TREATMENT OPTIONS

Many of the procedures we perform make use of IV sedation or general anesthesia. We know that sedation can be stressful and anxiety-filled event for first-time patients. Our goal is to make our patients as comfortable as possible. Our training and technology allow us to perform both simple and complex procedures in a relaxed environment. Our doctors have completed thousands of procedures using IV sedation and general anesthesia. With the assistance of our staff RN, we are able to complete our procedures in a safe and well-monitored setting, and in a manner that provides the highest level of patient security.

In Depth

Removing the Anxiety Factor
A child wonders what the first day of school will be like. Someone is about to start a new job. A young couple is about to be married. Each of these situations is a classic anxiety producer. What they have in common is that each involves the unknown. And that’s what anxiety is: the fear of a specific upcoming event that, in all likelihood, you’ve never before experienced.

An upcoming visit to an Oral and Maxillofacial Surgeon is another potential anxiety producer. In this case, the patient is typically most concerned about possible pain — whether the procedure is going to hurt.

The good news is that whether your procedure requires local or intravenous anesthesia, today’s technology makes it possible to perform complex surgery in the oral and maxillofacial surgery office with little or no discomfort for the patient. Knowing this should start to reduce your level of anxiety.

Extensive Training and Experience in the Control of Pain and Anxiety

The ability to provide patients with safe, effective outpatient anesthesia has distinguished the specialty of oral and maxillofacial surgery since its earliest days. As the surgical specialists of the dental profession, oral and maxillofacial surgeons are trained in all aspects of anesthesia administration. Following dental school, oral and maxillofacial surgeons complete at least four years of training in a hospital-based surgical residency program alongside medical residents in general surgery, anesthesia and other specialties. During this time, OMS residents must complete a rotation on the medical anesthesiology service, during which they become competent in evaluating patients for anesthesia, delivering the anesthetic and monitoring post-anesthetic patients. As a result of this extensive training, oral and maxillofacial surgeons are well-prepared to identify, diagnose and assess the source of pain and anxiety within the scope of their discipline, and to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Further, they are experienced in airway management, endotracheal intubation, establishing and maintaining intravenous lines, and managing complications and emergencies that may arise during the administration of anesthesia.

Putting Your Mind at Ease

The best way to reduce anxiety is to make certain you know what to expect during and after surgery. As with most anxiety-producing situations, the more you know, the less you have to be anxious about. Prior to surgery, your Oral and Maxillofacial Surgeon will review with you the type of anesthetic to be used, as well as the way you’re likely to feel during and after the operation.This is the time to discuss any concerns you may have about any facet of the operation.

During surgery, one or more of the following may be used to control your pain and anxiety: local anesthesia, nitrous oxide-oxygen, intravenous sedation and general anesthesia. Commonly, patients describe their feelings during surgery as comfortable and surprisingly pleasant.

After surgery, you may be prescribed a medication to make you as comfortable as possible when you get home.

The information provided here is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is provided to help you communicate effectively with your oral and maxillofacial surgeon. Always seek the advice of your oral and maxillofacial surgeon regarding an oral health concern.

The American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 9,000 oral and maxillofacial surgeons in the United States, supports its members’ ability to practice their specialty through education, research and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards.

There are many options available to assist patients with TMJ disorders. Treatment can range from conservative to surgical management. Hilton Head Oral and Maxillofacial Surgery can help you achieve a healthier jaw and improved quality of life.

In Depth

The temporomandibular joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet. It permits the lower jaw (mandible) to move and function.

TMJ disorders are not uncommon and have a variety of symptoms. Patients may complain of earaches, headaches and limited ability to open their mouth. They may also complain of clicking or grating sounds in the joint and feel pain when opening and closing their mouth. What must be determined, of course, is the cause.

Causes of TMJ Disorders

Determining the cause of a TMJ problem is important, because it is the cause that guides the treatment.

Arthritis is one cause of TMJ symptoms. It can result from an injury or from grinding the teeth at night. Another common cause involves displacement or dislocation of the disk that is located between the jawbone and the socket. A displaced disk may produce clicking or popping sounds, limit jaw movement and cause pain when opening and closing the mouth.

The disk can also develop a hole or perforation, which can produce a grating sound with joint movement. There are also conditions such as trauma or rheumatoid arthritis that can cause the parts of the TMJ to fuse, preventing jaw movement altogether. The Joint, the Muscles or Both are the Problem Stress may trigger pain in the jaw muscles that is very similar to that caused by TMJ problems. Affected patients frequently clench or grind their teeth at night causing painful spasms in the muscles and difficulty in moving the jaw. Patients may also experience a combination of muscle and joint problems. That is why diagnosing TMJ disorders can be complex and may require different diagnostic procedures.

