Oral & Maxillofacial Surgery

It is a dental specialty which deals with the surgery of maxillofacial region – mouth, face and facial bones, neck etc

• Extraction of Badly damaged and broken teeth
• Impacted wisdom tooth surgeries
• Fractures of the facial bones and other injuries to the face (maxillofacial trauma)
• Orthognathic surgery (i.e.,Correction of deformities of jaw and facial bones, cosmetic surgeries etc)
• Infections, Cysts and tumors of the oro facial region
• Cleft lip and palate
• Biopsies in the oral and facial region
• Cancers of the oral and maxillofacial region
• Temperomandibular joint surgeries
• Rhinoplasty (cosmetic nose surgery)
• Dental Implants

TOOTH EXTRACTION / REMOVAL

Extraction is the removal of complete tooth or the tooth root with minimum damage to the adjoining structures.

When does a tooth need to be extracted?

• When the tooth becomes too loose ( in case of severe gum / bone disease ).
• Tooth with large cavity which cannot be filled.
• Broken teeth.
• Tooth with large underlying infection.
• Over retained deciduous / milk teeth.
• When a milk tooth is blocking the permanent teeth from coming up
• Impacted teeth. Wisdom teeth or others which may interfere with the orthodontic treatment.
• Teeth involved in pathologies like cysts / tumors.

 Is tooth extraction / removal painful ?

Extraction is a painless procedure in majority of the cases. This is done by injecting a local anaesthetic solution around the tooth being extracted, which blocks all the pain while preserving the other sensations.  The numbness may stay for an hour to 2 hours after which it gradually recedes.

Are stitches necessary?

Stitches are not needed for the majority of extractions which are straightforward. But sometimes when the tooth is difficult to remove( gums around the teeth need to be incised &opened) or multiple teeth are removed in one sitting, stitches may be required.

Does removal of teeth affects eye sight?

Removal of teeth in no case affects the vision of the person and is not related to whether an upper or lower tooth is being extracted.

What if an infected tooth is not extracted?

Infection from the tooth may start spreading into the surrounding bone and gums. The bacteria may multiply rapidly from there to form an acute infection causing swelling, fever, severe pain, difficulty in opening the mouth, formation of extraoral sinus with pus discharge. This infection if left untreated may progress on to deeper tissues of head and neck and become life threatening in severe cases.

What are the possible complications of tooth extraction / removal ?

Pain, infection, difficulty in mouth opening, dry socket etc are possible complications. But these are very rare when the procedure is done properly.

IMPACTED TEETH (IMPACTED WISDOM TOOTH REMOVAL SURGERY)

Wisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or “impacted” between the jawbone and the gum tissue. Impacted teeth can result in swelling, pain, and infection of the cheek & gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, we recommend to people with such teeth to undergo impacted wisdom tooth removal surgery.

It’s not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.

Wisdom tooth should be extracted in following conditions:

• Repeated history of pain
• Swelling
• Pus discharge
• Cavities in the Wisdom teeth
• Tooth positioned in a manner, which will likely cause problems in the future
• X-ray reveals
• Localised gum infection
• Damage to adjacent teeth

 Wisdom tooth should not be extracted in following conditions:

• Teeth erupted in healthy position
• No signs of cavities or gum diseases
• Teeth are very deeply impacted or in a very risky position and likely not to bother you for rest of your life

Is impacted wisdom tooth removal surgery very painful?

Impacted teeth removal (also wisdom teeth removal) is absolutely painless. It is slightly uncomfortable and tiring due to the length of the procedure. Some patients may experience some pain and discomfort post removal but it depends on:

• Your threshold for pain
• How difficult was your tooth removal?
• How long the operative procedure lasted?

You will be given a prescription post surgery, and as long as you follow the instructions pain and discomfort is minimal.

What kind of anaesthesia is required?

Generally, simple and uncomplicated procedures are usually performed under local anesthesia. However, patients with low pain tolerance and requiring complicated procedures can be done under general anesthesia also.

What are the restrictions following the impacted wisdom tooth removal surgery?

• We advise patients to avoid strenuous physical activity for 24 hrs following surgery, but no restrictions for routine daily activities.
• Smoking before and after surgery can cause dry socket or delayed healing. You should stop smoking completely until the extraction sockets heal, which may take couple of weeks.
• Similar restrictions apply for alcoholic and aerated beverages.
• There will be restriction on certain foods for 24 hrs as well.

 What about discomfort following the surgery?

• Some difficulty in opening your mouth wide is expected from the 1st post surgery day of the surgery, but this will gradually return to normal. Mouth opening exercises help open the mouth earlier.
• Some patients experience temporary difficulty or soreness when swallowing.
• You will experience swelling around your jaws at the site of surgery, which generally increases for 48-72 hrs following which it tends to subside. Swelling can vary tremendously among patients and between different procedures.

UNCOMMON COMPLICATIONS

• Numbness – The roots and jawbone surrounding the lower wisdom teeth can be positioned very close to the nerves that supply sensation to your chin, lip, and tongue. While removing lower wisdom teeth, these nerves can sometimes be stretched or injured so that even after the local anesthetic wears off, you might feel an altered sensation in your chin/lip/tongue. However, permanent numbness is a very rare condition and generally this condition heals by itself over a period of time.
• Oro antral communication – Sometimes the root of a deep seated upper tooth may be in close vicinity or within the maxillary sinus and a communication may occur between the oral cavity and the sinus during the extraction. This may heal by itself or can be managed efficiently by the oral surgeon.