20 MountainGate Drive
Frederick, MD 21703
Oral & Maxillofacial Surgery
Oral and maxillofacial surgery corrects diseases, injuries, and defects in the hard and soft tissues of the oral and maxillofacial region.
They perform the following procedures:
Wisdom teeth are the third and final set of molars that emerge, usually during your late teens to early twenties. For some people the wisdom teeth emerge through the gums and have enough room to grow in naturally. For others, wisdom teeth often cause problems as they are trying to protrude through the gums. When a wisdom tooth is impacted the tooth is coming in at an angle and not straight through the gum line. This can cause pain, the tooth can come in unevenly, or the tooth may only emerge partially.
Impacted wisdom teeth can cause structural damage to the jaw and other teeth. They can also provide a place for bacteria to gather since they are hard to reach and clean. These potential problems make it necessary to remove impacted wisdom teeth so that larger problems do not arise. Routine x-rays during a dental exam can reveal if you will need to have your wisdom teeth removed.
Bone grafting is where the jawbone is built up to accommodate a dental implant or other restorative device. Bone grafting is a common procedure that is used frequently for dental implants and other periodontal procedures. The bone used to graph is taken from a sample from the patient. Many times, the bone is taken from another area of the mouth when drilling takes place. The bone fragments are suctioned from the mouth and used for the graft. Cadavers bone fragments are also used. They are harvested by bone banks and are a very safe source for bone donation.
Platelet Rich Plasma (PRP)
Medical research has demonstrated that using our own blood cells, accelerates healing and tissue regeneration in all forms of surgery. Specifically, platelets, plasma, and white blood cells are used for this procedure. The protein that is carried by the platelets is the magic ingredient that is being used in numerous private office settings for wound healing and various surgical procedures, including oral surgery.
As we only use innovative procedures in our offices and procedures, we routinely use platelet rich plasma (PRP) in oral surgeries that involve hard and soft tissues, derived from the patient. The plasma proteins are collected in the office in a short procedure which only takes a few minutes. The use of PRPs in surgery ensures that the patient has the best opportunity to successfully heal from their surgery. For patients who have a history of complications arising from hard and soft tissue regenerations, PRP is instrumental in surgical success.
Orthognathic surgery is typically performed by oral and maxillofacial surgeon or a craniofacial surgeon, with an orthodontist assisting. The purpose of Orthognathic surgery is to ensure that the necessary structure exists in the mouth so that the orthodontic treatment will be successful. Orthognathic surgery usually involves the jaw bones, where modifications are done by cutting the bones of the mandible or maxilla and putting them back together properly aligned. The surgery is performed under general anesthetic and the teeth are wired together after surgery so the jaw can heal correctly. Usually, the incisions are made inside the mouth and not in the skin.
After a car accident or other facial trauma, you may require surgery to correct the damage. Oral and Maxillofacial surgeons are specially trained to perform all types of surgery that is needed after facial trauma. Facial trauma can be repaired in a local hospital or outpatient surgery center. Some of the types of facial trauma, which may require surgery, include facial lacerations, knocked out teeth, broken or fractures cheek, nose, jaw, or eye socket.
Facial trauma causes a high degree of physical and emotional trauma to the patient. Correcting facial trauma requires special training and an in depth understanding of the long term functioning and appearance of the face. Oral and Maxillofacial surgeons take into consideration the patient’s prior appearance and any permanent damage that will affect the results.
Oral Pathology is the specialty that identifies and treats diseases of the mouth and maxillofacial region. Diagnosis is completed through radiographic, microscopic, biochemical and other in office examinations. Oral pathologists provide biopsy services for dentists and offer clinical their diagnosis based on their findings. Some of the diseases that Oral pathologists diagnose include mouth and throat cancer, mumps, salivary gland disorders, ulcers, Odontogenic Infection, and others.
Using oral surgery to help sleep apnea seeks to remove the excess tissue in the throat that is vibrating and blocking the upper air passages. One surgical procedure is an Uvulopalatopharyngoplasty (UPPP). This procedure involves removing the excess tissue from the upper mouth and throat. This procedure in performed in a hospital under general anesthesia. Maxillomandibular advancement is another type of procedure used to assist with sleep apnea. This procedure involves the upper and lower part of the jaw. In this procedure, the jaw is moved forward from the rest of the facial bones. This allows more room behind the soft palate, thereby reducing the obstruction. Finally a Tracheostomy is a last ditch effort when other treatments have failed. This involves the surgeon inserting a tube in your throat so you can breathe. It is covered during the day, but opens at night while you sleep. All of the aforementioned surgeries are routine and very safe.