The Role of the Oral and Maxillofacial Surgeon

When symptoms of TMJ trouble appear, an oral and maxillofacial surgeon should be consulted. A specialist in the areas of the mouth, teeth and jaws, the oral and maxillofacial surgeon is in a good position to correctly diagnose the problem.

Special imaging studies of the joints may be ordered and appropriate referral to other dental or medical specialists or a physical therapist may be made.

Range of Possible Treatment

TMJ treatment may range from conservative dental and medical care to complex surgery. Depending on the diagnosis, treatment may include short-term non-steroidal anti-inflammatory drugs for pain and muscle relaxation, bite plate or splint therapy, and even stress management counseling.

Generally, if non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated. Surgery can involve either arthroscopy (the method identical to the orthopaedic procedures used to inspect and treat larger joints such as the knee) or repair of damaged tissue by a direct surgical approach.

Once TMJ disorders are correctly diagnosed, appropriate treatment can be provided.

Injuries that result in broken jaws, missing teeth or similar types of facial damage are best treated by an oral and maxillofacial surgeon who has received specialized training in this area of dental medicine. Dr Low is board certified and has trained at multiple level one trauma centers, making him uniquely qualified to manage and treat facial trauma. Dr. Low is on staff at our local hospitals (Hilton Head and Costal Carolina Medical Center), and delivers emergency room coverage for facial injuries including: facial lacerations, fractured facial bones, fractured jaw bones, intraoral lacerations, avulsed (knocked out) teeth.

To assist in the prevention of facial injuries, Hilton Head Oral and Maxillofacial Surgery is an authorized provider of UnderArmor Performance Mouthwear. We invite all athletes to be fitted for mouth-guards. Call 843 689 6338 for an appointment.

In Depth

Maxillofacial injuries, also referred to as facial trauma, encompass any injury to the mouth, face and jaw. Almost everyone has experienced such an injury, or knows someone who has. 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. Do not attempt to move the individual yourself. If these symptoms are not present but the injury is severe or you are uncertain about its severity, take the person to the nearest hospital emergency room as quickly as possible.

At the hospital, the individual will most likely be seen by several medical personnel, one of whom will probably be an oral and maxillofacial surgeon. oral and maxillofacial surgeons, the surgical specialists of the dental profession, are specifically trained to repair injuries to the mouth, face and jaws. After four years of dental school, oral and maxillofacial surgeons complete four or more years of hospital-based surgical residency training that may include rotations through related medical fields, including internal medicine, general surgery, anesthesiology, otolaryngology, plastic surgery, emergency medicine and other medical specialty areas.

At the conclusion of this demanding program, oral and maxillofacial surgeons are well-prepared to perform the full scope of the specialty, which includes emergency care for the teeth, mouth, jaws, and associated facial structures.

Treating Facial Injury

One of the most common types of serious injury to the face occurs when bones are broken. Fractures can involve the lower jaw, upper jaw, palate, cheekbones, eye sockets and combinations of these bones. These injuries can affect sight and the ability to breathe, speak and swallow. Treatment often requires hospitalization.

The principles for treating facial fractures are the same as for a broken arm or leg. The parts of the bone must be lined up (reduced) and held in position long enough to permit them time to heal. This may require six or more weeks depending on the patient’s age and the fracture’s complexity.

When maxillofacial fractures are complex or extensive, multiple incisions to expose the bones and a combination of wiring or plating techniques may be needed. The repositioning technique used by the oral and maxillofacial surgeon depends upon the location and severity of the fracture. In the case of a break in the upper or lower jaw, for example, metal braces may be fastened to the teeth and rubber bands or wires used to hold the jaws together. Patients with few or no teeth may need dentures or specially constructed splints to align and secure the fracture. Often, patients who sustain facial fractures have other medical problems as well. The oral and maxillofacial surgeon is trained to coordinate his or her treatment with that of other doctors.

During the healing period when jaws are wired shut, the oral and maxillofacial surgeon prescribes a nutritional liquid or pureed diet, which will help the healing process by keeping the patient in good health. After discharge from the hospital, the doctor gives the patient instructions on continued facial and oral care.

Don’t Treat Any Facial Injury Lightly

While not all facial injuries are extensive, they are all complex since they affect an area of the body that is critical to breathing, eating, speaking and seeing. Even in the case of a moderately cut lip, the expertise of the oral and maxillofacial surgeon is indispensable. If sutures are needed, placement must be precise to bring about the desired cosmetic result. So a good rule of thumb is not to take any facial injury lightly.

