Coastal Oral & Maxillofacial Surgery performs many different oral & maxillofacial surgery procedures. The information provided here is meant to help educate you about some of the most common procedures we offer, including what to expect before and after surgery.

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Wisdom Teeth

The last teeth to develop and appear in your mouth are your wisdom teeth, or “third molars”, which come in between the ages of 17 and 25, a time of life called the “Age of Wisdom.”

Many dentists recommend the removal of wisdom teeth. Most prefer to take them out before you have any problems. The surgery and recovery are easier if you get your wisdom teeth removed before you start having issues. Surgery and recovery are always easier the younger you are as well.

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Dental Implants

When it comes to replacing missing teeth, dental implants are often the best treatment option. Dental implants are long-term replacements that your oral & maxillofacial surgeon places in the jawbone, rather than using removable dentures, or using adjacent teeth as anchors like fixed bridges.

A Solution of Choice for Replacing Missing Teeth69% of adults ages 35 to 44 have lost at least one permanent tooth and by age 74, 26% of adults have lost all of their permanent teeth. Dental implants are used to fuse titanium metal with the jawbone which creates a long-term replacement. They won’t slip or make sounds that scream “false teeth,”. They won’t decay like teeth anchoring fixed bridges and bone loss is generally not a problem. The best part is, dental implants can last a lifetime.

Anatomy of a Dental Implant
Dental implants are made of titanium, that your surgeon fuses with the jawbone. It fits over the dental implant that from the gum line. The crown, is then fitted for a natural appearance.
A fixed bridge can be used for people missing a single tooth, but it can mean cutting the healthy teeth nearby. These adjacent teeth may or may not need to be restored in the future. Bridges don’t last as long as dental implants and may need to be replaced through the course of a lifetime. Removable partial dentures can also lead to the loss of adjacent teeth.

Bridges and Bone LossYour surgeon may place two or more dental implants if you are missing several teeth in the same area of your mouth. These replacement teeth attached to the implants for functionality and the prevention of slipping and bone loss. Dental implants have a success rate of about 95% and almost 50 years of clinical research, which is why they are a popular treatment option for replacing missing teeth.

Implants vs. Conventional Dentures
Dental implants allow for an enjoyable life without the restrictions many denture wearers face.

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TMJ

The temporomandibular joint (TMJ) allows the lower jaw (mandible) to move and function. It is a small joint located in front of the ear where the skull and lower jaw meet.

Symptoms
Earaches, headaches and limited ability to open the mouth are some of the symptoms of TMJ disorder. Other signs include clicking or grating sounds in the joint and/or pain when opening and closing the mouth.

Causes
Causes of TMJ include arthritis, an injury, grinding the teeth at night or the dislocation of the disk located between the socket and jawbone. Clicking or popping sounds, limited jaw movement and pain when opening and closing the mouth can be due to a displaced disk.

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Corrective Jaw Surgery

Corrective jaw surgery benefits those with an improper bite/misaligned teeth or jaws, injuries and birth defects.

Evaluating Your Need For Corrective Jaw Surgery
In order to have corrective jaw or orthognathic, surgery, your dentist, orthodontist and oral & maxillofacial surgeon will have to determine if you are a candidate. If you are, the oral & maxillofacial Surgeon chooses the appropriate procedure and performs the surgery. Most treatments include orthodontics before and after surgery and may take several years to complete.

What Is Involved In Corrective Jaw Surgery?
Orthodontic braces are used to move teeth into a new position before your surgery. You may feel your bite is getting worse rather than better, but when your oral and maxillofacial surgeon re-positions your jaw during surgery, your teeth should fit together properly.
Additional or updated records, including x-rays, pictures and models of your teeth, may be taken to help guide your surgery as your pre-surgical orthodontic treatment nears completion.

Corrective jaw surgery may be performed under general anesthesia in a hospital, ambulatory surgical center or oral & maxillofacial surgery office. Surgery can last one to several hours to complete.

