The Oral and Maxillofacial Surgeon

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Oral and maxillofacial surgeons are the surgical specialists of the dental profession. Their surgical expertise and thorough understanding of both aesthetics and function uniquely qualify them to diagnose, treat and manage the conditions, defects, injuries, and the aesthetic aspects of the mouth, teeth, jaws and face.

Patients who visit their family dentist or primary care provider with complaints of pain or dysfunction in the oral and maxillofacial region are often referred to an oral and maxillofacial surgeon for help. This patient information pamphlet discusses the role of the oral and maxillofacial surgeon on your healthcare team and some of the many services provided in the oral and maxillofacial surgery office.

Training and Scope of Practice

After four years of dental school, oral and maxillofacial surgeons complete four or more years of hospital-based surgical residency training. Their residency includes 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 encompasses the diagnosis, surgical and related management of diseases, injuries and defects that involve both the functional and aesthetic aspects of the oral and maxillofacial regions.This includes preventive, reconstructive or emergency care for the teeth, mouth, jaws and associated facial structures.

Depending on the residency program, some surgeons may also opt to earn a medical or other advanced degree. Some may also complete fellowships in sub-specialty areas.

Office Surgery and Anesthesia

The oral and maxillofacial surgery residency incorporates extensive anesthesia training that enables oral and maxillofacial surgeons to perform a wide variety of procedures in both an office setting and a hospital environment. Local anesthesia, nitrous oxide, intravenous sedation and general anesthesia are competently and safely administered in the oral and maxillofacial surgery office and appropriately selected to meet the requirements of the patient and the procedure. Office-based surgery is often the most efficient and cost effective way to perform many procedures while maintaining maximum patient comfort and safety.

Dentoalveolar Surgery

Dentoalveolar surgery is the surgical management of diseases of the teeth and their supporting hard and soft tissues. 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, as they are the last teeth to develop and erupt into the mouth, other teeth can also become impacted.

Typical symptoms associated with impacted teeth are pain, swelling and signs of infection in the surrounding tissues. An impacted tooth has the potential to cause permanent damage to adjacent teeth, gum tissue and supporting bone structure. Impacted teeth are also associated with the development of cysts and tumors that can destroy large portions of the jaw. Many times impacted wisdom teeth are not treated until symptoms are present; but a recent study conducted by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation indicates that third molars should be removed by the time the patient is a young adult in order to prevent related gum disease or other problems.

Oral and maxillofacial seurgeons have extensive training in the diagnosis and management of impacted teeth, tooth extraction and dentoalveolar surgery.

Reconstructive Surgery

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, the Oral and Maxillofacial Surgeon can improve both the quantity and quality of the hard tissue. Skin grafts and soft tissue corrections can be utilized to 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 both oral and facial prostheses.

Dental Implants

Statistics show that 69% of adults ages 35 to 44 have lost at least one tooth and 26% of adults ages 65 to 74 have lost all of their permanent teeth. The good news is that these patients need no longer suffer with ill-fitting removable dentures or bridges. Dental implants offer a long-lasting, comfortable and functional alternative. Unlike fixed bridges or removable dentures, dental implants are placed directly into the jawbone where, after a few months, they fuse with the bone through a process called "osseointegration." When the fusion is complete, a permanent crown is affixed to the implant post, resulting in a natural and longlasting replacement that performs like your healthy, natural teeth.

The oral and maxillofacial surgeon is a key member of the dental implant team, which also includes you, the patient, and your restorative dentist. Dental implants can be placed in most patients, even those with chronic health conditions, gum disease and bone loss in the jaw area. The oral and maxillofacial surgeon is skilled in evaluating the patient's individual needs and developing an appropriate treatment plan. In most cases, dental implant surgery is performed in the oral and maxillofacial surgeon's office.

Facial Infections

Infections in the maxillofacial region can develop into life-threatening emergencies if not treated promptly and effectively. Pain and swelling in the face, jaws or neck may indicate an infection of dental or related origin. If the infection is severe, an oral and maxillofacial surgeon is able to work within the hospital setting to diagnose and treat the problem. For less severe infections, evaluation and treatment may be done in the oral and maxillofacial surgery office. Depending on the diagnosis and severity of the case, oral and maxillofacial surgeons may work with other specialists to provide comprehensive patient care.

Facial Trauma

Their broad-based and extensive dental and medical training in the hospital-based environment uniquely qualify oral and maxillofacial surgeons to treat and repair injuries to the face, jaws, mouth and teeth.

Oral and maxillofacial surgeons are experts in treating trauma, including fractures of the upper and lower jaws and orbits, and the cosmetic management of 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 maxillofacial and craniofacial complex, including 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.

