About the Oral and Maxillofacial Surgeon
Oral and maxillofacial surgeons are the surgical specialists of the dental profession. Their extensive education and training, surgical expertise and unparalleled understanding of esthetics and function uniquely qualify them to treat the conditions, defects, injuries and esthetic aspects of the mouth, teeth, jaws and face. Patients who complain of pain or problems in this area are routinely referred to an oral and maxillofacial surgeon for help.
Dr. Pasqual of Delray Beach, Florida, practices full scope oral and maxillofacial surgery. He is board certified and specializes in dental / facial implants, wisdom teeth, extractions, TMJ / TMD, oral pathology as well as facial surgery and facial aesthetics.
Visit our practice at www.pasqualoms.com
Scope of Practice
Following dental school, oral and maxillofacial surgeons complete a minimum of four years in 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. Their training focuses almost exclusively on the hard (ie, bone) and soft (ie, skin, muscle) tissue of the face, mouth, and jaws. Depending on the residency program, some surgeons may also choose to earn a medical or other advanced degree. Some may also complete fellowships in sub-specialty areas.
At the conclusion of this demanding program, oral and maxillofacial surgeons are well-prepared to:
- Manage diseases of the teeth and their supporting soft and hard tissues.
- Surgically reconstruct inadequate bone structure in the jaw area.
- Evaluate, plan a course of treatment and place dental implants to replace one, two or a mouthful of missing teeth.
- Expertly treat head and neck trauma and injuries to the face, jaws, mouth and teeth.
- Diagnose and treat facial pain.
- Diagnose and treat oral cancer and other diseases in the maxillofacial region.
- Perform corrective jaw surgery to improve the function and appearance of patients with such conditions as cleft lip and palate and other congenital defects.
- Diagnose and surgically treat obstructive sleep apnea.
- Perform facial cosmetic procedures to enhance facial appearance and function.
Oral and maxillofacial surgeons are unique among non-anesthesiology practitioners in health care, in that they train with anesthesiologists and anesthesiology residents. No other dental or medical specialty requires this level of training and, as a result, oral and maxillofacial surgeons are the only healthcare specialists, aside from anesthesiologists, to administer all levels of sedation and general anesthesia. Anesthesia administered in the OMS office ranges from conscious sedation, to deep IV sedation and general anesthesia. The level of anesthesia administered is carefully matched to the specific needs of the patient and the type of procedure that is to be performed.
Following are some of the many surgical procedures performed by oral and maxillofacial surgeons.
Dentoalveolar surgery is the surgical management of diseases of the teeth and their supporting hard and soft tissues.
Tooth Extractions – Oral and maxillofacial surgeons have extensive surgical training and experience in diagnosing and extracting teeth. Whether the extraction is simple or complicated by impaction, disease or infection, their surgical skills make them the obvious surgeon of choice for the patient in need.
Wisdom Teeth (Third Molars) – A tooth that fails to emerge or fully break through the gum tissue is, by definition, “impacted.” While this is a common problem associated with third molars, or wisdom teeth, which are the last teeth to develop and erupt into the mouth, other teeth can also become impacted.
Orthodontic Surgery – Often a patient is referred to an oral and maxillofacial surgeon for an extraction or another surgical procedure in preparation for orthodontic treatment, such as extraction of over-retained baby teeth or the exposure of unerupted teeth.
Preprosthetic Surgery – Oral and maxillofacial surgeons are experts at preparing the mouth for the placement of a partial or complete denture; ensuring a comfortable fit. Because dentures rest on a bone ridge, it is very important that the bone is the proper shape and size. Occasionally, excess bone must be removed or recontoured before the denture is inserted. In such cases, oral and maxillofacial surgeons may perform one or more of the following procedures:
- bone smoothing and reshaping
- removal of excess bone
- bone ridge reduction
- removal of excess gum tissue, and/or
- grafting of skin or specialized gum tissue
Oral and maxillofacial surgeons pioneered the placement of dental implants more than 25 years ago, and are still the leaders in providing the innovative techniques that offer patients long-lasting, natural looking results that last a lifetime.
Oral and maxillofacial surgeons have the training and experience to successfully place dental implants in most patients, even “high-risk” patients suffering from chronic health conditions, gum disease or bone loss in the jaw area.
Following are some of the procedures provided by oral and maxillofacial surgeons to assure the best possible outcome:
Immediate Loading – Advances in dental implant technology allow OMSs to extract teeth and place implants with crowns in one visit.
Bone Grafting – Oral and maxillofacial surgeons are the only dental specialists trained to obtain and place bone grafts in areas where little or no bone exists. Implant sites that lack the necessary bone can be enhanced with the use of bone grafts. Bone grafts are also used to treat bone loss resulting from traumatic injuries, tumor surgery or congenital defects.
Sinus Lift – A sinus lift is a bone grafting procedure that is sometimes performed when the amount of bone in a patient’s upper jaw is inadequate to accommodate a dental implant.
Oral and maxillofacial surgeons are skilled in evaluating their patient’s unique needs and developing an appropriate treatment plan. Whether they are replacing a single tooth or a mouthful of teeth, oral and maxillofacial surgeons can perform dental implant surgery comfortably in the office setting.
Inadequate bone structure in the upper and/or lower jaws can result from injury or trauma, tumor surgery or long-term denture wear. Using bone grafts from either the patient’s own bone or bone substitutes can improve the quantity and quality of the hard tissue. Skin grafts and soft tissue corrections can improve the architecture of the soft tissues in the oral and maxillofacial region. Through oral reconstructive surgery, a solid foundation can be provided for dental rehabilitation, which in turn aids nutrition and speech. If the patient is a candidate, dental implants may be used to replace lost teeth and other structures. Implants can also be used to anchor oral and facial prostheses.