The re-position of the jawbones is decided in accordance with your specific needs by your oral & maxillofacial surgeon. Sometimes bone may be added, taken away or reshaped. In order to hold the jaw in a new position, surgical plates, screws, wires and rubber bands may be used. Incisions are usually made inside the mouth to reduce visible scarring.

You will be provided with instructions for a modified diet (including solids and liquids, as well as a schedule for transitioning to a normal diet) and may be asked to refrain from tobacco products or avoid strenuous activity after surgery.

Medication easily controls pain after corrective jaw surgery. Patients are generally able to return to work or school from one to three weeks after surgery. The initial healing phase is about six weeks, while the complete healing of the jaws takes between nine and 12 months.

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Oral Cancer

It’s always best to stick to a regular self examination to detect oral cancer early on. Tobacco and/or alcohol use, poor oral hygiene, poor nutrition, irritation and chronic infections are all causes of oral cancer.

Perform a Self-Exam Monthly

Follow these steps when examining your mouth:

  • remove any dentures
  • look and feel inside the lips and the front of gums
  • tilt head back to inspect and feel the roof of your mouth
  • pull the cheek out to see its inside surface as well as the back of the gums
  • pull out your tongue and look at all of its surfaces
  • feel for lumps or enlarged lymph nodes (glands) in both sides of the neck including under the lower jaw

Early Detection and Treatment

Look for the following when self examining your mouth:

  • white patches of the oral tissues — leukoplakia
  • red patches — erythroplakia
  • red and white patches — erythroleukoplakia
  • a sore that fails to heal and bleeds easily
  • an abnormal lump or thickening of the tissues of the mouth
  • chronic sore throat or hoarseness
  • difficulty in chewing or swallowing
  • a mass or lump in the neck

If you have any of these symptoms, make an appointment with your oral & maxillofacial surgeon. They may suggest a biopsy to remove a piece of the suspicious tissue. If so, the tissue is sent to pathology laboratory for a microscopic examination to accurately diagnose the problem.

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Snoring and Sleep Apnea

Loud snoring can be a sign of obstructive sleep apnea (OSA), a life threatening disorder.

Snoring Is Not Necessarily Sleep Apnea

Sleep disturbances and waking up episodes doesn’t necessarily mean the person has OSA, that’s why it’s important to distinguish snoring and OSA.

Weight loss — as little as 10 pounds may be enough to make a difference.

Change of sleeping position — Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.

Avoid alcohol, caffeine and heavy meals — especially within two hours of bedtime.

Avoid sedatives Sedatives increase the tendency for airway obstruction.

Radio Frequency (RF) Radio waves can be used to shrink the tissue in the throat or tongue, while outer tissue remains unharmed. Long-term success of this procedure has not yet been determined.

Laser-Assisted Uvuloplasty (LAUP) is a surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This procedure is generally used to relieve snoring and can be performed in the Oral and Maxillofacial Surgeon’s office with local or general anesthesia.

Identifying & Treating OSA

Undiagnosed OSA risks heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido and can be life-threatening. The symptoms may be mild, moderate or severe and can cause daytime dizziness.

For those with sleep apnea, the upper airway can be obstructed by excess tissue, large tonsils or a large tongue, which alerts the body to wake the brain to restart the breathing process. This occurence repeats itself many times during the night and causes sleep deprivation and health-related issues.

Symptoms of Sleep Apnea

Other symptoms may include:

  • Snoring with pauses in breathing (apnea)
  • Excessive daytime drowsiness
  • Gasping or choking during sleep
  • Restless sleep
  • Problem with mental function
  • Poor judgment/can’t focus
  • Memory loss
  • Quick to anger
  • High blood pressure
  • Nighttime chest pain
  • Depression
  • Problem with excess weight
  • Large neck (>17″ around in men, >16″ around in women)
  • Airway crowding
  • Morning headaches
  • Reduced libido
  • Frequent trips to the bathroom at night

Diagnosing Sleep Disorders

If you notice any OSA symptoms, schedule an appointment with your oral & maxillofacial surgeon for a complete examination and diagnosis.