Prevention, the Best Policy

Because avoiding injury is always best, oral and maxillofacial surgeons advocate the use of automobile seat belts, protective mouth guards, and appropriate masks and helmets for everyone who participates in athletic pursuits at any level. You don’t have to play at the professional level to sustain a serious head injury. New innovations in helmet and mouth and face guard technology have made these devices comfortable to wear and very effective in protecting the vulnerable maxillofacial area. Make sure your family is well-protected. If you play the sport, make the following safety gear part of your standard athletic equipment.

Football: Helmets with face guards and mouth guards should be worn. Many of the helmets manufactured for younger players have plastic face guards that can be bent back into the face and cause injury. These should be replaced by carbon steel wire guards. Baseball: A catcher should always wear a mask. Batting helmets with a clear molded plastic face guard are now available; these can also be worn while fielding.

Ice Hockey: Many ice hockey players are beginning to wear cage-like face guards attached to their helmets. These are superior to the hard plastic face masks worn by some goalies, as the face guard and the helmet take the pressure of a blow instead of the face. For extra protection, both face and mouth guards — including external mouth guards made of hard plastic and secured with straps — can be worn.

Wrestling: More and more high school athletic associations require wrestlers to wear head gear. A strap with a chin cup holds the gear in place and helps steady the jaw. Recently, face masks have been developed for wrestlers, who should also wear mouth guards. Boxing: Mouth guards are mandatory in this sport. A new pacifier-like mouth guard for boxers has been designed with a thicker front, including air holes to aid breathing.

Lacrosse: Hard plastic helmets resembling baseball batting helmets, with wire cage face masks, are manufactured for this sport.

Field Hockey: Oral and maxillofacial surgeons recommend that athletes participating in this sport wear mouth guards. Goalies can receive extra protection by wearing Lacrosse helmets.

Soccer: Soccer players should wear mouth guards for protection. Oral and maxillofacial surgeons advise goalies to also wear helmets.

Biking: All riders should wear lightweight bike helmets to protect their heads. Scooters and Skateboarders: Bike helmets are also recommended for those who ride two-wheeled scooters and skateboards.

Skiing and Snowboarding: The recent surge in accidents among skiers and snowboarders has encouraged many safety conscious participants to wear lightweight helmets that will protect the maxillofacial area in the event of a fall or crash.

Horseback Riding: A helmet and mouth guard are recommended for horseback riding, particularly if the rider is traveling cross-country or plans to jump the horse.

Basketball, Water Polo, Handball, Rugby, Karate, Judo, and Gymnastics: Participants in these sports should be fitted with mouth guards.

A Word About Mouth Guards

New synthetic materials and advances in engineering and design have produced mouth guards that are sturdier yet lightweight enough to allow the wearer to breathe easily. Mouth guards can vary from the inexpensive “boil and bite” models to custom-fabricated guards made by dentists, which can be adapted to the sport and are generally more comfortable.

A mouth protector should be evaluated from the standpoint of retention, comfort, ability to speak and breathe, tear resistance and protection provided to the teeth, gums and lips.

There are five criteria to consider when being fitted for a mouth protector. The device should be:

• fitted so that it does not misalign the jaw and throw off the bite
• lightweight
• strong
• easy to clean
• should cover the upper and/or lower teeth and gums.

By encouraging sports enthusiasts at every level of play to wear mouth guards and other protective equipment, oral and maxillofacial surgeons hope to help change the “face” of sports.

In the event a facial or mouth injury occurs that requires a trip to the emergency room, the injured athlete, his parent or coach should be sure to ask that an oral and maxillofacial surgeon is called for consultation. With their background and training, oral and maxillofacial surgeons are the specialists most qualified to deal with these types of injuries. In some cases, they may even detect a “hidden” injury that might otherwise go unnoticed.

Due to a variety of circumstances, bone and soft tissues of the mouth may be lost. In these situations, techniques are available to replace missing teeth and soft tissues. When grafting is needed prior to dental implant placement or other reconstructive procedures, many options are available including the use of synthetic bone or your own bone. Small defects can routinely be repaired in the office setting. If a larger defect is present, we have the ability to perform our procedures in a hospital setting.

In Depth

When you loose a tooth, the surrounding bone material begins to be resorbed by the body. Over time, the area of the jawbone associated with missing teeth atrophies and shrinks. If this process is allowed to continue for a significant portion of time, it compromises the quality and quantity of bone suitable for the placement of dental implants and replacement teeth. Modern techniques in oral surgery allow us to replace or regrow missing bone structure, creating the foundation needed for implants of the correct size, restoring both jaw function and aesthetic appearance.

