Oral and Maxillofacial Surgery

Oral and Maxillofacial Surgery, according to the International Association of Oral and Maxillofacial Surgeons (IAOMS International Association of Oral & Maxillofacial Surgeons) is a surgical specialty of dentistry that includes diagnosis, surgery and treatments related to a wide spectrum of diseases, trauma, wounds and aesthetic aspects of the mouth, teeth, face, jaw and maxilla.

• Removal of dental pieces, from a simple extraction to surgery of retained pieces, such as wisdom teeth (wisdom teeth or third molars).
• Bone grafts for reconstruction of areas for placement of dental implants.
• Maxillary sinus floor lift.
• Cysts and tumors in the jaw or maxillary bones.
• Injuries to the tongue, gums, mucosa of the cheeks or lips.
• Infections in the dental area or in the jaws.
• Cysts and tumors in the mucosa of the mouth (cancer).
• Blows and fracture of teeth and maxillary bones.

The wisdom teeth, or third molars, are the last to erupt. The age varies from 15 years. In some cases, these teeth never come out, or only some come out.

Wisdom Teeth or Retained Wisdom Teeth

Wisdom Teeth can be classified into erupted and unerupted.

Erupted wisdom teeth: this is a tooth has come to the surface and is outside the gum. The root is in the bone.

In this case, complications can occur if there is not enough space. The teeth can come out crooked or in a very posterior position.

Unerupted wisdom teeth: this is a tooth that has not come to the surface and is not observed in the mouth. These teeth are called retained wisdom teeth.

A panoramic radiograph can diagnose if the teeth are in a good position, with space, or, on the contrary, if they present problems that can cause pain, injuries to other teeth, pressure on other teeth that cause discomfort or other damage.

Impacted third molars can cause problems immediately or sometimes over time, since difficulty in cleaning can cause cavities or periodontal problems.

If the wisdom teeth cause pain or other complications, they are usually removed. Those that have not caused problems can also be removed as a preventive measure.

Third molars will be removed when they are producing or may produce:

• Damage to neighboring teeth (cavities, root reabsorption)
• Infection and abscesses, a situation that can become so severe and complex that the patient has to be admitted to a hospital.
• Formation of cysts and tumors, which due to their growth and aggressiveness would force the patient to undergo major operations.
• Acute pain and chronic maxillofacial pain.
• Greater susceptibility to jaw fracture, in the case of blows or trauma by accident or aggression.
• The eventual “crowding” or changing of position of the anterior teeth, as well as the pressure on them, has been associated with third molars.
• When third molars erupt and are located in poor quality gums, they retain food and produce chronic inflammation of the masticatory mucus.

1st Appointment

In this appointment, the patient is studied both clinically and radiographically. A decision is made to operate or not based on the risks and benefits. The recommendations for the post-operative period are given, the medication prescription is delivered, and the procedure and convalescence time is discussed, as well as the type of anesthesia and how stress management.

To carry out a correct radiographic evaluation of the third molars, of the neighboring structures and in general of all the maxillofacial structures, it is essential to have a panoramic dental radiograph as a base, but currently the best radiographic study is carried out with a computerized digital tomography known as a CBCT study.

Third molar surgery is performed under the effect of an injection of a local anesthesia and is complemented by the use of sedative medications that will reduce emotional tension and stress. Sedation is generally applied orally with a pill that is given to the patient a few minutes before entering surgery. Intravenous sedation can also be used in collaboration with an anesthesiologist to achieve maximum effectiveness.

2nd Appointment

The convalescence time for third molar surgery is about 4 to 5 days, during which the patient must rest at home.

3rd Appointment and subsequent

At these appointments, the healing process of the wound is controlled. This healing period can last several months.

The cost of the surgery is directly related to the number of third molars that must be removed (one, two, three or all four), the degree of difficulty and complexity that each of them has and the type of sedation that is used.

From all points of view, the patient obtains a greater benefit when the third molars are all removed in the same appointment.