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What
is an Oral and
Maxillofacial Surgeon
The
American Association of Oral and
Maxillofacial
Surgeons (AAOMS) is pleased to provide
you
with this information regarding the specialty of oral and
maxillofacial surgery and its role in
patient
care. Patients who present to the primary care provider with
complaints of pain or dysfunction in the oral and maxillofacial
region are often candidates for referral to an oral and
maxillofacial surgeon.
The
following information will provide helpful
guidelines
for establishing a working relationship with an oral and
maxillofacial surgeon in your area.
TRAINING
AND SCOPE OF PRACTICE
After
four years of postgraduate dental education,
an
oral and maxillofacial surgeon completes four or
more
years of intensive, postdoctoral, hospital-based
surgical
residency training. Oral and maxillofacial
surgery
residents spend significant time rotating
through
related medical fields such as internal
medicine,
general surgery, anesthesiology, otolar-yngology,
plastic
surgery, and emergency medicine.
Depending
on the residency program, some surgeons
may
also opt to complete the necessary
requirements
to earn a medical or other advanced
degree.
Some may also subsequently complete
fellowships
in sub-specialty areas.
The scope
of oral and maxillofacial surgery encompasses
the
diagnosis, surgical and related management of diseases, injuries,
and defects that involve
both
the functional and esthetic aspects of the oral
and
maxillofacial regions. This includes preventive,
reconstructive,
or emergency care for the teeth, mouth, jaws, and facial
structures.
OFFICE
SURGERY
Oral and
maxillofacial surgeons can perform a wide
variety
of procedures in an office setting as well as
in
a hospital environment. Local anesthesia, nitrous oxide,
intravenous sedation, and general anesthesia
are
options available in the oral and maxillofacial
surgery
office for the appropriate patient and treatment. Office
surgery can be the most efficient and
cost-effective
way to perform many procedures
while
maintaining maximum patient comfort and
safety.
In
addition, many oral and maxillofacial surgeons
perform
laser surgery in the private office setting. A number of soft
tissue procedures, such as biopsy of
oral
tissues, can be done quickly and with less post-operative
discomfort
by using laser techniques.
DENTOALVEOLAR
SURGERY
A tooth
that fails to emerge or fully break through
the
gum tissue is, by definition, "impacted." 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, however,
such
as cuspids and bicuspids, can also become
impacted.
The usual 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
teeth are not addressed until symptoms
are
present, but early removal may be indicated if
radiographs
predict potential
problems.
Oral and maxillofacial
surgeons
have extensive training
in
the diagnosis and management of impacted teeth and in
tooth
extraction and dentoalveolar surgery.
RECONSTRUCTIVE
SURGERY
Inadequate
bone structure in the upper and/or
lower
jaws can be a result of injury, ablative tumor
surgery,
or long-term denture wearing. Osseous
grafts
using either autologous bone or bone substitutes
can
be performed to 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 intraoral soft tissues. 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 good
candidate,
dental implants may be used to replace
lost
teeth and improve function. Implants can also
be
used to anchor intraoral and extraoral prosthesis.
DENTAL
IMPLANTS
Millions
of Americans suffer from permanent tooth
loss.
Dental implants offer an excellent alternative
to
natural teeth. Dental implants are made of materials
that
are compatible with human bone and tissue. Small posts are
attached to the implants and
serve
as stable anchors for artificial replacement
teeth.
Working
as a team member with the restorative dentist, the oral and
maxillofacial surgeon can evaluate
the
patient and place implants in conjunction
with
necessary bone grafting of the jaw. Dental
implant
surgery is often done in the doctor’s office,
dependent
upon the patient’s individual needs.
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.
Appropriate
imaging studies and culture and
antibiotic
sensitivity tests are routinely done. Surgical
treatment
may include intraoral or extraoral
incision
and drainage as well as extraction of
involved
teeth. For less severe infections, evaluation
and
treatment may be done in the office setting.
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
Because
of their expanded dental/medical background
and
hospital-based training, oral and maxillofacial
surgeons
are uniquely qualified to deal with
injuries
to the face, jaws, mouth and teeth. Dental
occlusion
is the most important piece of the puzzle
in
dealing with complex facial fractures. Oral and
maxillofacial
surgeons have extensive training in
repairing
traumatic injuries, including fractures of
the
mandible, maxilla and orbits as well as closure of
extraoral
lacerations.