Wisdom teeth extractions are a fairly common procedure. Wisdom teeth often cause problems as they are trying to protrude through the gums. When a wisdom tooth is impacted, it means the tooth is coming in at an angle and not straight through the gum line. This can cause pain, the tooth can come in unevenly, or the tooth may only emerge partially.
When a wisdom tooth only emerges partially a flap of skin, called an operculum, may form over the tooth. This can make the tooth hard to clean, and pieces of food may be caught under the skin. This makes it easy for an infection, called pericoronitis, to develop. It will usually go away on its own, but it causes swelling and pain in the area.
Impacted teeth and wisdom teeth that can potentially cause problems, like infections, need to be removed. Extractions can range from a single tooth, to removing all four wisdom teeth at once. Based on the preference of the doctor and/or the patient, a local anesthetic could be used to numb the areas where the teeth will be extracted. Others will prefer to go under a general anesthetic so that they will be sedated during the procedure.
The gum tissue around the wisdom tooth is cut open to reveal the tooth. The tooth is loosened by gripping it tightly and wiggling it back and forth until it can be lifted out of the gums. Sometimes a tooth may be impacted so tightly that it cannot be simply lifted out of the gums. In cases like this the tooth will be broken up into pieces first before being removed. Depending on the incision and extraction site, sutures may be needed to close the area. Soluble sutures are the best option, which will dissolve on their own.
After the surgery you will need to rest. You need to be driven home by a friend or family member because of the anesthesia. You can expect for the extraction site to bleed for a little while after the surgery. Gauze will be applied at the completion of the surgery, and you will need to change it when it becomes soaked. If bleeding continues for longer than 24 hours you should call your dentist. Rest when you return home, but do not lie flat. This could prolong the bleeding. Prop your head up on a pillow when lying down. Your dentist will prescribe you pain medication, so if you become sore take as directed. You can also use an ice pack for the pain. Your dentist might also provide you with a cleaning solution to clean the extraction site.
You will be limited to soft foods for a few days after your surgery. Some recommended foods are:
- Mashed Potatoes
- Ice Cream
- Thin Soups
- …and other food you can eat without chewing.
When drinking, make sure you do not use a straw. The sucking motion can loosen your sutures and slow the clotting process. The same goes for smoking. If you have prolonged pain, bleeding, irritation, or don’t feel that the extraction site is healing properly call your dentist for a follow up.
Extraction Site Preservation
When removing a tooth it is important to consider what will be done with the empty space after that tooth is removed. Wisdom teeth are in the back of the mouth, so that site will heal on its own with no complications. If it is necessary to remove another tooth, plans must be made. If a tooth is removed and nothing is done with the extraction site, the jawbone will degenerate and change shape during healing and can cause your teeth to shift. This can create problems in your bite and affect your ability to speak and chew.
If you want to fill the space with a dental implant, a sturdy jaw bone is necessary to install the implant. If you opt for a dental bridge, the bridge must be molded and placed before the teeth shift.
Your dentist is always open to a conversation on what you would like to do with your extraction site before removing a tooth. They will be able to make a recommendation and layout a treatment plan. Make sure to schedule follow up appointments to properly care for your extraction site.
PATIENT INSTRUCTIONS – AFTER TOOTH EXTRACTION
1) Continue to Bite Firmly on this cotton for ____ hours (until _____________).
2) Change to Bite Firmly on new cotton for ____ hours (until _____________).
3) DURING THESE ABOVE _______ HOURS that you are biting on cotton, HOLD ICE against the extraction(s) side of your face – Use only ___ ice cube(s) in plastic bag; when ice melts dispose of water and get new ice.
IMPORTANT – IF YOU GET A JAW MUSCLE SPASM/PAIN, DO THE NEXT 2 ITEMS:
a) Every 15 minute cycles – Use Ice for 10 minutes and Moist Heat for 5 minutes.
b) Repeat “Slowly Stretching Mouth Wide Open” every 5 minutes and as needed.
4) AFTER THESE ABOVE _______ HOURS:
a) Remove and throw away the cotton – No More is normally needed.
b) Remove the ice against your face – No More is normally needed.
c) EAT Ice Cream, Milk Shakes, Sherbet, or Yogurt (something cold).