Your doctor will look for problems that might contribute to sleep-related breathing problems and interview household members about your sleeping and waking behavior. If the diagnosis is a sleep disorder, you may be referred to a sleep clinic to monitor your sleep patterns.

Treating Sleep Apnea

Your doctor will choose the right treatment for you, based on whether your OSA is mild, moderate or severe.

Behavior Modification - Your doctor may recommend non-medical treatments to reduce snoring if you are diagnosed with mild sleep apnea like weight loss, avoiding alcohol, caffeine and heavy meals and sedatives.

Oral Appliances - Recent studies show, patients with mild sleep apnea or unable to us C-PAP can use an molded oral appliance that is placed in the mouth at night to hold the lower jaw and bring the tongue forward. The appliance elevates the soft palate or retains the tongue to avoid falling back in the airway and blocking breathing by bringing the jaw forward.

Oral appliance should be checked by your oral & maxillofacial surgeon regularly to monitor compliance, to ensure the appliance is functioning properly and that symptoms are not worsening.

C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) - A C-PAP treatment can help patients with moderate OSA, using a mask that fits over the patient’s nose that moves pressured air to prevent the airway or throat from collapsing. This will prevent snoring and interruptions in breathing, but will not cure OSA. If you find you are unable to use these devices, don’t stop use without talking to your doctor, as your symptoms will return. Your oral & maxillofacial Surgeon can suggest other effective treatments.

Surgery for Sleep Apnea

Remember everyone’s nose and throat are shaped differently, so before surgery is considered your oral & maxillofacial surgeon will measure the airway and check for abnormal flow of air from the nose to lungs. Your doctor may choose one the following surgical procedures:

Uvulopalatopharyngoplasty (UPPP) – If the airway collapses at the soft palate, a UPPP may be performed on patients who are unable to tolerate the C-PAP. The UPPP procedure partially removes the uvula and reduces the edge of the soft palate to shorten and stiffen the soft palate.

Hyoid Suspension – If collapse occurs at the tongue base, a hyoid suspension may be use to secure the hyoid bone (U-shaped bone in the neck located above the level of the Adam’s apple) to the thyroid cartilage to help stabilize the region of the airway.

Genioglossus Advancement (GGA) – GGA treat obstructive sleep apnea by opening the upper breathing passage. This procedure tightens the front tongue tendon and reduces the degree of tongue displacement into the throat. This operation is often performed along at least one other procedure such as the UPPP or hyoid suspension.

Maxillomandibular Advancement (MMA) – MMA is a procedure that surgically moves the upper and lower jaws forward to open the upper airway. For some patients, the MMA is the only technique that can create the necessary air passageway to resolve their OSA.

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Facial Cosmetic Surgery

Women and men of all ages are choosing facial cosmetic surgery to improve their appearance and reduce the signs of aging and has long been the solution of choice for the correction of physical malformations resulting from aging, disease, injury and birth defects. Advanced medical devices and biomaterials makes facial cosmetic procedures minimally invasive, using local and/or intravenous anesthesia. Your doctor will choose the procedure best for you.

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Anesthesia

The more you know, the less you have to be anxious about.

Your oral & maxillofacial surgeon will review with you the type of anesthetic to be used, as well as the way you’re likely to feel during and after the operation. Be sure to discuss any concerns you may have. Local anesthesia, nitrous oxide-oxygen, intravenous sedation or general anesthesia may be used. Following surgery, you may be prescribed a medication for any discomfort you may have.

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Nutrition

In the past, patients undergoing jaw and fracture surgery had their jaws immobilized to promote healing by wiring or using elastic rubber bands to hold the teeth together. This technique is not as common, but may still be necessary in some cases. More commonly small screws and fixation appliances are used for accurate and predictable healing, which need not be removed following healing.

After surgery, swelling may make it difficult to consume any solid foods, so make sure to drink lots of liquids. You may also ask your surgeon about additional proprietary liquid nutritional supplements.

A 3-6 week+ non-chewing diet should be maintained until your oral & maxillofacial surgeon specifically approves a move to a more solid diet.

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