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Dentistry often encounters problems that are solved by specialized surgical intervention. It is for this purpose that dental surgery was created, combining knowledge and issues characteristic of both sciences. For example, specialists in this field are able to extract (remove) a tooth even in the case when only a small fragment remains on the surface, impossible to remove by the dentist.
What does a dental surgeon do?
Dental surgery, however, deals not only with the teeth and related problems – her area of interest is the entire oral cavity and even more. Among the most common medical procedures characteristic of this specialty there are a number of procedures related to the removal of various types of cancer, as well as preliminary steps for prosthetics and implantation. The dental surgeon will also help us in the case of pain and abnormalities in the joints of bones and muscles of the face, also in the field of rehabilitation after an injury.
Dental surgery – tooth autotransplantation
As already mentioned, dental surgery deals with complex cases of tooth extraction. However, it is not its only application in relation to human dentition. One of the most interesting cases of using the possibilities of modern dental surgery is tooth autotransplantation: transplantation of one tooth in place of another, lost in the area of the patient’s jaw or mandible. Thanks to this, not only the unsightly gap formed in the place of the missing tooth is eliminated – the comfort of chewing and grinding food is also improved. At the same time, it is important that the patient does not use a dead implant, but his own tooth, which functions in the same way as the lost one.
A wisdom tooth can be transplanted – the third molar, the eruption of which usually takes place between 17 and 21 years of age. The condition for the possibility of performing a transplant is the appropriate shape of the tooth. First, the dental surgeon prepares the alveolus and retrieves the molar, then installs it in a new location and immobilizes it with the help of a special splint, which stabilizes its position until the graft is accepted.
When the transplant of your own tooth is not possible or it is inadvisable for some reason, there are possibilities offered by dental implant prosthetics, which helps to regain the appropriate jaw mechanics. Currently, implants used in dental surgery are made of titanium. In this case, it is not its durability that is the priority, but the fact that the human body does not reject this material as a foreign body (so-called biocompatibility). Unfortunately, even the latest generation titanium implants are not able to perfectly replace the teeth that nature has given us – they only partially recreate their functionality.
Dental surgery – surgical procedures
A large part of the issues related to dental surgery belongs to the area of facial skeleton plastic surgery, as well as otolaryngology. In the case of operating within the human head and face, we always deal with work at the meeting point of these domains, because they are complementary to each other and only together enable an appropriate understanding of mutually conditioning processes. The head is a place where there is a huge accumulation of organs important for humans on a relatively small area, which is why the cooperation of various fields during the treatment of craniofacial elements is extremely important.
One of the classic operations performed in dental surgery since the beginning of the XNUMXth century is the so-called Caldwell-Luc surgery (the name comes from two doctors who at a similar time presented the idea of penetrating the maxillary sinus through the canine fossa). The indications for the use of this medical procedure are post-traumatic situations, in which inflammations involving pus occur, as well as foreign bodies that must be removed from the maxillary sinus.
A dental surgery specialist enters the maxillary sinus through the vestibule of the oral cavity and the canine fossa, and then removes the mucosa in which pathological changes have occurred. The next step is to facilitate the drainage of secretions from the maxillary sinus by establishing a connection with the nasal cavity. The operation ends with suturing in the mouth vestibule. The procedure is performed under general anesthesia. After the operation, it is necessary to rinse and cool the wound area, and antibiotic therapy will also be necessary.
Dental surgery, cancer and jaw reconstruction
Oral cancer
Dentistry surgeons play a direct role in diagnosing, treating, and performing surgery for people with oral cancer, along with doctors from other specialties. Oral cancer begins with the development of abnormal cancer cells and causes mouth ulcers (cancerous lesions) to develop. Oral cancer can develop in the mouth, cheeks, gums, tongue, lips, palate, sinuses, or the bottom of the mouth. Neck cancer and esophageal cancer are also considered oral cancer. Without early treatment, the disease is life-threatening.
Maxillary and mandible reconstructive surgery
Another type of surgery that dental surgery deals with is jaw reconstruction or correction. Thanks to the appropriate treatments, it is possible to correct facial injuries, repair soft tissue problems caused by trauma and / or reconstruct the jaw.
Maxillary and mandible reconstructive surgery restores the function and form of the patient’s natural features. Such surgeries often require a skin, nerve, or bone graft from another part of the patient’s body. The same skills are essential for cosmetic procedures, which are elective surgery to improve facial features as a result of aging or trauma.
Dental surgery – the course of the procedure
A procedure in the field of dental surgery, like any other medical procedure, requires proper preparation of the patient for the operation, and in this case, the administration of anesthetics by a doctor. When it comes to the duration of the procedure, it will all depend on what exactly the operation is about, as well as the degree of difficulty of the entire procedure, such as difficulty in accessing a given tooth.
Dental surgery – contraindications
There are few absolute contraindications for dental surgery procedures apart from the inability to tolerate general anesthesia. In such cases, other forms of anesthesia may be used, such as regional anesthesia or local anesthesia with intravenous sedation.
There are relative contraindications that may rule out some treatments. Cases like these are assessed individually by comparing the benefits against the risks. The contraindications include:
- high blood pressure (usually when your systolic blood pressure is 180 mmHg or more, or when your diastolic blood pressure is 110 mmHg or more);
- infections that need to be treated first;
- extensive bone necrosis;
- some cancers that can metastasize if surgery is performed.
Dental surgery and potential dangers
As with all operations, Dental surgery procedures are associated with certain risks. Even relatively common procedures, such as tooth extractions, pose a risk of potentially serious complications. In addition to the general risks of surgery (such as excessive bleeding, adverse scarring, postoperative infections, and adverse reactions to anesthesia), dental surgery poses special risks, especially in the case of reconstructive surgery or in the case of facial injuries.
They include:
- changes in the position of the jaw and bite;
- changes in airflow through the nose and sinuses;
- alveolar osteitis, also called dry socket, is caused when a blood clot fails to form or dies at the site of a tooth extraction before it can heal;
- osteitis – inflammation of the bones of the jaw characterized by pain when moving.
Dental surgery and convalescence
The recovery time will vary depending on the procedure in question. While most people can return to work and normal activities within a few days of a wisdom tooth extraction, for example, people who undergo orthognathic surgery may take months to fully recover. Certain factors can increase or decrease the recovery timeincluding general health before surgery, postoperative wound health, and whether or not the patient smokes.
It is very important to follow the recommended eating plan, whether it is a soft or liquid diet, and work with a dietitian if necessary to ensure proper nutrition. Surgeons often recommend eating smaller meals and snacks instead of a full meal for the first week or more, as too much consumption can irritate the treatment site.
Some dental surgery operations require the jaw to be wired. This will involve limiting yourself to a liquid diet. In addition, the patient will need to rinse their mouth thoroughly after brushing, and also rinse with salt water several times a day to remove bacteria from the gums and prevent plaque formation.
In people undergoing soft palate surgery, changes in the articulation of speech may occur, which require speech therapy. In fact, any operation on the jaw, tongue, soft or hard palate can affect speech, either temporarily or permanently. A speech therapist can help determine what treatment is needed. Damage to the branches of the trigeminal nerve is common after maxillofacial surgery, most of which resolve spontaneously over time. Severe cases may require medications and other treatments to block the neuralgia.
Some operations require comprehensive rehabilitation to restore nervous sensation or facial muscle function. Likewise, some scars may require months of continuous care to minimize their appearance or prevent the formation of thick, raised patches (hypertrophic scars).
You should work closely with your doctor to ensure a complete recovery. Attend all scheduled appointments and have realistic expectations of how long it will take to recover. It is never a good idea to rush this period.
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