Bone Grafting

Bone grafting is a technique that is used to repair areas of inadequate bone structure created by gum disease, previous extractions, or injuries. The bone material used for grafting can be taken from your own jaw, hip or lower leg, or obtained from a tissue bank. Bone structure in the posterior upper jaw may also be replaced with sinus bone grafts. In some cases, a membrane may be placed under the gums to protect the bone graft and encourage bone regeneration. This is known as guided bone or guided tissue regeneration.

For smaller defects, synthetic materials are often used to stimulate bone formation. In some cases, allograft material is prepared from cadavers or from a bovine source and used to promote the patients own bone to grow into the repair site. During the preparation of the graft, strict, aseptic sterilization techniques are employed and approved by the FDA to ensure that there are no transmissible agents in the grafts. The material is devoid of proteinaceous matter and only contains the minerals from the donors. It is very effective and very safe. The latest advancements in tissue engineering technology has allowed the use of concentrated bone forming proteins (known as BMPs) to allow predictable and abundant bone regeneration.

Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are empty air filled spaces lined by a tissue thin membrane. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.

The solution is called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone. The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.

If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will have to mature for several months. Once the graft has fully healed, the implants can be placed.

Ridge Expansion

In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.

Onlay Block Grafting

When there is inadequate volume of bone (either width or height), an onlay block graft can be used to secure a solid block of bone obtained from either the back of the lower jaw or the chin area to the area where the future implant will be placed. The block is secured with temporary screws and allowed to heal for six to nine months prior to placement of implants, at which time the screws will be removed. This clinical scenario is ideal in younger patients with congenitally missing teeth and retained wisdom teeth. The block graft can be obtained from the site of the wisdom teeth and repositioned to the site of the future implants. This essentially combines two surgeries into one with an extremely predictable result.

Nerve Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), usually other less aggressive options are considered first.

Soft Tissue Grafting

When teeth are lost, along with atrophy of the bone, shrinking of the soft tissue and gums also occur. When implants are placed in the esthetic zone, i.e. front teeth, grafting of deficient gum tissue might be required to achieve a natural, healthy smile around the implant and crown. This could potentially require a mucosal (gum) graft from your palate to the region around the implant and crown. If needed, this would occur later in the treatment sequence after the bone graft and implants have completely healed. Your surgeon will make the recommendation of when or if this procedure will be needed throughout the course of your treatment.

Distraction Osteogenesis

Distraction osteogenesis refers the slow movement (distraction) of two bony segments in a manner such that new bone is allowed to fill in the gap created by the separating bony segments. It was initially used to treat defects of the oral and facial region in 1990s. Since then, the surgical and technological advances made in the field of distraction osteogenesis have provided oral surgeons with a safe and predictable method to treat selected deformities of the oral and facial skeleton without the potential complications of grafting. This means faster recovery and no need for a secondary donor site.

Recent advances in technology have provided the oral and maxillofacial surgeon with an easy to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.

Distraction osteogenesis does have some disadvantages. It requires the patient to return to the surgeon’s office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and the patient needs to be informed how to activate the appliance, which needs to occur daily. Also, a second minor office surgical procedure is necessary to remove the distraction appliance.

Cleft lip and palate are among the most common congenital anomalies affecting children. When addressed early in a child’s life, these conditions can be corrected with a high degree of both functional and cosmetic success.

In Depth

Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not form properly. Together, these birth defects commonly are called “orofacial clefts”. These birth defects happen early during pregnancy. A baby can have a cleft lip, a cleft palate, or both.

Children with a cleft lip with or without a cleft palate or a cleft palate alone often have problems with feeding and talking. They also might have ear infections, hearing loss, and problems with their teeth.

The Centers for Disease Control and Prevention (CDC) recently estimated that each year 2,651 babies in the United States are born with a cleft palate and 4,437 babies are born with a cleft lip with or without a cleft palate. Cleft lip is more common than cleft palate. Isolated orofacial clefts, or clefts that occur with no other birth defects, are one of the most common birth defects in the United States. About 70 percent of all orofacial clefts are isolated clefts.

Cleft Lip

The lip forms between the fourth and seventh weeks of pregnancy. A cleft lip happens if the tissue that makes up the lip does not join completely before birth. This results in an opening in the upper lip. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. Children with a cleft lip also can have a cleft palate.

Cleft Palate

The roof of the mouth is called the “palate.” It is formed between the sixth and ninth weeks of pregnancy. A cleft palate happens if the tissue that makes up the roof of the mouth does not join correctly. Among some babies, both the front and back parts of the palate are open. Among other babies, only part of the palate is open.

Causes & Risk Factors

Just like the many families affected by birth defects, CDC wants to find out what causes them. Understanding the risk factors that can increase the chance of having a baby with a birth defect will help us learn more about the causes. CDC currently is working on one of the largest studies in the United States to understand the causes of and risk factors for birth defects. This study is looking at many possible risk factors for birth defects, such as orofacial clefts.