5) TODAY PLUS THE NEXT 2 DAYS:
a) No Rinsing out – This is Aggressive and Harmful to healing tissue.
b) No Spitting out – Swallowing is OK and normal.
c) Brush your teeth using only water so you can swallow the water.
d) No Smoking or use of any tobacco products in any form.
6) IF YOU HAVE PAIN TODAY OR THE NEXT 2 DAYS:
a) Take “ONE ASPIRIN” Tablet together with “ONE TYLENOL” Tablet starting today at _______________ when you change the cotton in your mouth, and repeat every 4 – 6 hours as needed for your pain.
b) IF this does not take care of your pain, it is important to Telephone me at (301) 662-0100 – If Voice Mail answers, very clearly leave BOTH your name and telephone number so that I can return your telephone call. REMEMBER TO CALL ME IF YOU NEED TO.
7) STARTING TOMORROW – FOR MINOR PAIN AND SWELLING:
Use only Moist Heat on these tender areas – (Do Not Use Ice). For 2 days have warm food, soups, and tea – (Do Not Use Cold Food/Drink).
I, UNDERSIGNING PATIENT, HAVE HAD THESE INSTRUCTIONS READ AND EXPLAINED TO ME, AND A COPY GIVEN TO ME TO TAKE HOME TODAY. I UNDERSTAND THAT I NEED TO DO EACH OF THESE INSTRUCTIONS FOR PROPER AND TIMELY HEALING TO TAKE PLACE.
INSTRUCCIONES DEL PACIENTE – DESPUES DE UNA EXTRACCION DENTAL
1) Continue mordiendo firmemente sobre este algodon por ____ horas (hasta ___________).
2) Cambie a morder firmemente sobre un nuevo algodon por ____ horas (hasta __________).
3) DURANTE ESTAS ______ HORAS que usted esta mordiendo el algodon, SOSTENGA HIELO sobre el lado de la cara donde le hicieron la extracción. Ponga cubitos de hielo ___ sólo en una bolsa de plástico, cuando el hielo se derrite disponer de agua y obtener cubitos de hielo nuevo.
IMPORTANTE – SI TIENE ESPASMO MUSCULAR O DOLOR, INCLUYA LOS DOS SIGUIENTES DETALLES:
a) Cada ciclo de 15 minutos – Use hielo por 10 minutos y calor humedo por 5 minutos.
b) Repita “Poco a poco extiende la boca abierta” cada 5 minutos y cuando sea necesario.
4) DESPUES DE LAS ________ HORAS ANTES INDICADAS:
a) Remueva el algodon y botelo – Normalmente no es necesario mas algodon.
b) Remueva el hielo de su cara – Normalmente no es necesario aplicar mas hielo.
c) COMA helado, batido de leche, sorbete o yogurt (algo frio).
5) HOY Y LOS DOS DIAS SIGUIENTES:
a) No enjuague su boca – Es Agresivo y dañino a la curación del tejido.
b) No escupa – deglución es correcto y normal.
c) Cepille sus dientes usando agua que usted pueda tragar.
d) No fume ni use productos de tabaco de ninguna clase.
6) SI TIENE DOLOR HOY O EN LOS PROXIMOS DOS DIAS:
a) Tomese UNA PASTILLA DE ASPIRINA junto con UNA PASTILLA DE TYLENOL
Comenzando hoy a ____________ cuando cambie el algodon de la boca, y repita esto cada 4 – 6 horas como sea necesario para el dolor.
b) Si esto no le alivia el dolor, es importante que me llame por telefono al (301) 662-0100 – Si le, sale la maquina contestadora, deje AMBOS su nombre y numero de telefono para que yo pueda devolverle su llamada. RECUERDE LLAMARME SI ES NECESARIO.
7) EMPEZANDO MANANA – PARA DOLORES E INFLAMACION MENORES:
Use Calor Humedo solo en las partes adoloridas – (No use hielo). Durante 2 días tienen comida caliente, las sopas y el té – (No utilice la comida fría o bebida).
YO, EL PACIENTE QUE FIRMA DEBAJO, HE RECIBIDO ESTAS INSTRUCCIONES LEIDAS Y EXPLICADAS, Y UNA COPIA DE LAS MISMAS ME HA SIDO ENTREGADA PARA LLEVAR A MI CASA HOY. YO ENTIENDO QUE TENGO QUE SEGUIR CADA UNA DE ESTAS INSTRUCCIONES PARA QUE UNA CURACION APROPIADA Y A TIEMPO TENGA LUGAR.