something about Oral maxillofacial Surgery Reporter: Huang Hai- yun

questions 1）Talk about the risks and complications involved in the removal of third molars. 2）What is the instruction after tooth extraction? 3） Avoid all rinsing for 24 hours after extraction. Why?

Oral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is a recognized international surgical specialty.

In the U.S.A., Canada, Australia, and New Zealand, oral and maxillofacial surgery is one of the 9 specialties recognized by the American Dental Association, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons, training programs lead to the trainee obtaining qualifications in both Medicine and Dentistry.

In other parts of the world oral and maxillofacial surgery as a specialty exists but under different forms as the work is sometimes performed by a single or dual qualified specialist depending on each country's regulations and training opportunities available.

An oral and maxillofacial surgeon is a regional specialist surgeon treating the entire craniomaxillofacial complex: anatomical area of the mouth, jaws, face, skull, as well as associated structures. Maxillofacial surgeons are usually initially qualified in dentistry and have undergone further surgical training.

The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing. Integrated programs are becoming more available to medical graduates allowing them to complete the dental degree requirement in about 3 years in order for them to advance to subsequently complete Oral and Maxillofacial surgical training.

conditions require oral surgery Teeth extraction Dental implants Jaw-Related Problems Other Conditions

EXTRACTION  One of the main goals of modern dentistry is the prevention of tooth loss. All possible measures should be taken to preserve and maintain your teeth because the loss of a single tooth can have a major impact upon your dental health and appearance. However, it is still sometimes necessary to remove a tooth. Here are some of the reasons a tooth may need to be extracted.

reasons some of the reasons a tooth may need to be extracted. Severe Decay Advanced periodontal disease Infection Orthodontic correction Malpositioned teeth Fractured teeth or roots Impacted teeth

Impacted Teeth Wisdom teeth : third molars Complete Bony Impaction Partial Bony Impaction Other teeth:cuspids bicuspids

Wisdom teeth : third molars fails to emerge in proper alignment or fails to fully emerge through the gum line

Damage can result in swelling, pain, and infection of the gum tissue :pericoronitis. cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors Some dentists believe that wisdom teeth may push the other teeth in the mouth forward and cause crowding and misalignment of the lower front teeth.

Indication Extraction of third molars is generally recommended: When wisdom teeth only partially erupt;  When there is a chance that poorly aligned wisdom teeth will damage adjacent teeth;  When a cyst (fluid-filled sac) forms, destroying surrounding structures such as bone tooth roots. 

Risks and complications PAIN :treated with pain medication.  INFECTION : Patients are usually placed on prophylactic antibiotics to prevent infections from developing. SWELLING :vary between patients.  apply an ice pack or a cold towel to the outside of your face BLEEDING : controlled with the pressure of biting on gauze. 

POSTOPERATIVE INSTRUCTIONS 1)You will experience pain and swelling. This is usually normal after an operation of this kind. 2)Bite on a gauze pack for 15-20 minutes. 3）Avoid biting the lips/cheeks.

INSTRUCTIONS 4）Do not spit. Hard spitting, rather than wiping the inside of the mouth, can easily destroy the clot from forming. 5）Do not smoke. Chemicals in cigarettes can react with chemicals in your mouth and actually break down a clot. Try to avoid smoking for 48 hours at least.

INSTRUCTIONS Don’t eat until the anesthesia (numbness) has completely gone. Avoid warm food as it can result in bleeding. Eat only soft foods. When eating, try to chew your food on the opposite side of the mouth.

INSTRUCTIONS 6）Avoid all rinsing for 24 hours after extraction. This is to insure the formation of a healing blood clot which is essential to proper wound healing. Disturbance of this clot can lead to increased bleeding or the loss of the blood clot. If the clot is lost, a painful condition called dry socket may occur. You may use warm salt water or mild antiseptic rinses after 24 hours only if prescribed.

