Oral And Maxillofacial Surgery

Teeth Extractions

The aim of extraction is to take out the tooth with severe problem or not suitable to retain, or to prepare for another course of treatment like orthodontic treatment.

 

Conditions leading to extraction include:

–Badly decayed/broken/fractured tooth that cannot be restored.

–An extremely mobile tooth resulting from severe gum disease.

–A tooth to be extracted for pathological reasons, e.g. a tooth associated with a tumour.

–A tooth that fails to erupt in a right place and causes damages and inflammation to the nearby tissues.

–A tooth that is abnormal in its appearance and structure.

–A tooth to be extracted for orthodontic need.

 

Depending on the approach applied, tooth extraction can be surgical or non-surgical extraction.  Non-Surgical (Simple) extraction is suitable for a normally erupted tooth. Under local anesthesia, appropriate forcep or dental instrument is used to loosen and pull out the tooth from the bone. Surgical teeth extractions (Impacted tooth surgery) is used when the tooth cannot be simply extracted by the dental instruments. This includes badly decayed/fractured/impacted tooth.

Operculectomy

Operculectomy is the surgical (minor) removal of the operculum, a flap of tissue over a partially erupted tooth, particularly a third molar, in pericoronitis. This leaves an area that is easy to keep clean, preventing plaque buildup and subsequent inflammation. The inflammation of the operculum (pericoronitis) occurs mostly as a result of opposing wisdom tooth constantly traumatizing the operculum (gum flap), causing pain and discomfort. This procedure is typically done with a surgical scalpel, electrocautery, or with lasers. Sometimes operculectomy is not an effective treatment, such that the operculum grows back and the need for a repeat surgery arises. However, if the upper wisdom tooth is easy to remove and is non-functional, then immediate removal of that tooth will dramatically relieve the pain from the area, followed by the operculectomy.

 

Reduction and immobilization of jaw fractures

Jaw or mandibular fractures is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Commonly occur in males in their 30’s and is typically as a result of trauma  such as fall onto the chin, hit or blow from  the side or road traffic accident.

 

General Signs and symptoms of jaw fractures:

–Pain and the feeling that teeth are not correctly aligned (traumatic malocclusion or disocclusion).

–The teeth are very sensitive to pressure that even a small change in the location of the teeth will generate this sensation

–Loose teeth.

–Numbness due to compression on related nerves.

–Trismus (difficulty opening mouth).

–Externally, signs of swelling, bruising deformity can all be seen.

–Intraorally, a step deformity will be seen between the teeth on either side of the fracture or a space can be seen (often mistaken for a lost tooth).

–Bleeding from the gum in the area.

 

Like all fractures, consideration has to be given to other illnesses that might jeopardize the patient, then to reduction and fixation of the fracture itself. Most important to be considered and handled is the compromise of the airway, the tongue could fall backwards or soft tissue swellings could block the airway.

Reduction refers to approximating the edges of the broken bones. This is done with either an open technique, where an incision is made, the fracture is found and is physically manipulated into place or closed technique where no incision is made. Simple fractures are usually treated with closed reduction and indirect skeletal fixation, more commonly referred to as maxillo-mandibular fixation (MMF). The indirect skeletal fixation is accomplished by placing an arch bar, secured to the teeth on the maxillary and mandibular dentition, then securing the top and bottom arch bars with wire loops.

After the procedure, post-operative instructions and care is given. Patient is placed under review till completely healed. Where necessary, skull x-rays will be taken 6 weeks post-op.

 

Incision and drainage of dental abscess

Surgical incision and drainage is a commonly used technique in oral surgery to treat dental infections which have progressed to oral swellings. If cavities of the teeth are left untreated, they can eventually progress to infections that spread into the jaw bones and later into the soft tissues. Not only is this process extremely painful for the individual, it is also extremely dangerous. This is because untreated dental infections which have penetrated into the surrounding tissues can lead to a spreading of the infection to the brain or heart in a short period of time, causing severe illness and potential death.

The first sign of a dental infection that has penetrated through the jaw bone into the surrounding soft tissues, other than pain, is a noticeable swelling of the individual’s mouth and/or face. In some cases,  tooth responsible for the infection may be salvaged. This is based on clinical assessment of the tooth and the relative prognosis for treating the infection by retaining the tooth. In most cases however, the tooth in question is often extracted in conjunction with performing the incision and drainage procedure.

 

How it is done:

Incision and drainage of abscess is generally performed in an out-patient setting under local anaesthesia. Sedation can also be employed in extremely apprehensive patients. Once the region of infection has been appropriately anaesthsized or “frozen”, a small incision/cut is made in the gums at the most prominent point of the oral swelling. The pus is then drained and the site is irrigated with sterile saline solution. In certain instances where a significant amount of swelling and pus are present or when the infection has been long standing, the clinician may decide to place a rubber drain to keep the surgical site patent. This allows for any residual drainage of pus to occur and prevents the need for any further surgery at this site. The drain must be removed by the clinician in 24 to 72 hours after placement. The patient is required to follow-up with the clinician on a regular basis during the healing period. The patients are often placed on antibiotic therapy following the surgical procedure for a period of 7 to 10 days. Analgesics for pain are also given.

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