The Oral and Maxillofacial Surgeon
Oral and maxillofacial surgeons are the surgical specialists of the dental profession. Their extensive education and training, surgical expertise and unparalleled understanding of esthetics and function uniquely qualify them to treat the conditions, defects, injuries and esthestic aspects of the mouth, teeth, jaws and face. Patients who complain of pain or problems in this area are routinely referred to an oral and maxillofacial surgeon for help.
Training and Scope of Practice
Following dental school, oral and maxillofacial surgeons complete a minimum of four years in a hospital-based surgical residency program. They train alongside medical residents in anesthesiology, internal medicine, general surgery, otolaryngology (Head & Neck surgery), plastic surgery and emergency medicine. Their training focuses almost exclusively on the hard (ie, bone) and soft (ie, skin, muscle) tissue of the face, mouth, and jaws. Depending on the residency program, some surgeons may also choose to earn a medical or other advanced degree. Some may also complete fellowships in sub-specialty areas.
At the conclusion of this demanding program, oral and maxillofacial surgeons are well-prepared to:
- Manage diseases of the teeth and their supporting soft and hard tissues.
- Surgically reconstruct inadequate bone structure in the jaw area.
- Evaluate, plan a course of treatment and place dental implants to replace one, two or a mouthful of missing teeth.
- Expertly treat head and neck trauma and injuries to the face, jaws, mouth and teeth.
- Diagnose and treat facial pain.
- Diagnose and treat oral cancer and other diseases in the maxillofacial region.
- Perform corrective jaw surgery to improve the function and appearance of patients with such conditions as cleft lip and palate and other congenital defects.
- Diagnose and surgically treat obstructive sleep apnea.
- Perform facial cosmetic procedures to enhance facial appearance and function.
Office Surgery and Anesthesia
Oral and maxillofacial surgeons are unique among non-anesthesiology practitioners in health care, in that they train with anesthesiologists and anesthesiology residents. No other dental or medical specialty requires this level of training and, as a result, oral and maxillofacial surgeons are the only healthcare specialists, aside from anesthesiologists, to administer all levels of sedation and general anesthesia. Anesthesia administered in the oral and maxillofacial surgery office ranges from conscious sedation, to deep IV sedation and general anesthesia. The level of anesthesia administered is carefully matched to the specific needs of the patient and the type of procedure that is to be performed.
Oral and maxillofacial surgeons pioneered the placement of dental implants more than 25 years ago, and are still the leaders in providing the innovative techniques that offer patients long-lasting, natural looking results that last a lifetime.
Oral and maxillofacial surgeons have the training and experience to successfully place dental implants in most patients, even “high-risk” patients suffering from chronic health conditions, gum disease or bone loss in the jaw area.
Following are some of the procedures provided by oral and maxillofacial surgeons to assure the best possible outcome:
Immediate Implants – Advances in dental implant technology allow oral and maxillofacial surgeons to extract teeth and place implants in one visit.
Bone Grafting – Oral and maxillofacial surgeons are the only dental specialists trained to obtain and place bone grafts in areas where little or no bone exists. Implant sites that lack the necessary bone can be enhanced with the use of bone grafts. Bone grafts are also used to treat bone loss resulting from traumatic injuries, tumor surgery or congenital defects.
Sinus Lift/Augmentation – A sinus lift is a bone grafting procedure that is sometimes performed when the amount of bone in a patient’s upper jaw is inadequate to accommodate a dental implant.
Oral and maxillofacial surgeons are skilled in evaluating their patient’s unique needs and developing an appropriate treatment plan. Whether they are replacing a single tooth or a mouthful of teeth, oral and maxillofacial surgeons can perform dental implant surgery comfortably in the office setting.
Dentoalveolar surgery is the surgical management of diseases of the teeth and their supporting hard and soft tissues.
Tooth Extractions – Oral and maxillofacial surgeons have extensive surgical training and experience in diagnosing and extracting teeth. Whether the extraction is simple or complicated by impaction, disease or infection, their surgical skills make them the obvious surgeon of choice for the patient in need.
Third Molars (Wisdom Teeth) – A tooth that fails to emerge or fully break through the gum tissue is, by definition, “impacted.” While this is a common problem associated with third molars, or wisdom teeth, which are the last teeth to develop and erupt into the mouth, other teeth can also become impacted.
Orthognathic Surgery – Often a patient is referred to an oral and maxillofacial surgeon for an extraction or another surgical procedure in preparation for orthodontic treatment, such as extraction of over-retained baby teeth or the exposure of unerupted teeth.
Preprosthetic Surgery – Oral and maxillofacial surgeons are experts at preparing the mouth for the placement of a partial or complete denture; ensuring a comfortable fit. Because dentures rest on a bone ridge, it is very important that the bone is the proper shape and size. Occasionally, excess bone must be removed or recontoured before the denture is inserted. In such cases, oral and maxillofacial surgeons may perform one or more of the following procedures:
- Bone smoothing and reshaping
- Removal of excess bone
- Bone ridge reduction
- Removal of excess gum tissue, and/or
- Grafting of skin or specialized gum tissue
Oral and maxillofacial surgeons are trained to perform biopsies of both benign and malignant lesions in the maxillofacial region, and are experts in the clinical and microscopic diagnosis of disorders involving the mouth and jaws. Oral lesions include benign tumors and cancers, growths of tooth origin and those that arise in the salivary glands, infections (both local and systemic) and manifestations of systemic disorders.
Oral surgeons are trained to identify abnormal growths or tissue through a clinical examination of the mouth and the evaluation of X-rays. Since the mouth is a most accessible area, the surgeon can either remove a representative sample (biopsy) for laboratory examination, or remove the entire pathology.
Oral cancer is no longer a disease experienced by the middle-aged patients with histories of smoking and alcohol consumption. Today oral and maxillofacial surgeons are seeing a growing number of oral cancer patients in their 20s and 30s. A growing use of smokeless tobacco and a rise in Human Papillomavirus (HPV) cases are considered responsible for this situation. Oral and maxillofacial surgeons stress that early detection and treatment of oral lesions greatly improve the patient’s prognosis. Lesions may be managed medically and/or surgically.
Reprinted with permission from American Association of Oral and Maxillofacial Surgeons.