Corrective Jaw (Orthognathic) Surgery
The way your facial bones develop will affect your oral health, facial appearance and proportion. The position and size of your facial bones and teeth will determine how well you bite, chew and speak.

Orthognatic Surgery is needed when jaws don’t meet correctly and/or teeth don’t seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

Who needs orthognatic surgery?
People who can benefit from orthognatic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is gradual process and in some instances, the upper and lower jaws may grow at different rates. This result can be a host of problems that can affect chewing function, speech, long –term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthognatic surgery may be required for the jaws, when need repositioning.

All these can be exist at birth or may be acquired after birth as a result of hereditary or environmental influences or the result of trauma to the face. Before any treatment begins a consultation will be held to perform a complete examination with X-ray.

Temporomandibular Joint (TMJ)

What is TMJ?
The Temporomandibular Joint is MJ is a small joint located in front of the ear. The TMJ is the place where the lower jaw (mandible) meets the skull (temporal bone). This joint is made up of several parts. The main parts are the bones, the cartilage, the disc and the capsule. The inside part of the capsule is lined by a special tissue call synovium. The synovium makes synovial fluid, which is the fluid that lubricates the joint. When all these parts are healthy the jaw motion is unrestricted, smooth, noiseless, and painless.

TMJ disorders are fairly common and range in severity from fairly innocuous to very severe. Common symptoms associated with these disorders are joint noises (clicking, popping and grating), pain, and difficulty opening or closing the mouth. These disorders can also be associated the muscle pain, headaches and ear pain.

Many different conditions like disc disorders, arthritis, dislocations and rarely tumors can affect this joint. As it can be expected, the treatment for each condition is different. Therefore, the most important step in treating this condition is to make the correct diagnosis.

Diagnosing TMJ
The signs and symptoms listed above are not only seen in patients with TMJ problems, but are also seen in patients with others conditions like myofascial pain, fibromyalgia, headaches, bruxism (grinding and clenching of the teeth)

Therefore, diagnosing TMJ disorders can be complex and may require several diagnostic procedures.

A comprehensive evaluation by an oral and maxillofacial surgeon is necessary. This evaluation will include a detailed medical history and physical examination, radiographs and in some instances, an MRI or CT scan, which will help to develop an effective treatment plan.

If symptoms of TMJ persist, an oral and maxillofacial surgeon should be consulted. Oral and maxillofacial surgeons have expertise in diagnosing and treating these problems.

Treating TMJ
There are several courses of action for treating TMJ – from non-surgical medical and dental care to complex surgeries.

Based on the diagnosis, the Oral and Maxillofacial Surgeon may treat the TMJ disorder with medications, a bite plate, splint or guard or may possibly recommend stress management counseling. Other non-surgical treatment options may include resting the jaw, the adoption of a soft diet or applying heat to the muscles.

However, if there is clear evidence that there is joint damage, surgery may be recommended. Some surgical options include:

• Arthrocentesis: flushing fluid from the joint and gently stretching it.
• Arthroscopy: using a miniature-telescoping instrument to diagnose and repair the joint.
• Arthrotomy: open surgery for more complex cases.

Facts about TMJ

• The temporomandibular joint is the most constantly used joint in the body.
• Three to five percent of Americans seek professional advice annually for temporomandibular disorder (TMD).

Wisdom teeth are the third and final set of molars in the mouth. They tend to appear during the late teens or early twenties. Many people live their whole lives with healthy, fully developed wisdom teeth without pain. However, symptoms sometimes appear from the misalignment or impaction of wisdom teeth that commonly lead to the recommendation of extraction.

Misaligned wisdom teeth, often which are positioned horizontally or angled toward or away from the teeth, may cause damage to the other teeth or jaw or pain. Also, these teeth may be hard to clean because of their positioning, allowing plaque and other debris to build up, which can lead to decay or infection of the teeth or tissue.

Impacted wisdom teeth are those that either do not break out or remain trapped in the jawbone or surrounding tissue due to lack of space in the dental arch. Bacteria may build up around a partially erupted wisdom tooth, which may lead to an infection and painful swelling, stiffness of the jaw or other illnesses. Partially erupted teeth often are more prone to tooth decay and gum disease.