The causes of orofacial clefts among most infants are unknown. Some children have a cleft lip or cleft palate because of changes in their genes. Cleft lip and cleft palate are thought to be caused by a combination of genes and other factors, such as exposures in the environment, maternal diet, and medication use.

Recently, the CDC reported on important findings about some factors that increase the risk of orofacial clefts:

• Smoking―Women who smoke during pregnancy are more likely to have a baby with an orofacial cleft than women who do not smoke.
• Diabetes―Women with diabetes diagnosed before pregnancy have been shown to be an increased risk of having a child with a cleft lip with or without cleft palate.

CDC continues to study birth defects, such as orofacial clefts and how to prevent them. If you smoke or have diabetes, and you are pregnant or thinking about becoming pregnant, talk with your doctor about ways to increase your chances of having a healthy baby.

Diagnosis

Orofacial clefts sometimes can be diagnosed during pregnancy, usually by a routine ultrasound. Most often, orofacial clefts are diagnosed after the baby is born. However, sometimes minor clefts (e.g., submucous cleft palate and bifid uvula) might not be diagnosed until later in life.

Treatments

Services and treatment for children with orofacial clefts can vary depending on the severity of the cleft; the presence of associated syndromes or other birth defects, or both; and the child’s age and needs. Surgery to repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Surgery to repair a cleft palate is recommended within the first 18 months of life.5 Many children will need additional surgeries as they get older. Although surgical repair can improve the look and appearance of a child’s face, it also may improve breathing, hearing, speech, and language. Children born with orofacial clefts also might need different types of treatments and services, such as special dental or orthodontic care or speech therapy

If you notice suspicious areas in your face or in your mouth such as sores, discolorations or lumps, please make an appointment for an evaluation. Early detection and treatment of potential oral malignancies will greatly increase the success of any potential treatment. The doctors and staff at Hilton Head Oral and Maxillofacial Surgery are trained to screen for oral anomalies.

In Depth

The Oral Cancer Foundation estimates that close to 42,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day.

Research has identified a number of factors that may contribute to the development of oral cancer. In the past, those at an especially high risk of developing oral cancer were over 40 years of age, heavy drinkers and smokers.

While smoking and heavy drinking are still major risk factors, the fastest growing segment of oral cancer patients is young, healthy, nonsmoking individuals under the age of 40. Recent research has identified the human papilloma virus version 16 as being sexually transmitted between partners and related to the increasing incidence of oral cancer in young non-smoking patients. There are also links to young men and women who use conventional “smokeless” chewing or spit tobacco. Promoted by some as a safer alternative to smoking, this form of tobacco use is actually no safer when it comes to oral cancers.

Other factors that may promote oral cancer include physical trauma, infectious disease, poor oral hygiene and poor nutrition; however, the research regarding their involvement is uncertain. It is likely that there is a complex interaction of many external and internal factors that play a role in the development of oral cancer.

Perform a Self-Exam Monthly

Historically the death rate associated with this cancer is particularly high, not because it is hard to detect or diagnose, but because the cancer is often discovered late in its development.

The National Cancer Institute’s SEER data indicate that when oral cancer is detected early, survival outcomes are improved and treatment-related health problems are reduced. Among healthcare professionals, your family dentist or oral and maxillofacial surgeon is in the best position to detect oral cancer during your routine dental examinations. If you are at high risk for oral cancer, you should see your general dentist or oral and maxillofacial surgeon for an annual exam.

In addition, oral and maxillofacial surgeons recommend that everyone perform an oral cancer self-exam each month. An oral examination is performed using a bright light and a mirror:

• remove any dentures
• look and feel inside the lips and the front of gums
• tilt head back to inspect and feel the roof of your mouth
• pull the cheek out to see its inside surface as well as the back of the gums
• pull out your tongue and look at all of its surfaces
• feel for lumps or enlarged lymph nodes (glands) in both sides of the neck including under the lower jaw

Early Detection and Treatment Provide a Better Chance for Cure

When performing an oral cancer self-examination, look for the following:

• white patches of the oral tissues — leukoplakia
• red patches — erythroplakia
• red and white patches — erythroleukoplakia
• a sore that fails to heal and bleeds easily
• an abnormal lump or thickening of the tissues of the mouth
• chronic sore throat or hoarseness
• difficulty in chewing or swallowing
• a mass or lump in the neck

See your oral and maxillofacial surgeon if you have any of these signs. If the oral and maxillofacial surgeon agrees that something looks suspicious, a biopsy may be recommended. A biopsy involves the removal of a piece of the suspicious tissue, which is then sent to a pathology laboratory for a microscopic examination that will accurately diagnose the problem. The biopsy report not only helps establish a diagnosis, but also enables the doctor to develop a specific plan of treatment.