Oral and maxillofacial surgeons are experts in treating and repairing facial trauma, including fractures of the upper and lower jaws and the orbits surrounding the eyes, and facial lacerations. Their knowledge of how jaws come together (dental occlusion) is critical when repairing complex facial fractures. In fact, the American College of Surgeons’ guidelines for optimal care require Level I and II trauma centers, those that treat the most serious and complex facial trauma patients, to have oral and maxillofacial surgeons on call to perform complex reconstruction of the mouth, face and jaws. Moreover, many of the techniques that are standard in today’s hospital emergency rooms were developed by oral and maxillofacial surgeons in combat hospitals during World War II, Korea, Vietnam and today’s international conflicts.
Extensive maxillofacial fractures are often accompanied by other medical problems. The oral and maxillofacial surgeon coordinates treatment with other medical specialties to return the patient to their normal activities as soon as possible. The young woman pictured in fig. (a) prior to surgery and (b) following surgery to repair her injuries.
Trauma does not only result from major events like combat or automobile accidents. Childhood facial injuries caused by skateboards, sports or bicycle accidents frequently involve dental or maxillofacial trauma. Younger children often sustain damage to teeth or supporting structures from falls. The use of safe and effective sedation techniques allow traumatic injuries to be effectively treated in the oral and maxillofacial surgery office, avoiding costly emergency room visits.
Infection, malocclusion, TMJ, tumors or nerve pathology may cause oro-facial pain. Oral and maxillofacial surgeons are trained to diagnose the full spectrum of conditions that may cause pain in the mouth or face and to provide the appropriate medical or surgical treatment.
Pain and swelling in the face, neck or jaws may indicate an infection, which can sometimes develop into a life-threatening emergency if not treated promptly and effectively. An oral surgeon can assist in diagnosing and treating this problem. Surgical treatment, if needed, may include draining the infected area and eliminating the source of the infection.
Lesion Removal and Biopsy
Oral surgeons are trained to identify abnormal growths or tissue through a clinical examination of the mouth and the evaluation of X-rays. Since the mouth is a most accessible area, the surgeon can either remove a representative sample (biopsy) for laboratory examination, or remove the entire pathology.
The temporomandibular joint (TMJ) is a common cause of facial pain and headache. 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. Patients may also complain of clicking or grating sounds in the joint, or pain when opening or closing their mouths. Some patients experience a combination of muscle and joint problems. Causes of TMJ disorders include osteoarthritis, cartilage displacement or injury, rheumatoid arthritis, or stress.
Oral and maxillofacial surgeons are trained to perform biopsies of both benign and malignant lesions in the maxillofacial region, and are experts in the clinical and microscopic diagnosis of disorders involving the mouth and jaws. Oral lesions include benign tumors and cancers, growths of tooth origin and those that arise in the salivary glands, infections (both local and systemic) and manifestations of systemic disorders.
Oral cancer is no longer a disease experienced by the middle aged patients with histories of smoking and alcohol consumption. Today oral and maxillofacial surgeons are seeing a growing number of oral cancer patients in their 20s and 30s. A growing use of smokeless tobacco and a rise in Human Papillomavirus (HPV) cases are considered responsible for this situation. Oral and maxillofacial surgeons stress that early detection and treatment of oral lesions greatly improve the patient’s prognosis. Lesions may be managed medically and/or surgically.
Differences in skeletal growth between the upper and lower jaws may lead to problems with chewing, swallowing, speech or TMJ performance. Patients may also experience psychological difficulties stemming from esthetic and social concerns.
Corrective Jaw Surgery – Oral and maxillofacial surgeons perform corrective jaw surgery to produce a more balanced and functional skeletal relationship for the patient. Often performed in conjunction with treatment by an orthodontist and restorative dentist, corrective jaw surgery is usually done in a hospital or ambulatory surgical center under general anesthesia.
Some common growth abnormalities, including under or overdevelopment of the jaws (prognathia, micrognathia, retrognathia), and skeletal malocclusions (bad bite) cannot be corrected through orthodontia alone. They must be addressed through corrective surgery.
Congenital Reconstruction – Congenital deformities like cleft lip and palate occur when all or a portion of the oral-nasal cavity does not grow together during fetal development. As members of a team of healthcare specialists, oral and maxillofacial surgeons play an important role in the carefully orchestrated, multiple-stage correctional program designed to help restore the jaw and facial structures leading to normal function and appearance. Care and treatment consider function, appearance, nutrition, speech, hearing, and emotional and psychological development.
Snoring/Obstructive Sleep Apnea
Approximately 45% of the population experience obstructive breathing patterns during sleep. Such problems can range from snoring to periods of true apnea, where breathing ceases for a brief period of time. Obstructive sleep apnea can lead to excessive daytime sleepiness, poor work performance and such cardiovascular disorders as hypertension, arrhythmias and congestive heart failure. Oral and maxillofacial surgeons are trained to diagnose and treat this condition and, in fact, pioneered many of today’s most successful surgical techniques for sleep apnea. When conservative methods fail to correct the problem, surgery may be performed to treat the soft and/or hard tissues.
Facial Cosmetic Surgery
As a result of their surgical and dental background and their ability to reconstruct facial structures damaged through trauma, oral and maxillofacial surgeons are keenly aware of the importance of harmony between facial appearance and function. Many of today’s facial cosmetic procedures can be performed on an outpatient basis in the oral and maxillofacial surgeon’s office. Some facial cosmetic surgery may require the use of an outpatient or same day surgery center, or hospital. Depending upon the procedure, surgery may be performed under local anesthesia, IV sedation or general anesthesia.