Removal of Wisdom Teeth
With the advancements in surgical and anesthesia techniques, extractions of wisdom teeth can normally be done on an outpatient basis in one of our oral and maxillofacial surgeon’s office. This procedure can be done under local anesthesia, general anesthesia or intravenous sedation. The ease of removal for the wisdom teeth depends on a number of variables, including root development and the position of the teeth. Some wisdom teeth may require a more involved surgical procedure.

Wisdom teeth should be removed before they begin to bother the patient, which can lead to a less complicated healing process. As the patient grows older, the wisdom teeth roots become longer, making it more difficult to remove the teeth and allowing for more complications. Additionally, researchers have found that older patients may be at risk for periodontal disease and other infections.

After the surgery, some swelling or mild discomfort may occur. Cold compresses may help the swelling and a prescription for pain may help with the discomfort. Also, a modified diet after surgery may be recommended.

Did You Know?

• Extraction of wisdom teeth is one of the most commonly performed surgical procedures.
• The time of life between the ages of 17 and 25 is often called the “Age of Wisdom.”
  It is estimated that approximately 85 percent of third molars will eventually need to be remove

PERIODONTAL DISEASE
Periodontal (gum) diseases, including gingivitis and periodontics are serious infections that left untreated can lead to tooth loss. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless firm that constantly forms on your teeth). In the midst form of disease gingivitis, the gum redden, swell and bleed easily. Gingivities is often caused by inadequate oral hygiene. Gingivitiis is reversible with professional treatment and good oral home care. Untreated gingivitis, with time can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and teeth that support the teeth are broken down and destroyed. This destructive process has very mild symptoms, eventually teeth can become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. This destructive process has very mild symptoms; eventually teeth can become loose and may have to be removed.

Causes of Periodontal Disease:
The main cause of periodontal disease is bacterial plaque, sticky colorless film that constantly forms on your teeth. 

• Tobacco use is linked with much serious illness such as cancer, lung and heart disease. 
• Second causes are genetics. 
• When a person mature and change - -puberty / menopause and times, when you are special health needs, such as menstruation / pregnancy – during these period, the body experiences hormonal changes, including the gums, which become sensitive and times react strongly to the hormonal fluctuations, which the person makes you more susceptible to gum disease.
• Stress also a risk factor or periodontal disease, which can make more difficult for the body to fight off infection. 
• Some medications such as oral contraceptives antidepressant, heart medicines can affect your oral health. 
• Cleaning /grinding the can put excess force on the tissues of the teeth and could speed up at the rate which these periodontal tissues are destroyed. 
• By diabetes, the person is at high risk for developing infections. 
• Poor nutrition can also affect the body’s to fight off infection.

GUM GRAFTS
There are many ways of doing Gum Grafts. There are two types of gum tissues (gingival) that surround the teeth. The part that around the neck of the tooth is firmly attached to the tooth underlying bone, and is called attached gingival. The attached gingival is immovable and tough, and is resistant to normal form of eating, tooth, tooth brushing, etc. Genetically each one of us has different width and thickness of attached gingival. In these cases, the gum slowly continue to recede overtime, this not an infection, as is seen with periodontal disease, an anatomic condition.

Exposed teeth are the result of gum recession. Gums may have reached for variety of reasons, including aggressive tooth brushing or periodontal disease. A soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss. In some cases, it can cover exposed roots to protect sensitivity improve esthetics of smile. Soft tissue grafts can be used to cover exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

GINGIVAL GRAFTING
The replacement of missing attached gum is called gingival grafting. The muscle that pulling down on the edge of the gum is first surgically resected and repositioned away from the gum margin. Then piece of an attached gingival is taken from the roof of the mouth, just adjacent to back teeth, and transplanted to the site in question. The new tissue reattaches and reforms a new layer of attached gum, which would last a lifetime with proper care. The roof of the mouth heals quickly, just like a skinned knee might. With this procedure the root is not covered, and tissue stays at the same level as before, except with attached gingival at the margin.

Bone Grafting & Reconstruction
When an area of your body is missing bone, this deficient area is frequently called a "bony defect". These defects may be as a result of:

• Trauma
• Tooth extractions or long-term tooth loss
• Cysts or tumor surgery
• Periodontal disease

A bone graft is a surgical procedure that replaces missing bone with material from the patient's own body (autogenously) or with an artificial, synthetic or natural substitute. The graft not only replaces the bone, but can actually help your body to re-grow bone that has been lost.

