of gum tissue surgery called crown-lengthening is sometimes needed to facilitate restorative and cosmetic dentistry, or to improve the appearance of your gums and teeth. This is done when not enough of the tooth is showing above the gums. In this case, your teeth or roots may actually be the proper lengths, but are simply covered by too much gum tissue. On a front tooth, this can result in an unaesthetic or "gummy" appearance of a tooth or of several teeth. Esthetic crown-lengthening is sometimes needed on one or several front teeth to set the gumline at a more natural and attractive level. If a tooth that is decayed or broken below the gum line, too little of the tooth is visible and exposed for your restorative dentist to adequately prepare the tooth for the restoration. In the crown lengthening procedure, we adjust the gum and bone level to expose more of the tooth, allowing the tooth to be restored properly with a filling or a crown or bridge. In this circumstance, the procedure is done more for functional reasons. Before crown-lengthening surgery After crown-lengthening surgery Treatment for Dental and Facial Trauma Oral and Maxillofacial Surgeons are uniquely qualified and experienced to manage and treat dental and facial trauma. Although most injuries are minor and are most easily and conveniently treated in our office, Dr. Stout is on staff at St. John’s Regional Medical Center, should the injury be severe enough to require treatment in an operating room. For children, various sedation techniques can be employed to deliver comfortable and safe treatment for injuries. When soft tissue injuries such as lacerations occur on the face, they are typically repaired by placing sutures (stitches). In addition to our goal of the best cosmetic result possible, care is taken to inspect for and treat injuries to such key structures as facial nerves and saliva glands and ducts. Fractures of the bones of the jaws and face are treated in a manner similar to the fractures in other parts of the body. When an arm or a leg is fractured, a cast is often applied to stabilize the bone and allow for proper healing. Since a cast cannot be placed on the face, we stabilize the fracture by wiring the jaws together. More severe fractures of the jaw are best treated and stabilized by the surgical placement of small bone plates and screws at the involved site. This allows a patient to return to normal function more quickly. Injuries to the Teeth Isolated injuries to teeth are quite common. Children often sustain damage to teeth during falls, sports, and skateboarding or bicycle accidents. Such traumatic injuries can usually be effectively treated in our office, avoiding the inconvenience and cost of an emergency room visit. In order to repair teeth which have been displaced or "knocked out," we carefully repositioning the teeth and splint the teeth until they are healed. Splinting stabilizes the unstable teeth by securing them to the adjacent healthy teeth for several weeks. If a permanent tooth is "knocked out", it should immediately be placed in cold milk, or better yet, back into the socket (We don’t typically attempt replantation of baby teeth). The sooner the tooth is re-inserted into its socket, the better for the survival of the tooth. The patient should be seen in our office as soon as possible. Although gentle rinsing is advisable, never attempt to wipe the tooth off, since the living cells of the tooth ligament may be injured or killed, lessening the success of replantation. After the acute treatment in our office, we may call upon other dentists such as an endodontist, who may be asked to perform root canal therapy, or a restorative dentist, who may need to repair or rebuild fractured teeth. In the event that injured teeth can not be saved or repaired, dental implants are typically utilized to replace traumatically lost teeth. TMJ Disorders and Facial Pain A common cause of facial pain and headaches is disease or problems of the temporomandibular joint (TMJ). This is the joint of the lower jaw as it hinges on the base of the skull. Temporomandibular joint disorders have a wide range of symptoms that may include earaches, headaches, limitation of jaw opening, or locking of the jaw. Patients may also complain of clicking or grating sounds in the joint or pain when opening or closing the mouth. Causes of TMJ dysfunction can be degenerative arthritis, trauma to the TMJ, inflammatory conditions such as rheumatoid arthritis, or grinding of the teeth. Many patients experience a combination of disorders of the muscle and the joint. We often see patients suffer a crescendo in any of these symptoms during times of stress. An accurate diagnosis can be quite challenging, and involves your careful history, a clinical examination, and special imaging studies such as Xrays, CT scans, or MRIs. Once a specific problem is identified, we can make appropriate recommendations for treatment. Conservative treatment using a soft diet, anti-inflammatory medications, physical therapy or bite splint therapy is utilized first. These measures are particularly effective with muscular disorders. With certain conditions, particularly derangements within the joint itself, joint surgery may be appropriate. Arthrocentesis and arthroscopic joint surgery are two minimally invasive procedures that have proven effective in the resolution of most derangements of the joint. These procedures can be done on an outpatient-surgery basis at our office or a hospital surgery center under general anesthesia. More complex joint surgery may rarely be indicated for advanced conditions. Oral Pathology and Infections The inside of the mouth is normally lined with a special type of skin called mucosa that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign of a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or pre-cancerous growth: Reddish patches or whitish patches in the mouth A sore that fails to heal and bleeds easily A lump or thickening on the skin lining the inside of the mouth Chronic sore throat or hoarseness Difficulty in chewing or swallowing These changes can be detected on the lips, cheeks, palate, gums, and tongue, and even on the skin. Pain does not always occur with pathology and, curiously, is not often associated with oral cancer. However, oral pain without an obvious cause or reason may be a serious problem, and should be investigated. Do not ignore any unusual tissues, lumps or sores. If indicated, we will perform a biopsy or other test can be performed to arrive at a definitive diagnosis and an appropriate treatment plan. Early detection and treatment of precancerous lesions is very important to the prognosis. Lesions may be managed medically, but are generally surgically excised in our office. Treatment of Dental Infections A toothache is a minor infection of the tissues inside and surrounding a tooth. If not treated promptly and effectively, infections in the jaws and face can develop into life-threatening emergencies. Pain and swelling in the face, jaws, or neck very often indicates an infection of dental origin. For minor infections, evaluation and treatment are done in our office. For more severe infections, appropriate imaging studies and antibiotic sensitivity tests may be needed. For both minor and severe infections, our treatment may include antibiotics, drainage of infectious fluid, and sometimes extraction of involved teeth. One very common type of dental infection is a deep cavity that invades the pulp or nerve and extends to the tip of a tooth root. In most cases these infections can be treated successfully using endodontic or root canal treatment. This is the best choice for a tooth that is otherwise healthy and stable. However, one of the shortcomings of endodontic treatment is the difficulty of treating the very tip of the tooth, since the access is from the crown end, and the instruments used to clean out the infection are so tiny. In those cases where endodontic treatment has failed to completely clean out the infection, a root canal surgery is often needed to clean out the infection at the very tip of the root and to seal it with a small filling. This is called an apicoectomy and retrofill procedure. Xray after apicoectomy and retrofill procedure. The apicoectomy and retrofill serves as a last resort procedure; since the only other option for an infected area at the root tip is extraction. This common procedure is carried out in our office with a recovery similar to that of a tooth extraction.