Specialist Surgery of the Mouth, Face & Jaws Here at AOMS, we provide a comprehensive range of surgical procedures and treatments for patients with oral and maxillofacial conditions, which include:
dentoalveolar surgery
Removal of teeth
Removal of wisdom teeth An impacted wisdom tooth can damage neighbouring teeth or become infected. It can also invite bacteria that lead to gum disease.
Untimely removal of impacted wisdom teeth can lead to problems such as infection, decay, crowding, damage to adjacent teeth, cysts and line of weakness in the jaw bone. As it is in an area that’s hard to clean, it can also invite bacteria that can lead to gum disease. Oral bacteria can also lead to more severe conditions. As it can travel through your bloodstream and lead to infections and illnesses, it can affect your heart, kidneys and other organs.
Removal of wisdom teeth is routine in most cases. Usually, you can return to work 5-7 days after surgery. A follow-up appointment is unnecessary for most people.
Why remove them? Mainly, wisdom teeth should be surgically removed due to:
infection,
decay
food-trapping
cyst formation
to assist orthodontics
to avoid likely future problems
to avoid more difficult tooth removal when older
Exposure of teeth
Apicectomy
Transplantation of teeth
Fibrotomy (Precision) Fibrotomy is a minor procedure which helps to reduce the incidence of rotated teeth returning to their original position after the braces are removed. During orthodontic treatment, the fibres holding the teeth are stretched, and when the braces are removed, they may pull the tooth back around again. The fibrotomy disrupts these fibres and reduces the likelihood of this occurring.
Frenectomy Frenectomy is a minor procedure to remove a band of skin and fibres that can pass down from the lip between the two upper front teeth resulting in spacing between these teeth. This space can open up again after being closed by orthodontic treatment. Commonly 3-4 dissolving stitches will be used, which dissolve in 7-10 days.
These procedures are carried out with a local anaesthetic used by your Dentist or School Dental Nurse for fillings. The numbing paste is placed on the gums beforehand to make it more comfortable. You must remember not to bite or chew on your lip if it is numb, as it will be very painful afterwards! Healing after the surgery is quick. However, you may notice a fine red line on the gum for 1-2 days. To help to heal, start bathing the mouth the next day with warm saltwater. You can put a half teaspoon of table salt in a glass of warm water, holding in the mouth for 1 minute and repeating three times a day for a week.
You should try to keep your teeth as clean as possible. Continue wearing your orthodontic elastics and any appliance(s) that you were before the procedure. Orthodontic plates should be left out on the day of the procedure but should be worn again that evening.
maxillofacial trauma
Fractured teeth
Fractures of the mandible, maxilla, zygomatic complex, orbit, frontal sinus
Soft tissue trauma
Maxillofacial trauma is any injury to the face or jaws. It may present with skin lacerations, burns, obstruction to the nasal cavity or sinuses, damage to the orbital (eye) sockets, fracture to the jawbone, and missing or broken teeth. The most common causes of this type of trauma are sports, accidents (automobile and workplace), penetrating injuries, and violence. The treatment for maxillofacial trauma varies and depends upon the type and severity of the injury. Part of the procedure is a careful and systematic evaluation of structure and systems and includes a comprehensive physical exam and x-rays. In some cases, the diagnosis and treatment must be postponed until the swelling subsides or until more severe injuries are resolved. The knowledge of how jaws come together (dental occlusion) is vital when repairing complex facial fractures. Here at AOMS, we are Oral and Maxillofacial Surgeons with expertise in treating and repairing facial injury and trauma, which include fractures of the upper and lower jaws and the orbits surrounding the eyes, and facial lacerations.
dental implants
Dental Implants Dental implants are a long term solution to replace missing teeth, support a fixed bridge (and eliminate the need for a removable partial denture) or anchor a full denture. Advancements in implant materials and techniques continue to improve the success rate of implants, which more and more patients are enjoying its benefits. Who provides dental implant treatment? The placement of dental implants requires specialized knowledge, training, skills and facilities. Oral and Maxillofacial Surgeons best do the surgery. They are specialists with advanced education and training in the complexities of the bone, skin, muscles and nerves involved, ensuring you get the best possible results. Your dentist can often provide the crowns, bridges and dentures which attach to the implants. For more complex cases, this work is provided by a specialist restorative dentist (prosthodontist).
Orthognathic surgery
Abnormalities of the jaw & face
Chin & jaw reconstruction
Orthognathic surgery refers to "straightening of the jaw(s) using surgery" [ortho – straight, gnathic – jaw(s)]. Whereas orthodontic treatment corrects the position of the teeth, orthognathic surgery, on the other hand, positions the bones of the jaws (maxilla/mandible). Orthognathic surgery is performed to correct a wide range of minor and major skeletal and dental irregularities such as misalignment of jaws and teeth. This type of surgery can improve chewing, speaking and breathing. Although the surgery can dramatically enhance the patient's appearance, orthognathic surgery is performed to correct functional problems.
One or both jaws may be surgically repositioned during the one operation. The procedure involves making cuts (osteotomies) in the bones and moving the cut segments into their predetermined position under a general anaesthetic. The surgery is usually preceded by a period of orthodontic treatment. This ensures both the teeth and the bones will be in their correct position after the surgery. Finally, a short period of orthodontic treatment is then usually required to complete the alignment of the teeth.
