Oral Surgery
What counts as oral surgery and what does it entail?
Oral Surgery
The term oral surgery is a broad one, covering all surgical processes related to your gums, jaw, teeth and any surrounding tissues or structures.
These procedures include gum grafts, implants, extractions, sleep apnoea moderation and cleft lip and palate reparations, plus any other jaw-related surgeries.
Usually, this work is conducted by an oral and maxillofacial surgeon or sometimes a periodontist, both of which must also complete 3 to 4 years of extra training once they leave dental school to then qualify as an authorised specialist.
What does an oral and maxillofacial surgeon do?
This is a specialised area within dentistry that oversees the care of all treatments relating to the face and jaw.
Part of this governance is to treat disease and injuries sustained in sites around the mouth and teeth.
They undergo rigorous extra training of at least 3 to 4 years within a hospital-based setting on top of standard dental experience to qualify for this task.
This incorporates all parts of the surgical procedure including the administration and monitoring stages of all types of anaesthesia.
Types of procedure an oral surgeon specialises in
Tooth impaction
Ordinarily affecting the third molars, or wisdom teeth, these teeth emerge through the gumline usually between the ages of 17 and 21.
The problem occurs when there isn't enough room for them in an already established oral setup, and thus they don’t come out fully and remain ‘impacted’.
This can result in soreness and infection of nearby tissue, which in turn can result in significant damage to adjacent teeth, gums and even bone and lead to the initial stages of tumour formation or cysts that can literally destroy the jaw and/or teeth if not attended to promptly.
There are also occasions when other teeth can become impacted such as the cuspids or ‘canine teeth’ which sit on either side of the incisors) and bicuspids (between the molars and cuspids) so it is important to be aware and watchful for this issue anywhere in your mouth.
Tooth extraction
The most frequently performed of today’s surgeries is tooth extraction, which is commonly recommended in the case of severe tooth decay, dental impact or trauma, wisdom tooth issues, and gum disease (periodontitis).
On other occasions, an extraction may be needed to correctly fit dentures or some other prosthetic aid.
As a general rule, a good dentist will choose to save natural teeth whenever possible but there are times when an extraction is absolutely necessary, and this would be thoroughly discussed with you prior to any surgery being arranged.
Issues of the jaw joint
An intricate connection of tissues and bone the temporomandibular joint connects the jaw to the skull.
When this isn't fully coordinated it can present problems like jaw clicks, stiffness, locking, tension and headaches, plus related neck problems and some studies even suggest some swallowing issues (dysphagia) can also be traced back to the jaw.
Treatments and management methods include medications, splints, physical therapy plans, and in some advanced cases corrective jaw joint surgery may be needed.
Also known as orthognathic surgery, corrective jaw surgery will also be used when skeletal deficiencies are present such as abnormal bone structure.
This procedure is usually recommended in the case of displaced chewing operation, or when addressing a facial misalignment.
These surgeries are also a standard method of lessening the pain resulting from temporomandibular joint dysfunction (TMD).
Overbite and Underbite
When teeth and/or jaw are misaligned, orthognathic surgery may be recommended.
An orthognathic surgeon is a specialist that looks at problems such as chewing issues, swallowing difficulty, speaking, eating, breathing and sleep apnoea. Sometimes a specialised oral appliance may be inserted, while on other occasions, jaw correction may offer the best course of action, both of these will be covered in greater detail later in this article.
Improved denture fit
Before wearing dentures for the first time, oral surgery can be performed to correct any way in which the jaw structure is unsuitable for the fitting of dentures.
Jaw surgeries can also be used to create longer-term bone support, or even add a bone graft to areas requiring support.
Cancer treatments
Oral surgery can also treat certain types of cancer, this branch of surgery is broad-reaching, and includes the head and neck, salivary glands, sinuses, throat, larynx and lips.
Dental implants
Broadly considered the best and most reliable tooth replacement choice, dental implants are the most likely to remain intact.
Comprised of small threaded pillars, usually made of medical grade titanium or zirconium oxide (zirconia), these measures are stronger than porcelain and can also maintain smoother edges over time.
These ‘pillars’ are bedded into the jawline as a replacement for a tooth's missing roots, and the whole area is then given time to heal.