Trauma does not only result from major events like combat or automobile accidents. Childhood 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. Such traumatic injuries can usually be effectively treated in the oral and maxillofacial surgery office, avoiding costly emergency room visits. Various safe and effective sedation techniques can be employed to deliver prompt, comfortable and successful treatment in the office setting.

TMJ Disorders and Facial Pain

Oral and maxillofacial surgeons are also trained to diagnose and treat facial pain. A common cause of facial pain and headache is disease or dysfunction of the temporomandibular joint (TMJ). Located where the lower jaw and skull meet, the TMJ is the ball and socket joint that enables the lower jaw (mandible) to move and function. TMJ disorders display a number of symptoms that may include earaches, headaches, and a limited range of movement. Patients may also complain of clicking or grating sounds in the joint, or pain when opening or closing their mouths.

Causes of TMJ disorders can be degenerative (osteoarthritis), traumatic (cartilage displacement or injury), inflammatory (rheumatoid arthritis), or stress related. Some patients experience a combination of muscle and joint problems. In order to properly diagnose and treat the problem, oral and maxillofacial surgeons conduct a clinical examination and utilize a number of diagnostic procedures, including imaging studies (radiograph, CT, MRI). Usually, non-surgical management (soft diet, anti-inflammatory drugs, physical and/or bite splint therapy) is the first step. For certain conditions, joint surgery may be an appropriate option.

Lysis and lavage and arthroscopic joint surgery are minimally invasive procedures that have proven effective in resolving certain conditions involving TMJ pain and dysfunction.These procedures can be done under general anesthesia on an outpatient-surgery basis at a hospital or ambulatory surgery center. More complex joint surgery may be indicated for advanced conditions.

Oral Pathology

The diagnosis of pathology in the maxillofacial region is an important part of the oral and maxillofacial surgery practice. If indicated, biopsies and other tests can be performed to diagnose the problem and develop an appropriate treatment plan. Early detection and treatment of oral lesions greatly improve the patient's prognosis. Lesions may be managed medically and/or surgically.

Oral and Facial Deformities

Common Dentofacial Deformities

		Common dentofacial deformities include an open bite (a), a prognathic or protruding jaw (b) and a retrognathic or receding lower jaw (c). The oral and maxillofacial surgeon performs special jaw surgery to correct these problems.
(a)	(b)		(c)

Differences in skeletal growth between the upper and lower jaws may lead to both functional and psychological difficulties. Functional difficulties may include problems with chewing, swallowing, speech or TMJ performance.

Patients may also exhibit psychological difficulties stemming from aesthetic and social concerns. Some abnormalities may only involve misaligned teeth and can be corrected orthodontically with braces or other appliances. Serious growth disturbances, however, require surgery to realign the upper and lower jaws into a more normal relationship. Common dentofacial deformities, including under or overdevelopment of the jaws (prognathia, micrognathia, retrognathia), or misaligned teeth (overbite or underbite), can make it difficult to eat, swallow, speak and breath.

The oral and maxillofacial surgeon performs special corrective jaw surgery to produce a more balanced, functional skeletal relationship for the patient. Often performed in conjunction with treatment by an orthodontist and restorative dentist, corrective jaw surgery is usually performed in a hospital or ambulatory surgical center under general anesthesia.

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 for these patients.The goal is to help restore the jaw and facial structures, leading to normal function and appearance. Care and treatment must consider function, appearance, nutrition, speech, hearing, and emotional and psychological development.

Snoring/Obstructive Sleep Apnea

Obstructive breathing patterns during sleep occur in approximately 45% of the population and 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.

Facial Cosmetic Surgery

Their surgical and dental background and their ability to reconstruct facial structures damaged through trauma, have made oral and maxillofacial surgeons attuned to the importance of harmony between facial appearance and function. Before any cosmetic procedure is performed, the oral and maxillofacial surgeon will request a thorough medical history to evaluate the patient's overall general health.

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.

ORAL AND MAXILLOFACIAL SURGEONS: AN IMPORTANT LINK

Oral and maxillofacial surgery is the specialty of dentistry that includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and aesthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

An oral and maxillofacial surgeon is a graduate of an accredited dental school who has completed an additional four or more years of training in an accredited, hospital-based oral and maxillofacial surgery residency program.

Oral and maxillofacial surgeons are an important link in the referral network for primary care providers. Through appropriate referrals, patients can be provided with expedient and cost-effective health care for conditions relating to the specialty of oral and maxillofacial surgery.

To find an oral and maxillofacial surgeon in your community, visit the Find an OMS database at aaoms.org, or call the American Association of Oral and Maxillofacial Surgeons at 847/678-6200.

The American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 7,000 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.