Oral Surgery Basics
The American Dental Association recognizes oral and maxillofacial surgery – commonly referred to as oral surgery – as one of dentistry’s nine specialty areas. This dental specialty focuses on the diagnosis and surgical and adjunctive treatment of diseases, injuries and defects related to the functional and esthetic aspects of the face, mouth, teeth and jaws (maxillofacial area).
Conditions Treated With Oral Surgery
An oral surgeon is an important link in your referral network of primary care providers. When functional dental concerns – such as keeping teeth, overcoming congenital growth issues, controlling serious oral disease and treating trauma-related damage – supersede esthetics, oral surgeons are the appropriate dental specialists with whom to seek a referral.
General dentists, orthodontists, pediatric dentists and medical physicians usually serve as the referrers. Prosthodontists often work hand-in-hand with oral surgeons to develop orthotics and prosthetic appliances to treat a number of functional issues. However, it’s important to note that whenever surgery involves the face, a cosmetic dentist should also be consulted as part of the dental team. Some patients also may wish to consult with a plastic surgeon.
An oral surgeon is skilled in the following:
Removing diseased and impacted teeth and administering anesthesia. An oral surgeon can remove impacted and damaged teeth and provide in-office anesthesia services, including intravenous (IV) sedation and general anesthesia.
Placing dental implants. In collaboration with a cosmetic or restorative dentist who designs your new smile or restorations, your oral surgeon can help with the planning and subsequent placement of your tooth implants. Oral surgeons can reconstruct bone in areas requiring it for implant placement and, when necessary or desired, modify gum tissue around the implants to produce a more natural and attractive appearance.
Treating facial trauma. Oral surgeons can repair minor-to-complex facial skin lacerations, set fractured jaw and facial bones, reconnect severed nerves and treat other facial injuries involving the oral tissues, jaws, cheek and nasal bones, eye sockets, and the forehead.
Evaluating pathologic conditions. Oral surgeons treat patients with benign cysts and tumors of the mouth and face, as well as people with malignant oral, head and neck cancer, and severe infections of the oral cavity, salivary glands, jaws and neck.
Alleviating facial pain. An oral surgeon can diagnose and treat facial pain disorders, including those caused by temporomandibular joint (TMJ) problems. Your oral surgeon can order imaging studies of the joints and make appropriate referrals to other dental and medical specialists, or a physical therapist. When non-surgical treatment is insufficient or there is definite joint damage, your oral surgeon may suggest surgery.
Performing reconstructive and cosmetic surgery. Oral surgeons can correct jaw, facial bone and facial soft tissue problems that result from trauma or the removal of cysts and tumors. Such corrective surgeries restore form and function to the maxillofacial area and often involve using skin, bone, nerves and different tissues from other parts of the body to reconstruct the jaws and face.
Performing corrective jaw (orthognathic) surgery. Oral surgeons correct minor and major skeletal and dental jaw irregularities to improve chewing, speaking and breathing. Usually in collaboration with an orthodontist (a dental specialist who treats improper bites or malocclusions), an oral surgeon surgically reconstructs and realigns the upper and lower jaws into proper dental and facial relationships in order to improve biting function and facial appearance. Oral surgeons also surgically correct birth (congenital) defects of the face and skull, such as cleft lip and cleft palate.
Your dentist, orthodontist and oral surgeon all must collaborate to determine whether orthognathic surgery is right for you or your child. However, it is the oral surgeon who decides which procedure is appropriate. As part of the dental team, the oral surgeon often provides surgical consultation and educational and emotional support for the family over the course of long-term treatment.
Providing surgical treatment for obstructive sleep apnea (OSA). If your dentist suspects that you have a sleep disorder, you will likely be referred to a sleep clinic for a polysomnography, an overnight clinic test that monitors your sleep patterns. Your dentist then will help select the best treatment for you based on whether your OSA is mild, moderate or severe. If non-surgical treatments such as behavior modification or oral appliances do not work, your dentist may refer you to an oral surgeon for a surgical procedure. Surgical procedures to correct sleep apnea include:
- Uvulopalatopharyngoplasty, which shortens and stiffens the soft palate by partially removing the uvula and the edge of the soft palate to correct airway collapses
- Genioglossus advancement, which opens the upper breathing passage by tightening the front tongue tendon, reducing tongue displacement into the throat
- Maxillomandibular advancement, which surgically moves both jaws forward to open the upper airway
Education and Training for Oral Surgeons
To be certified as a diplomate of the American Board of Oral and Maxillofacial Surgery, an oral and maxillofacial surgeon (commonly called an OMFS or oral surgeon) must graduate from an accredited dental school and be licensed in the state in which he/she is practicing. The oral surgeon also must have completed four or more additional years of training in an accredited, hospital-based oral and maxillofacial surgery residency program.
Oral surgeon residents train alongside medical residents in general surgery, advanced anesthesia, plastic surgery (reconstructive or bone grafting/tissue grafting), medicine and pathology. An OMFS may treat patients in hospitals, outpatient facilities and surgery centers, as well as in a dental practice setting.
Choosing an Oral Surgeon
When selecting an oral surgeon, key questions to consider include:
How long has the oral surgeon been in practice? Ideally you want to select and be referred to an oral surgeon who has built a successful practice through years of experience. The more procedures an oral surgeon has performed, the more experience and expertise he or she can offer you.
What is the oral surgeon’s training and clinical experience in performing the specific procedure(s) you require? Ask about his or her experiences, knowledge and background with your particular problem.
What professional dental societies does the oral surgeon belong to? Has the oral surgeon received any credentials or credible accolades from these groups? Select an oral surgeon that is certified as a diplomate of the American Board of Oral and Maxiollofacial Surgery.
What continuing education courses has the oral surgeon taken? How recently have they been completed? Each state and the American Dental Association require that dentists take continuing education classes to keep them up-to-date on the latest procedures and technological advances in the field.
What is the oral surgeon’s diagnosis and proposed treatment plan? Be sure to ask about all the options to treat or correct your condition, as well as the pros and cons of each. Make sure that all aspects are thoroughly explained to you.
What are the estimated costs of the proposed treatment options? In cases where dental insurance does not cover treatment costs, does the oral surgeon offer third party and/or in-house financing?
What is the oral surgeon’s referral process and dental/medical/laboratory/hospital network? When your oral surgeon works in collaboration with other dental and medical professionals on your case, it is important that you have the same level of trust and confidence in their professional skills and care as you do in those of your oral surgeon. You also need to determine whether these dental/medical professionals – as well as the hospital and/or other surgical center where they and/or your oral surgeon may practice – accept your insurance, and whether the specific treatments/procedures they will perform are covered under your insurance plan. If laboratory-fabricated restorations are involved, is the laboratory technician certified or accredited? How long has your oral surgeon worked with this laboratory/technician? Is your oral surgeon satisfied with the quality of the laboratory and/or technician?
Emergencies are unlikely, but do find out what provisions the practice offers. What type of emergency care does the oral surgeon offer? For instance, can the oral surgeon be reached and readily available after office hours, on weekends and holidays? 