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Dental Procedures

The physicians and surgeons of Head & Neck Surgical Associates started their training with degrees in dentistry. To further their knowledge of oral cavity conditions and associated systemic disease, they continued with medical school and residencies in Oral and Maxillofacial Surgery, Otolaryngology/Head and Neck Surgery, and Plastic and Reconstructive Surgery.

HNSA’s surgeons perform a number of routine, as well as highly complex, dental procedures. Should you require dental implants, preprosthetic surgery, have an oral lesion and require a biopsy and/or lesion removal, or have wisdom teeth that need to be removed, our medical staff can assist you. Our surgeons’ training in the aforementioned procedures is the most comprehensive available today. We would be happy to provide you with a consultation to discuss any of these procedures, or schedule an appointment should you already understand your dental needs.

We look forward to seeing you and creating a specialized program for you.

• Dental Implants
• Oral Pathology
• Preprosthetic Surgery and Bone Grafting
• Wisdom Teeth Removal

Dental Implants

Dental implants are the most contemporary form of tooth replacement. Implants are small titanium posts which are inserted into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. The bone bonds with the titanium, creating a strong foundation for artificial teeth. The process of replacing missing teeth is generally completed in the following stages:

Stage One

Stage one involves the surgical placement of implants. The procedure is performed on an outpatient basis while you receive either local anesthesia or a light intravenous anesthetic. The length of the procedure is usually one to two hours and you are able to go home in the company of a responsible adult the same day. Most patients are able to return to normal activities within two to three days. Temporary tooth replacements (partial denture or “flippers”) are usually worn while the implant is healing.

Stage Two

Over a period of four to six months the implants undergo a process called "osseointegration" in which the bone fuses to the implant. The second stage surgery is then performed to expose the underlying implant and attach small metal posts which protrude from the gums and allow the dentist to attach artificial teeth. This second stage procedure is usually a minor surgical procedure and can be performed with a local anesthetic. You should be able to return to normal activities immediately. After four to six weeks of tissue healing, the final artificial teeth may be fabricated.

Stage Three

This stage includes fabrication of replacement teeth which attach to your implants. This procedure, which will be performed by your dentist, will start approximately one month following your stage two surgical procedure. The time frame will vary according to your healing response, the number of teeth being replaced, and the technique selected by your dentist. On average, approximately four to six weeks is required for full arch replacement of missing teeth. This process requires several appointments with your dentist.

To read about these and other procedures offered by the doctors of HNSA, please visit: http://www.aaoms.org/pamphlets.cfm.

 

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Oral Pathology

The doctors of HNSA are both dentists and physicians who are uniquely qualified to diagnose and treat various pathologic conditions of the oral cavity. Despite the fact that oral cancer is more common than cervical cancer in the United States, there is currently no national screening program for oral cancer. Recent research by HNSA physicians suggests that the best chance of discovering a malignant or pre-malignant lesion in the oral cavity is through regular dental examinations.

Patients are commonly referred to the surgeons of HNSA, often by their dentists, in order to evaluate suspicious lesions in the oral cavity. While the vast majority of these lesions are benign, the physician may recommend a biopsy. This is typically performed under local anesthesia on an outpatient basis. A representative sample of tissue is obtained and sent to a pathologist for microscopic evaluation. This process generally takes seven to ten days, after which your surgeon may or may not recommend further treatment.

Oral lesions:

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:

• Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
• A sore that fails to heal and bleeds easily
• A lump or thickening on the skin lining the inside of the mouth
• Chronic sore throat or hoarseness
• Difficulty in chewing or swallowing

These changes can be detected on the lips, cheeks, palate, gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

We recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Should you be concerned about anything that seems abnormal in your oral cavity, please contact us so we may be of assistance.

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Preprosthetic Surgery and Bone Grafting

Bone that surrounds and supports teeth (alveolar bone) is dependent upon tooth function to maintain itself. Once teeth are lost, that support is also lost, and the alveolar bone begins to resorb. In years past, various procedures were developed to combat this problem (vestibuloplasty, hydroxyapetite augmentation, etc.), all of which met with limited or short-term success. With the development of dental implants, patients with tooth loss and alveolar bone deficiency can now be successfully restored to functional occlusion in a predictable, long-term fashion. Often this requires the placement of a bone graft to restore deficient bone prior to the placement of the implants.

Depending on the size and location of the bony defect, your surgeon may recommend the placement of a bone graft into your upper or lower jaw (or both) prior to, or at the same time as, implant placement. The most commonly used bone grafts are of two types: 1) allogeneic (synthetic bone) and 2) autogenous bone (from your own body). Common donor sites include the chin, the hip and the shin. In addition, a modern technique of creating bone with gradual traction (distraction osteogenesis) is possible in selected cases. These procedures are usually performed on an outpatient basis under intravenous sedation or general anesthesia.

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Wisdom Teeth Removal

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly in the mouth, and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. Wisdom teeth may grow sideways, partially emerge from the gum, or remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.

The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth as poorly positioned, impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result of such bacteria is swelling, stiffness, pain and illness (often very severe). The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jaw bone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

With an oral examination and x-rays of the mouth, the surgeons of HNSA can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Typically, patients are first evaluated in their teenage years by a dentist, orthodontist or oral and maxillofacial surgeon.

Wisdom teeth removal surgery is performed under proper anesthesia. The physicians and surgeons of HNSA have the training, licensing and experience to administer various types of anesthesia to make procedures more comfortable and effective. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques.

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