A Word About Oral Care

Keep in mind that your mouth is one of your body’s most important early warning systems. Don’t ignore any suspicious lumps or sores. Should you discover something, make an appointment for a prompt examination. Early treatment may well be the key to complete recovery.

Reconstruction involves surgical procedures to restore form, function and aesthetics. These procedures are often needed following facial trauma or previous surgical procedures. From their experience gained working at major hospital centers, our doctors are skilled in reconstruction using the most advanced surgical techniques.

In Depth

Oral and maxillofacial surgeons routinely evaluate and treat patients with different levels of maxillofacial defects resulting from trauma, tumor resection and/or teeth extractions.

In acute trauma cases, the goal of reconstruction is a one-stage repair, made possible by the application of well-known oral and maxillofacial surgery techniques. Delayed treatment has been replaced by early or immediate surgical treatment and stabilization of small bone fragments augmented by bone grafts and miniplate rigid fixation. These advances have allowed surgeons to approach and often reach the goal of restoring pre-injury facial appearance and function while at the same time minimizing revision surgery.

Without treatment in a timely manner, many individuals will develop future problems, often more severe than if the injury had been immediately repaired. However, modern oral and maxillofacial surgery surgical techniques can now offer hope for patients with pre-existing post-traumatic facial deformities despite considerable delays between injury, diagnosis, and treatment. These innovative techniques establish a higher standard of care for the management of facial injuries.

Tumor resection can result in either a complete defect or significant discontinuity defect that not only creates considerable facial defects but also causes the patient significant functional insufficiencies, including masticatory and speech related deficiencies. Oral and maxillofacial surgeons can provide the patient with a variety of dental, bony, and soft tissue reconstructions techniques that will address the most complicated facial tumor related injuries. From bone grafting, with or without platelet rich plasma enhancement, to distraction osteogenesis and to orthognathic surgery, oral and maxillofacial surgeons are the most prepared surgeons to treat these defects.

When teeth are removed from the mouth in a traumatic way, as in an accident, the extraction itself will likely leave a significant dental alveolar defect. These defects can result in significant oral cosmetic abnormalities and/or functional bony defects that could prevent the patient from properly smiling and chewing. Oral and maxillofacial surgeons can offer a vast variety of treatments that almost always resolve these defects including bone grafting,distraction osteogenesis, soft tissue and skin grafting.

Corrective jaw surgery moves your teeth and jaws into a more balanced and functional position. The goal of this procedure is to improve your bite and function, and many patients also benefit from improve appearance and speech.

In Depth

Corrective jaw, or orthognathic, surgery is performed by oral and maxillofacial surgeons to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth, which, in turn, can improve chewing, speaking and breathing. While the patient’s appearance may be dramatically enhanced as a result of their surgery, this is generally considered a side benefit, as orthognathic surgery is performed to correct functional problems.

Following are some of the conditions that may indicate the need for corrective jaw surgery:

• difficulty chewing, or biting food
• difficulty swallowing
• chronic jaw or jaw joint (TMJ) pain and headache
• excessive wear of the teeth
• open bite (space between the upper and lower teeth when the mouth is closed)
• unbalanced facial appearance from the front, or side
• facial injury or birth defects
• receding chin
• protruding jaw
• inability to make the lips meet without straining
• chronic mouth breathing and dry mouth
• sleep apnea (breathing problems when sleeping, including snoring)

Who Needs Corrective Jaw Surgery?

People who may benefit from corrective jaw surgery include those with an improper bite resulting from misaligned teeth and/or jaws. In some cases, the upper and lower jaws may grow at different rates. Injuries and birth defects may also affect jaw alignment. While orthodontics can usually correct bite, or “occlusion,” problems when only the teeth are misaligned, corrective jaw surgery may be necessary to correct misalignment of the jaws.

Evaluating Your Need for Corrective Jaw Surgery

Your dentist, orthodontist and oral and maxillofacial surgeon will work together to determine whether you are a candidate for corrective jaw, or orthognathic, surgery. The oral and maxillofacial surgeon determines which corrective jaw surgical procedure is appropriate and performs the actual surgery. It is important to understand that your treatment, which will probably include orthodontics before and after surgery, may take several years to complete. Your oral and maxillofacial surgeon and orthodontist understand that this is a long-term commitment for you and your family.They will try to realistically estimate the time required for your treatment.

Corrective jaw surgery may reposition all or part of the upper jaw, lower jaw and chin. When you are fully informed about your case and your treatment options, you and your dental team will determine the course of treatment that is best for you.

