Q At a recent dental exam, my general dentist noticed an area on my gums which concerned him. He has recommended that I see an oral and maxillofacial surgeon for evaluation and possible treatment. Why?
A Oral and maxillofacial surgeons are well trained in the identification and treatment of pathologies of the oral and perioral hard and soft tissues. After taking your history and a careful clinical exam, they can advise you on the need for further tests or observation or the need for a biopsy to determine the exact diagnosis and need for treatment of the lesion. Their training and expertise can provide evaluation, management and possible surgical care for all the pathologies which present in the oral cavity and perioral tissues.

Q Does the oral surgeon always use sutures when removing impacted wisdom teeth (3rd molars)?
A The use of sutures depends on the type of tooth impaction. Sutures are used to hold the tissue in place until initial healing occurs (usually around 7 days). Most impacted teeth require some suturing. These sutures are commonly resorbable(dissolve in the mouth) and do not need removal in the office. Your oral surgeon will explain if sutures were used in the surgery, and how to manage them in the healing period.

Q I have osteoporosis and I take a bisphosphonate drug to help strengthen my bone structure. Recently I heard these drugs can interfere with bone healing in some people. Is that true?
A Bisphosphonate drugs have been used intravenously to help cancer patients and orally for patients with osteoporosis. These drugs have improved the quality of life forpatients with metastatic cancer that involves the skeletal system. They have also been extremely effective in the prevention of bone fractures in patients with osteoporosis. Unfortunately,there have been reports of an increasing number of cases of osteonecrosis of the jaw. This condition is characterized by an area of nonhealing, exposed jaw bone which can lead to severe loss or destruction of the jaw bone. The majority of these cases have been related to the injectable form of bisphosphonate however there has been a small percentage related to the oral form. Most cases of osteonecrosis have been diagnosed after dental procedures such as tooth extraction however the condition can occur spontaneously. Patients who have been taking bisphosphonates and are considering elective dental surgery should speak with their prescribing medical specialist, family dentist, or oral and maxillofacial surgeon about the risks and benefits of continuing treatment.

Q My dentist recommended that I have my wisdom teeth extracted. Will I have to stay home from school?
A Usually the postoperative course is influenced by the complexity of the extractions. In most situations the patient is advised to stay home for a couple of days following the removal of the wisdom teeth. This is due to the occurrence of post op discomfort and swelling which often tends to reach its peak within forty-eight to seventy-two hours after surgery. Ultimately the recuperative period will depend on the individual's ability to heal.

Q I lost a tooth sometime ago and now worry that I do not have enough bone to allow dental implant placement. Do I have options if bone is missing?
A Your Oral Surgeon can advise you if there is sufficient bone to allow dental implant placement by examining you and reviewing your x-rays. Bone grafting is an option to make you an implant candidate. Various bone grafting materials can be used including your bone, bank bone, bovine bone mineral or other bioactive substance that promotes bone growth. Bone grafting for dental implants has become common and quite successful, enabling you to move ahead with dental implants versus conventional restorations such as a bridge.

Q I have been told that my jaws do not “match” one another affecting my bite and profile. What are my options for treatment?
A Discrepancies between the upper and lower jaws can be significant and may require surgery in conjunction with orthodontic care. Such surgery is termed “orthognathic” and can be used to correct many skeletal(bony) abnormalities of the jaws. It is usually covered by medical insurance. A few examples include: retrusive or small lower jaw; protrusive or large lower jaw; gummy smile or long upper jaw. Crooked or asymmetric aws can also be fixed. See your oral surgeon and orthodontist to discuss proper diagnosis and treatment.

Q My child has a bump on their lower lip. It periodically swells, then "pops" and decreases in size. What is this?
A A bump on the lips or within the oral cavity should be evaluated by your dentist. An area that swells periodically and then decreases in size is most typically a mucocele. It forms due to blockage of minor salivary glands. This creates a swelling filled with mucous from the gland. Treatment of a mucocele requires removal of the soft tissue enlargement and underlying minor salivary gland tissue. An oral and maxillofacial surgeon would evaluate the area and perform removal in their clinic.

Q My child was seen by his orthodontist and he recommended having teeth removed to facilitate his growth and dental development. Our general dentist referred us to an oral and maxillofacial surgeon for their removal because my child is extremely fearful and apprehensive. Why?
A You were referred to an oral and maxillofacial surgeon because of their training and expertise in anesthesia and their ability to safely and comfortably manage the surgical experience for your child. As part of their residency, they have full training in anesthesia and can provide care from local anesthesia to conscious sedation and outpatient general anesthesia. All of these anesthesia modalities are provided in an office setting and will allow your child to have a safe and comfortable surgical experience without the need and cost of hospital care. There are many anesthesia options which you and your surgeon can discuss to provide an optimal experience for your child.

Q My child has a baby tooth that has been loose for some time but it hasn't come out yet. I can see the permanent tooth coming in behind it. Do I need to do anything?
A You should see your dentist or paediatric dentist to evaluate your child's teeth if a loose tooth does not come out on its own or if the permanent teeth proceed to erupt when the primary teeth is still in place. They will examine the area and make radiographs. They may recommend removal of the primary tooth to facilitate the eruption of the permanent tooth in a timely fashion.

Q My seventeen year old daughter told me that she wants to get her tongue pierced. I don't feel comfortable with this. What do you suggest?
A Common symptoms after oral piercing include pain, swelling, and occasionally infection. It may also induce a slight change in speech and periodically contribute to chipped or cracked teeth. The oral cavity is very vascular, especially the tongue. If a blood vessel is penetrated during the piercing severe bleeding can occur which may be difficult to control. As mentioned earlier, swelling of the tongue can be a common side effect. In extreme cases the swelling can become so severe that it can compromise the airway and prevent breathing. I would advise against it. She may think it's fashionable now but many young people are not aware of the potential complications that can occur.

Q I need to have a tooth removed and my dentist suggested a dental implant. What is a dental implant?
A Dental implants are a titanium implant that is placed into the bone of the upper or lower jaw. It replaces the root of the missing tooth. The bone integrates, or heals directly to the surface of the implant, which gives it longevity. Once this healing has occurred, your dentist makes a crown, or tooth, to go on top of the implant.

Q What is an oral and maxillofacial surgeon?
A An oral and maxillofacial surgeon has received extensive training and experience in the diagnosis and management of impacted teeth, misaligned jaws, and dental related infections of the head and neck. They also treat accident victims suffering facial injuries, perform jaw reconstruction with bone grafts, care for patients with tumors and cysts of the jaws, and provide dental implant surgery for patients who are missing teeth.
Another significant aspect of their training is the acquisition of knowledge and skill in advanced and complex pain control methods, including intravenous sedation and ambulatory general anesthesia. Thus, the oral and maxillofacial surgeon is able to provide quality care with maximum patient comfort and safety in the office setting.

Q Should my wisdom teeth be removed if they haven’t caused any problems yet?
A Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. Third molars however frequently become impacted due to a lack of space in the dental arch and their growth and eruption may be prevented by overlying gum, bone, or another tooth. Impacted third molars can be painful and lead to infection. However, not all problems related to third molars are painful or visible. These teeth may eventually crowd or damage adjacent teeth or roots. Sometimes they may even be associated with the growth of certain cysts or tumors. As wisdom teeth grow, their roots become longer and therefore more difficult to remove. This is why it is often recommended to remove impacted third molars when the roots are one-third to twothirds formed, usually between the ages of seventeen and twenty.