INSTRUCTIONS 7）Do not drink hot liquids like tea or coffee. Cool liquids are good for you though, so drink plenty of water. 8）cold fomentation for some patients to reduce the inflammation and swelling.

INSTRUCTIONS 9）DO NOT SPIT OR SUCK THROUGH A STRAW: This will promote bleeding and may dislodge the blood clot causing a dry socket. 10）If the pain has not receded in 48 hours, or if you have bleeding or foul odors, or you have a high fever,call your dentist and tell them about these symptoms

Dental implant .

WHAT？ The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Suitable candidates for dental implants need to have an adequate bone level and density,

Jaw-Related Problems Unequal jaw growth. Improve fit of dentures. Temporomandibular joint (TMJ) disorders.

Unequal jaw growth Orthognathic surgery the upper and lower jaw fail to grow properly. some of these problems – like improper teeth alignment – can be corrected with braces and other orthodontic appliances, more serious problems require oral surgery to move all or part of the upper jaw, lower jaw, or both into a new position that is more balanced, functional, and healthy.

Improve fit of dentures For first-time denture wearers, oral surgery can be done to correct any irregularities of the jaws prior to creating the dentures to ensure a better fit. Alveoloplasy Excision of torus Labio-buccal sulcus extention Ridge augmentation

Temporomandibular joint (TMJ) disorders. Dysfunction of the TMJ(TMD), the small joint in front of the ear where the skull and lower jaw meet, is a common source of headache and facial pain. Most patients with TMJ disorders can be successfully treated with a combination of oral medications, physical therapy, and splints. However, joint surgery is an option for advanced cases and when the diagnosis indicates a specific problem in the joint.

TMD symptoms Jaw pain or soreness that is more prevalent in the morning or late afternoon  Jaw pain when you chew, bite or yawn  Clicking when opening and closing your jaw  Difficulty opening and closing your mouth  Locked or stiff jaw when you talk, yawn, or eat 

TMD symptoms An earache without an infection Sensitive teeth when no dental problems can be found

Other Conditions Treated By Oral Surgery Facial injury repair. Lesion removal and biopsy. Cleft lip and cleft palate repair. Facial infections. Snoring/sleep apnea.

Facial injury repair Oral surgery is often used to fix fractured jaws and broken facial bones. There are 2 types of fractures:   open: The bone is exposed to air inside the mouth or outside the facial skin closed: The bone is completely covered by soft tissue. 

steps Three in the repair of most fractures. 1. Reduction of the fracture:  Realigning the bony parts in their original anatomic relationship.  2.Fixation of the fracture : Methods and materials are used to hold the bony parts in their correct relationship while healing occurs.    3.Healing and Rehabilitation:  This is the time that is allowed for healing and for physical therapy.  Adequate nutrition and rest, avoiding alcohol and, tobacco is very important. 

Lesion removal and biopsy .Oral surgeons can take a small sample of abnormal growth or tissue and then send it for laboratory testing for identification. Some lesions can be managed medically or can be removed by the oral surgeon. HEAD AND NECK SURGERY：tumor

Cleft lip and cleft palate repair Cleft lip and cleft palate result when all or portions of the mouth and nasal cavity do not grow together properly during fetal development. Oral surgeons work as part of a team of healthcare specialists to correct these problems through a series of treatments and surgical procedures over many years.

Facial infections Pain and swelling in the face, neck or jaws may indicate an infection. Infections in this area of the body can sometimes develop into life-threatening emergencies if not treated promptly and effectively. An oral surgeon can assist in diagnosing and treating this problem. Surgical treatment, if needed, may include cutting into and draining the infected area as well as extracting any teeth that might be involved.

Snoring/sleep apnea When conservative methods fail to alleviate this problem, surgery can be tried. Surgical procedures involve removing the soft tissues of the oropharynx (an area in the back portion of the mouth) or the lower jaw. Laser surgery is a newer treatment option. Depending on the surgical technique used, the laser is used to either slowly scar the palate, which tightens it, or to remove palate tissue.