What Is Involved in Corrective Jaw Surgery?

Before your surgery, orthodontic braces move the teeth into a new position. Because your teeth are being moved into a position that will fit together after surgery, you may at first think your bite is getting worse rather than better. When your oral and maxillofacial surgeon repositions your jaws during surgery, however, your teeth should fit together properly.

As your pre-surgical orthodontic treatment nears completion, additional or updated records, including x-rays, pictures and models of your teeth, may be taken to help guide your surgery.

Depending on the procedure, corrective jaw surgery may be performed under general anesthesia in a hospital, an ambulatory surgical center or in the oral and maxillofacial surgery office. Surgery may take from one to several hours to complete.

Your oral and maxillofacial surgeon will reposition the jawbones in accordance with your specific needs. In some cases, bone may be added, taken away or reshaped. Surgical plates, screws, wires and rubber bands may be used to hold your jaws in their new positions. Incisions are usually made inside the mouth to reduce visible scarring; however, some cases do require small incisions outside of the mouth. When this is necessary, care is taken to minimize their appearance.

After surgery, your surgeon will provide instructions for a modified diet, which may include solids and liquids, as well as a schedule for transitioning to a normal diet. You may also be asked to refrain from using tobacco products and avoid strenuous physical activity.

Pain following corrective jaw surgery is easily controlled with medication and patients are generally able to return to work or school from one to three weeks after surgery, depending on how they are feeling. While the initial healing phase is about six weeks, complete healing of the jaws takes between nine and 12 months.

Enjoy the Benefits

Corrective jaw surgery moves your teeth and jaws into positions that are more balanced, functional and healthy. Although the goal of this surgery is to improve your bite and function, some patients also experience enhancements to their appearance and speech. The results of corrective jaw surgery can have a dramatic and positive effect on many aspects of your life. So make the most of the new you!

Sleep apnea is a serious and debilitating health condition. If you have tried conservative treatment such as lifestyle changes or oral appliances without success, or are unable to tolerate the use of a CPAP device, oral surgery can provide other options to assist you in managing your sleep apnea.

In Depth

People who snore loudly are often the target of bad jokes and middle of the night elbow thrusts; but snoring is no laughing matter. While loud disruptive snoring is at best a social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder: obstructive sleep apnea, or OSA.

Snoring Is Not Necessarily Sleep Apnea

It is important to distinguish between snoring and OSA. Many people snore. It’s estimated that approximately 30 percent to 50 percent of the US population snore at one time or another, some significantly. Everyone has heard stories of men and women whose snoring can be heard rooms away from where they are sleeping.

Snoring of this magnitude can cause several problems, including marital discord, sleep disturbances and waking episodes sometimes caused by one’s own snoring. But, snoring does not always equal OSA; sometimes it is only a social inconvenience. Still, even a social inconvenience can require treatment, and there are several options available to chronic snorers.

Some non-medical treatments that may alleviate snoring include:

• Weight loss — as little as 10 pounds may be enough to make a difference. Change of sleeping position — Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.
• Avoid alcohol, caffeine and heavy meals — especially within two hours of bedtime.
• Avoid sedatives — which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.

Your doctor has other treatment options, including the following:

• Radio Frequency (RF) of the Soft Palate uses radio waves to shrink the tissue in the throat or tongue, thereby increasing the space in the throat and making airway obstruction less likely.
• Over the course of several treatments the inner tissue shrinks while the outer tissue remains unharmed. Several treatments may be required, but the long-term success of this procedure has not as yet been determined.
• Laser-Assisted Uvuloplasty (LAUP) is a surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This procedure is generally used to relieve snoring and can be performed in the Oral and Maxillofacial Surgeon’s office with local or general anesthesia.

Identifying and Treating OSA

Unlike simple snoring, obstructive sleep apnea is a potentially life-threatening condition that requires medical attention. The risks of undiagnosed OSA include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and interpersonal relationship problems. The symptoms may be mild, moderate or severe.

Sleep apnea is fairly common. One in five adults has at least mild sleep apnea and one in 15 adults has at least moderate sleep apnea. OSA also affects 1 percent to 3 percent of children. During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw.

The cessation of breathing, or “apnea,” brought about by these factors initiates impulses from the brain to awaken the person just enough to restart the breathing process.This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems. Sleep apnea is generally defined as the presence of more than 30 apneas during a seven hour sleep. In severe cases, periods of not breathing may last for as long as 60 to 90 seconds and may recur up to 500 times a night.