Childhood
injuries resulting
from
skateboarding, sports or bicycle accidents often
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. For the pediatric patient, various sedation
techniques
can be employed to deliver prompt and effective treatment in the
private office setting.
FACIAL
PAIN
Oral and
maxillofacial surgeons are trained to diagnose
and
treat complaints of facial pain. A common
cause
of facial pain and headaches is disease or
dysfunction
of the temporomandibular joint (TMJ).
TMJ
disorders have a wide range of symptoms that
may
include earaches, headaches, and limitation of
jaw
opening. Patients may also complain of clicking
or
grating sounds in the joint or pain on opening or
closing
the mouth.
Causes
of TMJ dysfunction can be degenerative
(osteoarthritis),
traumatic (meniscal displacement
or
injury), inflammatory
(rheumatoid
arthritis),
or
stress-related. Some
patients
experience a
combination
of muscle
and
joint problems.
Diagnosis
involves clinical
examination,
necessary
imaging
studies (radiograph, CT, MRI) and nerve
blocks.
Once a specific problem is identified, recommendations
can
then be made for treatment.
Usually,
conservative management (soft diet, anti-inflammatory
drugs,
physical and/or bite splint therapy)
is
the first step. With certain conditions, joint
surgery
may be an appropriate option.
Arthroscopic
joint surgery is minimally invasive and
has
proven effective in the resolution of certain
conditions
involving TMJ pain and dysfunction. The
procedure
can be done on an outpatient-surgery
basis
at a hospital or ambulatory surgery center
under
general anesthesia. More complex joint surgery may be indicated
for advanced conditions.
ORAL
PATHOLOGY
Differential
diagnosis of pathology in the maxillofacial region is an important
part of the practice of
oral
and maxillofacial surgery. If indicated, biopsies
and/or
other tests can be performed to arrive at a
definitive
diagnosis and appropriate treatment plan.
Early
detection and treatment of oral lesions greatly
improve
the patient’s prognosis. Lesions may be
managed
medically or surgically excised.
OROFACIAL
DEFORMITIES
Discrepancies
in skeletal growth between the upper
and
lower jaws may lead to both functional and
psychological
difficulties. Functionally, this may
involve
problems with chewing, swallowing, speech,
or
temporomandibular joint (TMJ) function.
Patients
may also exhibit psychological difficulties
stemming
from esthetic and social concerns.
Some
abnormalities may involve only misaligned
teeth
and can be corrected orthodontically with
braces
or other appliances. Serious growth disturbances require surgery
to realign the upper and/or
lower
jaw into a more normal relationship. Common
dentofacial
deformities, including under or overdevelopment
of
the jaws (prognathism, micrognathia,
retrognathia)
or misaligned teeth (over-bite or
imaging
studies radiograph, CT, MRI) and nerve
blocks.
Once a specific problem is identified, recommendations
can
then be made for treatment.
COSMETIC
MAXILLOFACIAL SURGERY
Because
of their surgical and dental background, oral
and
maxillofacial surgeons are finely 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. A careful physical exam will
be
conducted. The procedure to be performed will
be
discussed, as well as the anticipated results,
expected
changes in appearance, type of anesthesia
to
be used, and possible risks and complications.
Cosmetic
maxillofacial surgery may be performed
on
an outpatient basis in the oral and maxillofacial
surgeon’s
office, surgical facility, surgery center, or on an inpatient
basis in the hospital, depending
upon
the surgeon’s and patient’s preference. Surgery
may
be performed under general anesthesia, IV
sedation,
or local anesthesia.
AN
IMPORTANT LINK
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.
American Association of
Oral and Maxillofacial Surgeons
9700 W. Bryn Mawr Avenue
Rosemont, Illinois 60018-5701
847/678-6200 Fax: 847/678-6286
Website: www.aaoms.org
© 1999 American Association of Oral and Maxillofacial Surgeons
(AAOMS).
All rights reserved. Printed in the United States of America.
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