Any surgery carries potential risks. With orthognathic surgery, the significant risks include bleeding, reduced blood supply to the osteotomised jaw segments, infection, unfavourable bone cuts/splits, permanent numbness/tingling to lips, cheeks, and teeth, incorrect positioning of the jaws/segments, jaw joint problems, and damage to teeth. Your Surgeon will discuss these with you in more detail during your consultation appointments in the Rooms. Please remember, however, that in most cases, any associated problems are minor and can be quickly attended. A positive approach is critical both before and after jaw surgery. Various studies support the fact that positive thinking can assist the body during the process of healing. The support of your family in the days and weeks following your surgery will also aid your recovery.
Before Surgery A pre-anaesthetic consultation and examination, coupled with investigations such as blood tests, may be required before surgery. Your admission to Quay Park Surgical Centre or Ormiston Hospital usually is on the day of surgery. The necessary anaesthetic and hospital forms need to be completed and returned before this. If you wish to talk with the anaesthetist before your admission, this can easily be arranged. The anaesthetist may want to meet with you beforehand if any issues are arising from your anaesthetic questionnaire or your pre-operative investigations. You must not have anything to eat or drink for 6 hours before your surgery. If you are a smoker, you are advised to stop two weeks before your operation. On the day of surgery, you should take all your usual medication (unless otherwise instructed) with a small sip of water. NOTE: If you are diabetic and/or are taking blood-thinning medicines (e.g. Aspirin) you will need to discuss this with your surgeon or anaesthetist. Normally, Aspirin should be stopped 10 days before your operation. All herbal remedies, including St. Johns Wort, Arnica and Garlic, should be discontinued 1 week beforehand.
After surgery Your doctor will provide you with instructions to help with your healing and recovery, and advice which include:
Diet - You will be provided with detailed dietary information.
Oral hygiene - A mouthwash will usually be prescribed.
What should be avoided, such as tobacco and strenuous activities
Medication prescriptions such as pain relievers, antibiotics, and a nasal spray if needed.
When to return to work or school, which usually takes one to three weeks
Follow-Up Appointments A review appointment will be made, usually 1 week after the surgery. This is typically followed by appointments at approximately 1 month, 3 months and 1 year postoperatively, at which time further facial x-rays are taken. Initial jaw healing generally takes about six weeks after surgery, but complete healing can take up to 12 weeks. You will also continue to see your orthodontist afterwards, and they will usually take more study models and photographs after 3 months. Your orthodontist finishes aligning your teeth with braces after the initial jaw healing. The entire orthodontic process, including surgery and braces, may take several years. Once the braces are removed, retainers to hold tooth position may be used.
TEMPOROMANDIBULAR JOINT
Functional disorders
Internal derangement
The small joint located in front of the ear where the skull and lower jaw meet is called the temporomandibular joint (TMJ). This joint allows the lower jaw to move and function.
Problems with the TMJ and the nearby soft tissues and muscles can cause a variety of symptoms including earache, headache, jaw stiffness, clicking and grating noises, pain on chewing, and an abnormal bite. When symptoms of TMJ trouble appear, you should consult an oral and maxillofacial surgeon (OMS). As specialists in the areas of the mouth, teeth and jaws, your OMS can correctly diagnose the problem.
Diagnosing TMJ disorders can be diagnosed from the history and clinical examination. Diagnosis can be complex and may require further investigations using different diagnostic procedures, such as:
Plain x-rays
Blood tests
Arthrography
Arthroscopy
CT scan
MRI scan
Bone scan
Individual imaging studies of the joints may be ordered, and appropriate referral to other dental or medical specialists or a physical therapist may be made. Overview of the Treatment of TMJ problems TMJ disorders and their associated structures are common and do not result in ongoing or chronic issues. The majority of TMJ problems do not require surgery.
Internal disorder and myofascial pain occur most commonly. Management should be kept as simple (and reversible) as possible. Symptoms associated with these disorders tend to come and go and often resolve spontaneously. Simply resting the joints by avoiding harmful habits such as gum chewing or grinding of the teeth, adopting a soft diet and eating small portions can help. The application of localised heat (by way of a wheat bag or warm flannel) and the use of short-term anti-inflammatory pain-relief medication such as Nurofen can relieve symptoms. A custom made bite-splint, worn at night over the top teeth, will unload the joint and can aid recovery. Physiotherapy may also be recommended. TMJ arthrocentesis (joint wash-out) is a common procedure used to reduce pain and improve mouth opening for patients with the internal disorder.
Depending on the diagnosis, treatment may range from conservative dental and medical care to complex surgery and may be short-term non-steroidal anti-inflammatory drugs for pain and muscle relaxation, bite plate or splint therapy, and even stress management counselling. If non-surgical treatment is unsuccessful or if there is apparent joint damage, such as a torn disc or significant degenerative arthritis, open surgery may be required. Inflammatory forms of TMJ arthritis are often managed jointly by an Oral and Maxillofacial Surgeon and a Rheumatologist.
Dislocation, trauma, condylar hyperplasia, and ankylosis involving the TMJ usually require more complex surgical management.
Surgery procedure can either be arthroscopy, the method identical to the orthopaedic procedures used to inspect and treat larger joints such as the knee, or repair of damaged tissue by a direct surgical approach. Once your TMJ disorder is correctly diagnosed, your OMS can provide the best treatment to relieve the problem.
