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The Oral and Maxillofacial Surgeon

Oral & maxillofacial surgeons are surgical specialists in the dental profession. On account of their surgical & dental background, oral & maxillofacial surgeons are very uniquely qualified to perform procedures that involve the aesthetic & functional aspects of the mouth, teeth, jaws and face. 

Oral & maxillofacial surgeons undergo extensive education and training in various surgical procedures that involve soft tissue (skin & muscle) and hard tissue (bone & cartilage) and they are very finely attuned to creating the perfect balance between facial appearance & function.

Training and Scope of Practice

After completing dental school, all Oral & Maxillofacial Surgeons complete a minimum of 4 years of training in any hospital-based surgical residency programs alongside the medical residents in general surgery and anesthesia as well as other specialties such as otolaryngology, plastic surgery & emergency medicine.

Their training almost exclusively focuses on the hard (i.e., bone) & soft (i.e., skin, muscle) tissues of the jaws, face and mouth. Based on their residency program, certain surgeons might opt to earn a medical/other advanced degree. Some of them might complete fellowships in their sub-specialty areas. At the end of this highly- demanding program, oral & maxillofacial surgeons are very well-prepared to:

At the conclusion of this demanding program, oral and maxillofacial surgeons are well-prepared to:

- Manage diseases related to the teeth & their supporting soft & hard tissues
- Diagnose & treat facial pain
- Surgically reconstruct any  inadequate bone structure that lies in the jaw area
- Evaluate and plan a course of treatment as well as place dental implants to replace 1/2/ all missing teeth
- Expertly treat head & neck trauma as well as injuries to the teeth, mouth, face and jaws
- Diagnose & treat oral cancer as well as other diseases of the  maxillofacial region
- Perform various facial cosmetic procedures that enhance facial appearance & function
- Diagnose & surgically treat OSA
- Perform corrective jaw-surgery to improve function & appearance of patients who have conditions such as the cleft lip & palate

Office Surgery and Anesthesia

Oral & maxillofacial surgeons are very unique among the non-anesthesiology practitioners in healthcare, as they train with anesthesiologists & anesthesiology residents. This level of training is not required in any other medical or dental specialty. Resultantly, oral & maxillofacial surgeons are the sole healthcare specialists, apart from anesthesiologists, who administer all different levels of sedation & general anesthesia. Anesthesia that is administered in an OMS office could range from conscious sedation, to general anesthesia and deep IV sedation. The level of the anesthesia administered is very carefully-matched to the individual needs of the patient & the kind of procedure that has to be performed. Here are some surgical procedures that oral & maxillofacial surgeons perform:

Dentoalveolar surgery - This is the surgical management of different diseases of the teeth & their supporting soft & hard tissues.

Tooth Extractions - Oral & maxillofacial surgeons have vast surgical training & experience in diagnosing as well as extracting teeth. Whether this extraction is simple/complicated by impaction, disease/infection, the surgical skills that these surgeons have, make them the best choice for a patient in need.

Wisdom Teeth (Third Molars) - A tooth which does not break fully through gum tissue or fails to emerge is called an “impacted” tooth. Though this is quite a common problem related to third molars, other teeth may also be impacted.

Orthodontic Surgery - There are times when a patient will be referred by their dentist to an oral & maxillofacial surgeon for some surgical procedure or extraction.

Preprosthetic Surgery - Oral & maxillofacial surgeons are experts when it comes to preparing the mouth for placement of a partial/complete denture, and in ensuring a comfortable fit. Since dentures rest on the ridge of a bone, it is crucial that this bone be of the right shape and size. At times, excess bone will have to be removed/recontoured even before the dentist inserts the denture. In these cases, oral & maxillofacial surgeons might perform 1/ more of these:

- Bone smoothing & reshaping
- Removal of the excess bone
- Bone ridge reduction
- Removal of excess gum tissue
- Skin grafting skin/grafting of specialized gum tissue

Dental Implants

Over 25 years ago, oral & maxillofacial surgeons pioneered placement of dental implants. To date, they are the leaders in providing innovative techniques which offer patients natural-looking and long-lasting results that last for a lifetime.