Once healing is complete, they are then restored with other oral procedures such as dental bridges, crowns or dentures.
Dental bone graft
This procedure is needed when the jaw area has encountered some bone loss, this might be for a few reasons, one of which is missing teeth.
When you have all of your natural teeth, the nerves of the root are actively responding to their upkeep, and this keeps the jaw fully engaged, this in turn relates a message to the neural response which sends nutrients to the jaw to supply it with the necessary chemicals to keep it healthy and strong.
If a tooth has been lost, over time the missing roots do not generate the required nerve stimulation and therefore do not receive those required nutrients.
A dental bone graft serves to create density and heft to your jawbone to provide a foundation on which dental implants can be built.
Another frequent bone graft use is when periodontitis (gum disease) causes the bones around your teeth to diminish. In this instance, teeth and oral structures can begin to move a lot more than desired and a bone graft helps to reduce this movement and aid oral health and stability.
Sleep apnoea
Sleep apnoea is the result of tissues around the back of the throat retracting and causing airway blockage during sleep.
OSA or Obstructive sleep apnoea, to give it its full title, is often treated with oral appliance therapy or using a CPAP machine while sleeping.
Oral appliance therapy is used where mild to moderate OSA is present and is achieved using an oral Mandibular Advancement Device (MAD).
The oral Mandibular Advancement Device is a specific treatment that aims to temporarily push the jaw and tongue into a more advanced forward position, this in turn reduces constriction on the throat and provides greater airway space which can both prevent both sleep apnoea and snoring.
A CPAP machine or Continuous Positive Airway Pressure machine creates mild air pressure and has the effect of keeping the airway continuously open.
When it comes to either of these suggested treatments, a highly qualified sleep specialist and a dental technician with experience in oral appliances should collaborate when making this determination.
If neither of these methods are appropriate for your sleep apnoea then surgical intervention may be needed.
One such surgery is Uvulopalatopharyngoplasty, otherwise called UP3 (UPPP) is a process whereby tissues are removed to create a wider airway thus allowing air to move through the throat much more easily.
Periodontal Surgery
In cases of moderate or severe periodontitis, urgent treatment may be needed to prevent further damage to teeth and neighbouring tissues and oral structures.
Periodontal surgery involves making incisions at specific points along the gumline and pulling the tissue temporarily back from the teeth.
The roots of the teeth are then thoroughly cleaned and scraped, the removed plaque, tartar and bacteria flushed away, after which the originally pulled back gum tissue is replaced and sutured.
Gum graft for receding gums
Gum recession is ever prevalent in today’s world of harsh chemicals both in the air around us and in the food and drink we consume.
The gum grafting procedure involves bolstering an area of lost tissue with donor tissue. This ‘donor’ tissue is either taken from the roof of your own mouth or procured from an authorised tissue bank and simply built into the area where the tissue loss has occurred and is then left to heal.
Repairs to cleft lip and palate
On rare occasions, a baby can be born with an opening in their upper lip, which is referred to as a cleft lip, while on other occasions the opening can be in the roof of their mouth known as a cleft palate.
On very rare occasions they can be born with both of these conditions.
These conditions are the byproduct of under-developed facial structures before birth.
In these cases, surgery may be necessary to aid normal eating function and allow for correct speech as they grow older.
Surgery for a cleft lip
The surgeon makes an incision on either side of the cleft to create a flap of tissue, these flaps are then stitched to each other and after healing should create a normal lip appearance, sometimes the nasal tubes will also need surgery and this will be done at the same time.
Surgery for a cleft palate
For palate repair, much in the case of cleft repair, incisions are made around the cleft, muscle and tissues are then repositioned, and the area is then stitched and left to heal.
In some cases, there may be the risk of fluid build-up in the ears which can cause varying levels of hearing loss. In these cases, small tubes are fitted into the ear to widen the space and allow the smooth passage of any fluid.
What happens prior to oral surgery?
At the evaluation appointment your dental practitioner will fully investigate your teeth, jaw joints, jawline, gums and all affected oral structures, X-rays will usually be taken to get a clearer and more precise view of nerves, roots and jawbone.
The results of these tests will illustrate the best way forward.
Where does oral surgery take place?
Often, these procedures are performed at your dentist's office as an outpatient. In these instances, you may be offered sedation such as medications, nitrous oxide or IV solutions.
