Dental Procedure Blog series
The following series of blogs will cover the different areas of dentistry. The aim is to
simplify and explain the jargon that patients encounter in the normal course of dental
visit. It is based on the Ontario Dental Association’s procedure categories and
descriptions.
Oral and Maxillofacial Surgery
Oral and Maxillofacial surgery encompasses a lot of territory. Sugery may be performed
in a general practice setting, oral surgery clinic or hospital.
Exodontia is the removal of teeth from the mouth. Removals may be straight forward. A
tooth that requires sectioning and bone removal to facilitate the extraction is considered
complicated.
Removals cover fully erupted teeth, i.e. teeth that have grown into the mouth, partially
erupted teeth and remaining roots. Each of these may be straight forward or
complicated by either the medical or dental circumstances of the patient.
Removals also refer to fractured parts of teeth. These are usually retained by gum
tissue, move and can’t be ‘reattached’ to the tooth.
When removing teeth, the alveolar ridge (the bone under the gum) may be sacrificed. It
may be fused to the tooth, fracture or crumble, or be removed for access to the tooth
during the procedure. When a replacement of any type is contemplated the ridge
becomes important from reasons of support to aesthetics. In this situation various forms
of alveolar ridge preservation and or augmentation is performed using a variety of
techniques.
Surgical exposure of teeth is usually done for orthodontic reasons. The aim is to help
the tooth move into the mouth in the correct location. The developing tooth must have
the bone covering it removed enough to have an orthodontic bracket attached.
Surgical movement of teeth i.e. transplantation/repositioning may also be done for
various reasons from orthodontics and aesthetics, to better functioning.
Remodeling and recontouring of oral tissues usually involves reshaping the bone or the
alveolus as it is known. The procedure is called an alveoplasty. When only the soft
tissues are reshaped it is referred to as gingivoplasty when done to the gums and
stomatoplasty when the other soft tissues of the mouth are involved.
Reconstruction of the alveolar ridge may be necessary after trauma to the face and
jaws. The alveolus is the foundation of the dental structures and is crucial for
rehabilitative treatments.
Oral surgeons are generally the specialty involved in the surgical treatment and removal
of tumors in the mouth whether benign or malignant. This is referred to as Surgical
excision . Other pathological entities that are excised are cycsts and granulomas .
If there is a large external facial swelling present that is the result of trauma or infection,
it may be surgically incised and drained to help resolve the swelling as these may be life
threatening.
Exploration of pathologic entities may be needed to arrive at a diagnosis and
appropriate treatment. As in general surgery, sometime s the only sure way to
determine what is happening is to see it firsthand.
When there is trauma to the oro-facial complex and fracture parts are splinted and
stabilized, the opposing jaw maybe used as the splint. As in any fractured bone the
pieces are reduced, that is, brought back together before splinting.
Trauma is usually accompanied by tissue cuts and tears needing laceration repairs.
Hemorrhage control is also a component of trauma management and all oral surgeries.
It may however be a major concern for certain patients and require more involved
intervention.
Oral surgeons also manage jaw joint (tempormanibular , TMJ) issues from fractures to
dislocations. Facial sinus (antral ) surgery, frenectomy ( the releasing of muscle poorly
located attachments) , implant placement and post surgical care all fall into the bailiwick
of the oral surgeon. This survey is a brief review of the scope of oral surgery.
Next blog we will address orthodontics.