Oral & maxillofacial surgeons are highly-trained and experienced when it comes to successfully placing dental implants. They are also able to treat patients who are considered to the “high risk” because they are suffering from gum disease, chronic health conditions, and jawbone loss.

Here are some of the procedures that oral & maxillofacial surgeons provide to assure the best-possible outcome:

Immediate Loading – Today, the advances in dental implant technologies allow OMSs to successfully extract teeth & place implants with the crowns in just one visit

Bone Grafting - Oral & maxillofacial surgeons are the sole dental specialists who are trained to obtain & place bone grafts in the areas where there is very little/no bone. Bone grafts can be used to enhance implant sites which do not have the required bone. These grafts are used  in the treatment of bone loss that results from congenital defects, traumatic injuries or tumor surgery

Sinus Lift – This is a bone grafting procedure which may at times be performed when there is inadequate amount of bone in the upper jaw of the patient and cannot accommodate a dental implant.

Oral & maxillofacial surgeons are highly-skilled in evaluating the unique needs of their patients & developing the appropriate treatment plan. Whether a single tooth is being replaced or the entire mouthful of teeth need replacement, oral & maxillofacial surgeons can perform this dental implant surgery very comfortably in their office setting.

Reconstructive Surgery

Some people have inadequate bone structure in their lower and/or upper jaws and this could be a result tumor surgery, injury or trauma long-term denture wear. Bone grafts from the patient’s own bone/bone substitutes can be used to improve the quality & quantity of the hard tissue. The soft tissue and skin grafts corrections can significantly improve the soft tissues’ architecture in the oral & maxillofacial region.

Via oral reconstructive surgery, a very solid foundation can then be provided for the dental rehabilitation of the patient. In turn, this helps nutrition and speech. In case the patient is a suitable candidate, dental implants might used to replace his/her lost teeth & other structures. Implants can be used to anchor oral & facial prostheses.

Facial Trauma

Oral & maxillofacial surgeons are the experts in treating & repairing facial trauma. This includes fractures of the lower and upper jaws as well as orbits around the eyes & facial lacerations. Their vast knowledge of how the jaws come together is crucial while repairing highly-complex facial fractures.

As a matter of fact, the guidelines set by the American College of Surgeons, for optimal care need Level I & II trauma centers- These treat the complex & serious facial trauma patients, to have oral & maxillofacial surgeons on call to perform the complex reconstruction of the jaws, mouth and face. In addition, a number of the techniques that are considered to be standard in current day  hospital ER’s  were developed by oral & maxillofacial surgeons in different  combat hospitals during WWII, Korea, Vietnam & today's international conflicts.

Trauma results from certain major events like combat and automobile accidents. But childhood facial injuries that are caused by sports, skateboards, and bicycle accidents also frequently involve dental/maxillofacial trauma. Younger children tend to sustain damage to the teeth/supporting structures from falls. Using safe & effective sedation techniques allows these traumatic injuries to be very effectively treated in the oral & maxillofacial surgery office, and avoids expensive emergency room visits.

Oro-Facial Pain

Malocclusion, infection, TMJ, nerve pathology or tumors can cause oro-facial pain. Oral & maxillofacial surgeons are well-trained to diagnose the entire spectrum of conditions which might cause pain in the face or mouth to provide the required medical/surgical treatment.

Facial Infections

Pain & swelling in the jaws, face or neck might indicate an infection. Sometimes this can also develop into life-threatening emergency in case it is not treated promptly & effectively. An oral surgeon is skilled in diagnosing & treating this particular problem. If surgical treatment is required, it may include draining that infected area & eliminating the source of that infection.

Lesion Removal and Biopsy

Oral surgeons are also trained to identify any abnormal growths/tissue via the clinical examination of the mouth – they will also evaluate X-rays. The surgeon can remove a biopsy for lab examination/ remove the complete pathology.