Platelet Rich Plasma
Platelet Rich Plasma (PRP) is a non-toxic, non-immune substance that accelerates healing. It can be used in patients to improve their chance for successful Osseo integration of dental implants. PRP is produced from a patient's own blood in a process called Platelet Enrichment Activation. PRP contains densely concentrated growth factors that accelerate and enhance bone growth around titanium dental implants, as well as other areas requiring additional bone.

What are the advantages of PRP treatment?
Platelet Rich Plasma Treatment helps with bone grafting of bony defect areas with:

• Improved healing
• Speeds bone growth
• Non-toxic
• Safe and sterile
  

DENTAL DISEASES
They are annoying and painful and there are plenty of things that can cause them such as bacterial, viral or fungal infections. A loose orthodontic wire, a denture that doesn’t fit, or a sharp edge from a broken tooth or filling may also be the culprit.

Mouth sores may be symptoms of a disease or disorder. A dentist should examine any mouth sore that lasts a week or longer. Among the most common mouth sores are:

Canker sores. Small ulcers with a white or gray base and a red border. Unlike cold sores, canker sores appear inside the mouth. And, they are not contagious. There may be only one canker sore or several and they often return. Their exact cause is uncertain but some experts believe that immune system problems, bacteria or viruses may be involved.

Fatigue, stress or allergies can increase the likelihood of a canker sore. A cut caused by biting the cheek or tongue, or reactions from hot foods or beverages may contribute to canker sore development. Intestinal problems, such as ulcerative colitis and Crohn’s disease, also seem to make some people more susceptible.

Treating Canker Sores: They usually heal on their own after a week or two, but an outbreak may occur. Over-the-counter topical anesthetics and antimicrobial mouthrinses may provide temporary relief. Stay away from hot, spicy or acidic foods that can irritate the sore. Antibiotics and some oral bandages can reduce secondary infection.

Cold sores. Annoying and painful, cold sores, also called fever blisters or Herpes simplex, are groups of fluid-filled blisters. They often erupt around the lips and sometimes under the nose or around the chin. Cold sores caused by herpes virus type 1 are very contagious. The initial infection (primary herpes), which often occurs before adulthood, may be confused with a cold or flu and can cause painful lesions to erupt throughout the mouth.

Once a person is infected with primary herpes, the virus stays in the body and causes occasional attacks. For some people, the virus remains inactive. Recurring herpes lesions look like multiple tiny fluid-filled blisters (cold sores) that most commonly appear around the edge of the lips. An attack may follow a fever, sunburn, skin abrasions or emotional upset.

Treating cold sores: Cold sore blisters usually heal in a week by themselves. Over-the-counter topical anesthetics can provide some relief. Prescription antiviral drugs may reduce these kinds of viral infections.

Leukoplakia. Thick, whitish-color patch that forms on the inside of the cheeks, gums or tongue. These patches are caused by excess cell growth and are common among tobacco users. They can result from irritations such as an ill-fitting denture or the habit of chewing on the inside of the cheek. A danger is that leukoplakia can progress to cancer. Your dentist may recommend a biopsy if the patch appears threatening.

Treating leukoplakia: The dentist examines the lesion and checks the biopsy results to help determine how to manage the disease. Treatment begins with removing the factors that contribute to the lesion: quitting tobacco or replacing ill-fitting dentures or bridges.

Candidiasis. This fungal infection (also called moniliasis or oral thrush) occurs when the yeast Candida albicans reproduce in large numbers. It is common among denture wearers and most often occurs in people who are very young, elderly, debilitated by disease, or who have a problem with their immune system. People who have dry mouth syndrome are very susceptible to candidiasis. Candida may flourish after antibiotic treatment, which can decrease normal bacteria in the mouth.

Treating candidiasis: Control focuses on preventing or controlling the conditions that caused the outbreak. Good oral hygiene is essential. Clean dentures to remove Candida and remove them at bedtime. Saliva substitutes and prescription medications may be helpful when the underlying cause is incurable or unavoidable.