Oral and Maxillofacial Surgeons are specialists of the dental profession. Their extensive education includes a hospital- based surgical residency program. They train alongside medical residents in internal medicine, general surgery, and anesthesiology, and also spend time in otolaryngology, plastic surgery, and emergency medicine. Depending on the residency program, some surgeons may also choose to earn a medical or other advanced degree.
After completion of this demanding program, oral and maxillofacial surgeons are prepared to:
- Manage diseases of the teeth and supporting hard and soft tissues
- Surgically reconstruct inadequate bone structure in the jaw area
- Evaluate, treatment plan and place dental implants to replace missing teeth
- Treat head and neck trauma and injuries to the face, jaws, mouth and teeth
- Diagnose and treat oral cancer and other diseases in the maxillofacial region
Facial Trauma Management
Maxillofacial injuries encompass any injury to the mouth, face and jaw. Most maxillofacial injuries are caused by a sports mishap, motor vehicle accident, on-the-job accident, act of violence or an accident in the home.
If a person is unconscious, disoriented, nauseated, dizzy, or otherwise incapacitated, call 911 immediately. If these symptoms are not present, the person may be transported to the nearest hospital.
Oral and Maxillofacial Surgeons Treat injuries to teeth, mouth, jaws and facial structures.
At the hospital, the patient may be seen by a team of medical personnel, and may include on oral and maxillofacial surgeon. One of the most common serious injuries to the face occurs when bones are broken. Fractures can involve the jaws, cheekbones, eye sockets and combinations of these bones. Since injuries can affect sight and the ability to breath, hospitalization is required.
When treating facial fractures, parts of the bone must be lined up (reduced) and held in position long enough to permit healing. Extensive and complex maxillofacial fractures require multiple incisions to expose the bones and a combination of wiring or plating techniques may be used. During the healing period, the jaws may be wire shut. A liquid or pureed diet will help the healing process and maintaining nutritional health.
Not all facial injuries are extensive, but they are critical to breathing, eating, speaking and seeing. Since avoiding injury is the best policy, Dr. Lebsack recommends the use of seat belts, protective mouth guards, and appropriate face masks and helmets for everyone who participates in athletic events at any level.
In the event a facial or mouth injury may require a trip to the emergency room, an oral and maxillofacial consultation is recommended. In some cases, a “hidden” injury may go unnoticed.
Dentoalveolar surgery includes teeth extractions, bone contouring, exposure of teeth for orthodontic purposes, and denture preparation(pre-prosthetic surgery). This treatment can be done under local anesthesia (numbing medicine), conscious sedation or general anesthesia. Recent x-rays from your dentist may be used, or a panoramic x-ray may be indicated to identify vital structures in the area of the surgery.
Depending on the nature of the procedure and level of post-operative discomfort will dictate when the patient resumes normal activity. Post-operative pain medicine and antibiotics (if indicated) will be prescribed after treatment is complete. Post-operative instructions will be provided as a guideline to your home recovery.
Wisdom Teeth Extraction
The majority of Dr. Lebsack’s patients who come to him on a daily basis don’t usually need to have any major surgical procedure performed. Most of them just need to have their wisdom teeth or other non-restorable teeth extracted.
“A lot of people have trouble with their wisdom teeth,” Dr. Lebsack explained. “Most people experience problems around their late teens and early twenties. The wisdom teeth may be partially blocked and cause infection or crowd adjacent teeth and may damage those teeth. Your dentist should refer you to an Oral Maxillofacial Surgeon for a consultation and possible removal between 16 and 21 years of age.”
Where are Your Wisdom Teeth Now?
Wisdom teeth, or third molars, are usually the last teeth to develop. They are located in the very back of the mouth. They usually complete development between the ages of 15 and 20.
It’s important to make sure that your dentist evaluates your wisdom teeth with regular radiographs around age 16, and, depending on the development of these teeth, your dentist should refer you to an Oral and Maxillofacial Surgeon for a consultation and possible removal between 16 and 21 years of age. This procedure is very common and can be completed in a short period of time, making it easy and convenient for students returning home for holiday breaks.
Why should they be removed?