Symptoms of Sleep Apnea

Those who have OSA are often unaware of their condition and think they sleep well. The symptoms that usually cause these individuals to seek help are daytime drowsiness or complaints of snoring and breathing cessations observed by a bed partner. Other symptoms may include:

• Snoring with pauses in breathing (apnea)
• Excessive daytime drowsiness
• Gasping or choking during sleep
• Restless sleep
• Problem with mental function
• Poor judgment/can’t focus
• Memory loss
• Quick to anger
• High blood pressure
• Nighttime chest pain
• Depression
• Problem with excess weight
• Large neck (>17″ around in men, >16″ around in women)
• Airway crowding
• Morning headaches
• Reduced libido
• Frequent trips to the bathroom at night

Diagnosing Sleep Disorders

If you exhibit several OSA symptoms, it’s important you visit your Oral and Maxillofacial Surgeon for a complete examination and an accurate diagnosis.

At your first visit, your doctor will take a medical history and perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. An interview with your bed partner or other household members about your sleeping and waking behavior may be in order. If the doctor suspects a sleep disorder, you will be referred to a sleep clinic, which will monitor your nighttime sleep patterns through a special test called polysomnography.

Polysomnography will require you to sleep at the clinic overnight while a video camera monitors your sleep pattern and gathers data about the number and length of each breathing cessation or other problems that disturb your sleep. Often a “split night” study is done during which a CPAP (continuous positive airway pressure) device is used. During polysomnography, every effort is made to limit disturbances to your sleep.

Treating Sleep Apnea

Obstructive sleep apnea can be effectively treated. Depending on whether your OSA is mild, moderate or severe, your doctor will select the treatment that is best for you.

Behavior Modification – If you are diagnosed with mild sleep apnea, your doctor may suggest you employ the non-medical treatments recommended to reduce snoring: weight loss; avoiding alcohol, caffeine and heavy meals within two hours of bedtime; no sedatives; and a change of sleeping positions. In mild cases, these practical interventions may improve or even cure snoring and sleep apnea.

Oral Appliances – If you have mild to moderate sleep apnea, or are unable to use CPAP, recent studies have shown that an oral appliance can be an effective first-line therapy. The oral appliance is a molded device that is placed in the mouth at night to hold the lower jaw and bring the tongue forward. By bringing the jaw forward, the appliance elevates the soft palate or retains the tongue to keep it from falling back in the airway and blocking breathing. Although not as effective as the continuous positive airway pressure (CPAP) systems, oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances, who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or behavioral changes.

Patients using an oral appliance should have regular follow-up office visits with their Oral and Maxillofacial Surgeon to monitor compliance, to ensure the appliance is functioning correctly and to make sure their symptoms are not worsening.

CPAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) – A CPAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe sleep apnea.Through a specially fitted mask that fits over the patient’s nose, the CPAP’s constant, prescribed flow of pressured air prevents the airway or throat from collapsing. In some cases a Bi-PAP device, which blows air at two different pressures, may be used.

While CPAP and Bi-PAP devices keep the throat open and prevent snoring and interruptions in breathing, they only treat your condition and do not cure it. If you stop using the CPAP or Bi-PAP, your symptoms will return. Although CPAP and Bi-PAP are often the first treatments of choice, they may be difficult for some patients to accept and use. If you find you are unable to use these devices, do not discontinue their use without talking to your doctor.Your Oral and Maxillofacial Surgeon can suggest other effective treatments.

Surgery for Sleep Apnea

Surgical intervention may be a viable alternative for some OSA patients; however, it is important to keep in mind that no surgical procedure is universally successful. Every patient has a different shaped nose and throat, so before surgery is considered your Oral and Maxillofacial Surgeon will measure the airway at several points and check for any abnormal flow of air from the nose to lungs. Be assured, your doctor has considerable experience and the necessary training and skill to perform the following surgical procedures:

• Uvulopalatopharyngoplasty (UPPP) – If the airway collapses at the soft palate, a UPPP may be helpful. UPPP is usually performed on patients who are unable to tolerate the CPAP. The UPPP procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.
• Hyoid Suspension – If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam’s apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat.The procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.
• Genioglossus Advancement (GGA) – GGA was developed specifically to treat obstructive sleep apnea, and is designed to open the upper breathing passage. The procedure tightens the front tongue tendon; thereby, reducing the degree of tongue displacement into the throat. This operation is often performed in tandem with at least one other procedure such as the UPPP or hyoid suspension.
• Maxillomandibular Advancement (MMA) – MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway. For some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition.

Sleep apnea is a serious condition and individuals with OSA may not be aware they have a problem. If someone close to you has spoken of your loud snoring and has noticed that you often wake up abruptly, gasping for air, you should consult your Oral and Maxillofacial Surgeon.