Other Pathologies

TMJ Disorders

The TMJ is essentially a hinge & gliding joint. It is also one of the most constantly-used joint in the human body. The condyle is the rounded upper-end of the lower jaw which is the movable portion of this joint and the articular fossa is the socket. A displaced disk might produce clicking/popping sounds and limit jaw movement. The person may also feel pain when opening & closing the mouth. TMJ can be caused by cartilage displacement/injury, osteoarthritis, rheumatoid arthritis, or stress.

Oral Pathology

Oral & maxillofacial surgeons are also trained to perform biopsies of benign & malignant lesions that appear in the maxillofacial region. They are experts in the microscopic & clinical diagnosis of disorders that involve the mouth & jaws. The oral lesions include cancers and benign tumors, growths of the tooth origin & ones which arise in the salivary glands, local & systemic infections and manifestations of carious systemic disorders.

Today, oral cancer is not just a disease that middle-aged patients who have smoking & alcohol consumption histories, suffer from. Now, oral & maxillofacial surgeons are seeing an increase in the number of oral cancer patients in the 20-30 years age group.  It is considered that the growing use of smokeless-tobacco & the increase in Human Papillomavirus (HPV) cases are responsible for this situation.  Oral & maxillofacial surgeons stress that early-detection & treatment of oral lesions significantly improve the prognosis of the patient. The lesions can be managed surgically and/or medically.

Oro-Facial Deformities

Differences in the skeletal growth between the lower and upper jaws might result in problems with speech, chewing, swallowing or TMJ performance. The patients might also experience certain psychological difficulties that stem from esthetic & social concerns.

Corrective Jaw Surgery - Oral & maxillofacial surgeons also perform corrective jaw surgery and produce a much more balanced & functional skeletal structure for a patient. These are generally performed along with treatment by an orthodontist & restorative dentist, and the corrective jaw surgery is carried out in a hospital/ambulatory surgical center and under general anesthesia.

Certain common growth abnormalities, including jaw under/over-development of (prognathia, micrognathia, retrognathia) & bad bite (skeletal malocclusions) can’t be corrected via orthodontia alone. They have to be addressed via corrective surgery.

Some common growth abnormalities, including under or overdevelopment of the jaws (prognathia, micrognathia, retrognathia), and skeletal malocclusions (bad bite) cannot be corrected through orthodontia alone. They must be addressed through corrective surgery.

Congenital ReconstructionCongenital deformities such as the palate and the cleft lip occur when all/a portion of the oral-nasal-cavity doesn't grow together in the fetal development stage. Oral & maxillofacial surgeons play a very important role in this carefully orchestrated, multiple-stage correctional-program that is designed to help in the restoration of the jaw & facial structures that lead to normal function & appearance. Care & treatment take into consideration factors such as appearance, function, speech, nutrition, hearing, as well as emotional & psychological development.

Snoring/Obstructive Sleep Apnea

Almost 45% of the population experience obstructive-breathing patterns in their sleep. These problems can include snoring as well as periods of true apnea, where the person stops breathing for a short span of time. OSA causes daytime drowsiness. This can result in lost productivity, accidents, and problems in interpersonal relationships. The symptoms could be mild/moderate/severe. It can also result in cardiovascular disorders such as hypertension, arrhythmias & congestive heart failure. Oral & maxillofacial surgeons are expertly trained to diagnose & treat this condition. When the conservative methods are unsuccessful in correcting the problem, surgery might be performed to treat hard and/or soft tissues.

Facial Cosmetic Surgery

Oral & maxillofacial surgeons have a surgical & dental background and they are able to reconstruct facial structures that are damaged via trauma. Oral & maxillofacial surgeons are very keenly aware of how important the harmony between the facial appearance & function is. Many current-day facial cosmetic procedures can also be performed on an out-patient basis in the oral & maxillofacial surgeon's office.

Some facial cosmetic surgery might need the use of an out-patient or the same day surgery center/hospital. Based on the procedure, the surgery can be performed under IV sedation, local anesthesia/ general anesthesia.

Reprinted with permission from American Association of Oral and Maxillofacial Surgeons.