Most patients develop and grow 32 permanent, adult teeth. Sometimes there is not enough room to accommodate the eruption of these teeth. When this happens, they are classified as impacted.
If you do not have enough room for your third molars to erupt, several adverse results can occur:
- Infection - The gum tissue around the partially erupted wisdom tooth can become irritated and infected. This can lead to chronic pain, swelling, chewing, and difficulty swallowing.
- Damage - Lack of room may prohibit adequate hygiene leading to decay of adjacent teeth, or gum disease (bone loss).
- Pathology - Diseases can develop in association with impacted 3rd molars. Cysts are fluid-filled sacks inside the jawbone that can expand and destroy bone and occasionally adjacent teeth. Although rare, tumors can be associated with delayed removal of wisdom teeth.
- Crowding - Although controversial, impacted teeth may contribute to the crowding of your teeth. This is most commonly seen in Orthodontic (braces) patients. Wisdom teeth removal cannot be recommended solely to avoid crowding, but can be indicated to eliminate their possible role in future crowding and other bite changes. It is not recommended to wait until there is pain. By the time wisdom teeth start to hurt, damage may have already occurred.
Oral surgeons are trained to identify abnormal growths or tissue through a clinical examination of the mouth and the evaluation of x-rays. Biopsies of both benign and malignant lesions can be accomplished by the oral and maxillofacial surgeons, who are experts in the clinical and microscopic diagnosis of disorders of the mouth and jaws. Oral lesions include benign tumors and cancers, growths of tooth origin and those that arise in the salivary glands, infections and manifestations of systemic disorders.
Today there is another option for patients who are missing permanent teeth. Rather than resting on the gums like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone. This titanium metal “fuses” with the jawbone through a process called “osseointegration”.
Although dental implants have been around for over 20 years, people are still becoming aware of the advantages that dental implants have over conventional dentures and bridges. Dental implants act as secure anchors for artificial replacement teeth, making them “the next best thing to natural teeth.” They can be used to replace one tooth or several teeth, and can also be used in combination with a bridge to replace a number of adjacent missing teeth.
Are you a candidate?
- Existing Medical conditions. If you can have routine dental treatment, you generally can have an implant placed. High blood pressure and diabetes patients are usually successful candidates.
- Gum disease. Implants placed in patients who have lost their teeth to periodontal disease or decay can be successful.
- Smokers. Smoking lowers the success rate of implants, but doesn’t eliminate the possibility of getting them.
- Bone loss. Bone grafting may be necessary to increase the volume of bone to adequately ensure the success of implants
A Team Effort
A successful implant requires that the patient; the restorative dentist; and the surgeon, follow a careful plan of treatment. A comprehensive evaluation includes an examination, x-rays, and consultation with the implant team prior to placement.
When implants have stabilized in the jaw, the restorative dentist prepares an impression to make a model from which the dentures or crowns are fabricated.
TMJ diagnosis and Management
The temporomandibular joint (TMJ) is a common cause of facial pain and headache. This joint is located where the lower jaw and skull meet, the TMJ is a ball and socket joint that allows the lower jaw (mandible) to move and function. Symptoms of TMJ disorders may include earaches, headaches and a limited range of jaw movement. There also may be clicking or grating joint sounds associated with limited jaw movement. Patients may also experience a combination of muscle and joint problems. Causes of TMJ disorders include osteoarthritis, cartilage displacement or injury, rheumatoid arthritis, or stress.
The goals of treatment are to decrease symptoms and to restore function. Treatment may range from conservative medical and dental care to surgery. Generally speaking, if non-surgical treatment is unsuccessful, or if there is joint damage, surgery may be indicated. Once TMJ disorders are correctly diagnosed, appropriate treatment can be provided.
Office Surgery and General Anesthesia
Oral and Maxillofacial Surgeons, like Dr. Jon Lebsack, are unique among health care providers. Their exposure to anesthesiologists and anesthesiology residents elevates their training to a higher level. No other dental or medical specialty requires this standard of training. Other than anesthesiologists, oral and maxillofacial surgeons are the only health care specialists that administer all levels of sedation and general anesthesia. In addition, Dr. Lebsack is certified in CPR and Advanced Cardiac Life Support.