In more severe or complicated cases, a hospital visit will be needed under local or general anaesthetic.
How long does it take?
This will depend on multiple factors including the type of surgery, the number of teeth, whether you will be sedated and how difficult the procedure is.
As a guideline, a single tooth extraction may take around 30 minutes, while corrective placement may take between 2 and 4 hours.
What happens after surgery?
Immediately after your procedure, you will be given detailed instructions on how to care for and monitor the affected area.
It is essential that these instructions are followed to the letter as they prevent the risk of postoperative infections such as infection or bleeding, both of which can render the surgery ineffective or indeed create even more severe issues.
From an insurance perspective
If you have dental or medical insurance, please be sure as to the exact procedure required and under which umbrella it falls, often the cause of the damage is determinant in this such as an accident that requires a hospital visit.
If not in an NHS setting, this would often fall under medical insurance and not dental insurance!
The details are key and it can be a costly scenario.
As an overview, some dental insurance will cover some hospital procedures, and some medical insurance will cover some dental procedures, and it's important to know what your policy extends to.
Reasons to have oral surgery
In the normal way, your teeth, gum and all parts of the jaw are naturally synchronised in perfect harmony and built to maintain optimal health and function.
Unfortunately, this intricate oral machine does not always stay that way as the strains and stresses of life begin to take their toll, and this is when oral surgery can become necessary.
Common risks and complications
As with any surgery, there is always some risk and dental procedures are no different, please be aware of the following and report any of the tell-tale signs.
Potential risks include:
Injury to neighbouring teeth
Injury to roots
Injury to jawline
Infection
Fragmentation of tooth roots
Numbness
Sinus issues
Dry socket (disruption of a setting blood clot after extraction)
Should any of the above problems arise, it is a matter of urgency that a dentist, doctor or hospital be notified immediately.
For a full list of potential problems, please consult your dental technician as there may be some further things to discuss based on your oral situation that are not covered here.
Most if not all of these risks can be greatly minimised by following the aftercare guidelines specified by your dentist.
What is the healing time and future prognosis
Healing times vary depending on the type of surgery of course and how your body responds to trauma, but generally, oral recovery takes from around a week up to 2 weeks in some cases.
Medications should be provided for the length of your recovery but if the pain, redness or swelling is of a significant level despite taking the medications as prescribed it is important you contact a medical professional and be seen promptly.
Returning to daily activities
Returning to your daily life and routine such as school or work should be possible within 3 days, once again, more complicated procedures require longer respite for the area to fully heal before duress, so in the case of more extensive care such as corrective jaw surgery, it could take longer.
Eating after oral surgery
During the initial recovery stages, the pressure on the teeth and jaw must be minimised, so hard or crunchy foods should be temporarily removed from your shopping list.
Better foods that are both healthy and soft in texture may include:
Pasta
Soup
Mashed vegetables
Fish
Yoghurt
Another option might be something a little colder that may help to soothe any resulting inflammation or swelling.
If problems arise
In the following instances, it is essential that your healthcare team be contacted immediately. This could mean that something has come unstuck in the post-operative stage, or may even be already infected.
Key things to watch for are:
Pain at the site
Redness
Excessive swelling
High temperature
Anything that doesn’t seem right and isn't going away
Where to go if you suspect developing dental issues
Where possible, speak to a dentist first, that have a more broad understanding of facial and oral mechanics and treatments.
However, if it feels like an emergency either before or after treatment, a & e may be the faster option or a walk-in centre, the rule here is that you need to alert someone the same day or night and as fast as you possibly can.
In the case of normal developing issues though without emergency presentation, the dentist is your best route of care, and to assess if further oral surgery is required.
Life Dental and Wellbeing, here to help
There are of course many other questions and concerns that you may have about oral surgery and its pros and cons.
Here at Life Dental and Wellbeing, we strive to be a leading source of advice and therapy as well as being an industry leader in our own field of dentistry.
Should you have any enquiries about any of the above, or indeed any dental health queries, our expert team will have the answer or point you in the right direction, so please call us on 01392 278843, or email us at lifedentalandwellbeing.co.uk and we’ll get back to you with an answer as soon as we can.
Wishing you a good day and happy oral health.
