What You Feel or See: Conditions, symptoms, or signs relating to oral and maxillofacial surgery, oral pathology, or oral medicine
The mouth and facial areas are incredibly complex, which is why they function so well when we’re in good health. The downside of this is that there’s a lot that can go wrong if our health isn’t up to scratch, if we’ve become injured, have genetic abnormalities, or a combination of these.
Thankfully, modern dentistry allows almost every condition and disease of the mouth and face to be treated. Here are some of the most common oral and facial conditions and diseases, and the available options for treating them.
- Loose Teeth
You can feel movement when you bite or grasp and apply force with your fingers. Occasionally a tooth may feel so loose you feel could extract it yourself or eating could become extracted from eating. There are several conditions that cause teeth to become loose. The most common of these are:
Diseases of the gums and supporting bone can deteriorate the bone, leading to teeth becoming loose. Unless treated by a periodontist, general dentist or dental hygienist, the condition will continue to worsen. The current available options include:
- Scaling teeth – removing hard deposits such as plaque and tartar
- Periodontal surgery
- Fixed prosthesis – Maryland bridge
- Crowns splinted together.
- Splinting teeth together by bonding with reinforced plastic
- Tooth extraction and replacement with removable or fixed prosthesis
Trauma (A blow or injury to the teeth)
In cases where facial injuries cause the teeth to become loose or wobble but not break, the chances of recovery are high. The teeth will often return to normal on their own after only a few weeks. However, endodontic (root canal) therapy is required if the injury causes the dental pulp (nerve) to die. The following treatment options are usually available:
- Pushing the teeth back into place, avoiding heavy chewing for 1-2 weeks, and wait for healing to take place
- Splinting by bonding the teeth together with reinforced plastic and await healing
Continued pain after a number of weeks often indicates the tooth has died and requires endodontic treatment. In situations where a few teeth have received a severe blow, they can bond to the supporting bone and become ankylosed – solidly attached to the bone. While they may continue to function at an acceptable level, there is a chance they could resorb (degenerate). Tooth extraction is not usually required.
- Gums Bleed Easily
Gums that bleed easily (such as when brushing your teeth normally) usually indicate periodontal disease. In such cases, periodontal surgery may be required. Tooth extraction is always the very last and least desirable option.
- Slightly Broken Tooth
A slight break that occurs on the coronal area of the tooth (the visible part of a tooth) can usually be repaired with a simple restoration method.
- Moderately Broken Tooth
If a large amount of the coronal portion of the tooth has broken off, and the dental pulp (nerve) is visible (often red and may bleed), endodontic (root canal) therapy is usually needed to restore the tooth. A crown must also usually be placed onto the tooth.
- Severely Broken Tooth
In situations where a tooth is broken so severely that the coronal portion is missing, and where the dental pulp may be seen below the gum line, endodontic therapy is almost certainly required. A reinforcement post and extensive crown are usually required to restore the tooth. If a fracture extends vertically to the root or the tooth otherwise cannot be saved, extraction and artificial tooth replacement is almost always necessary.
- Tooth Completely Knocked Out of the Mouth
A particularly severe blow can completely dislodge a tooth from the mouth. If this happens to you, try to find the tooth immediately and place it in a cup of milk, or in the mouth under the lower or upper lip. Find a dentist as soon as possible (the sooner, the better) – they will determine if the tooth can be replanted into the socket. Teeth that have been knocked out and then replanted quickly are often able to function again. The more time the tooth is out of the mouth, the less likely it can be successfully replanted. If the tooth cannot be found, or the dentist determines it is unsuitable for replanting, then artificial replacement will be required.
- Tooth Appears Pink or Gray
A tooth that has a pink color to it usually indicates the dental pulp (nerve) has become enlarged, and a gray tooth often means the pulp has died. In both cases, endodontic (root canal) therapy is almost always required, and severe cases may require extraction and artificial replacement.
- Jaws or Neck Become Swollen
A diseased tooth can cause swelling in the mouth, lower or upper jaw, or neck, which may also occur quickly. Treatment usually requires draining of the cause of the swelling and endodontic therapy on the affected tooth. In cases where a severely diseased tooth has cause excessive swelling, extraction of one or more teeth may be necessary.
Swelling that gradually develops in the lower or upper jaws or the neck over months or years is most often due to some form of cyst or tumor. In such cases, professional observation should be sought as soon as the swelling is recognized. This type of swelling is not usually tooth-related, but a biopsy (microscopic observation of a small tissue sample) may be necessary, and/or surgical removal.
- Tooth Pain
Pain in a tooth often indicates the tooth has developed dental caries (tooth decay). Although many patients may be under the impression that carious (decayed) teeth require extraction, it is almost always the case that other treatments such as a restoration (filling), or endodontic (root canal) therapy are more acceptable and preferential to extraction.
- A Specific Tooth is Sensitive to Pressure
Endodontic (root canal) therapy is usually required for a tooth that is pressure-sensitive. If the affected tooth has already received root canal treatment, it may need further endodontic therapy or require extraction. Other conditions such as clenching or bruxism (grinding teeth), a heavy occlusion (bite), or a crack in the affected tooth can also cause sensitivity to pressure.
- Gums that are Oozing Pus
Pus oozing from the gums is usually a sure sign of periodontal disease in its later stages, and either periodontal (gum and bone) surgery or extraction of the affected tooth is usually necessary.
- Pimple on the Gums
A pimple protruding from the gums is often a sign that the dental pulp (nerve) of a tooth has died. The pimple is caused by pus escaping from the root end of the affected tooth. The tooth can be treated with either endodontic (root canal) therapy, surgically removing a small piece of the tooth root and filling the root canal from the root end (apicoectomy), or in severe cases, extraction of the affected tooth.
- Decayed Teeth
Teeth that have developed dental caries (tooth decay) of almost any stage (small, medium, or large) can often be treated with relatively simple restorations (fillings), or crowns. Only cases where teeth have deteriorated extensively due to prolonged decay require extraction.
- Crooked or Misaligned Teeth
Teeth that have developed crooked or become misaligned should be straightened or realigned by orthodontic treatment. Occasionally, there are too many teeth present in relation to the size of the jaws, often requiring extraction of some teeth before orthodontic therapy can take place.
- Chronic Tooth Pain
There are many possible causes of chronic tooth pain, and such pain requires definite diagnosis. The tooth may have:
- Developed extensive dental caries (decay) requiring restoration or possible extraction
- Dead dental pulp (nerve) requiring endodontic (root canal) therapy
- Cracked and require placement of a crown and possibly endodontic treatment
- Previous root canal therapy that has failed requiring retreatment or extraction
Chronic pain in a tooth may also be due to excessive bruxing or clenching (grinding).
- Some Teeth Have Not Yet Erupted
A tooth or teeth that have impacted (unerupted) or only partially erupted can lead to problems such as destroying surrounding bone from various abnormal growth patterns, or by growing into the mouth in an unusual pattern. Surgical exposure can assist unerupted teeth that appear as though they will erupt into the mouth normally. An impacted tooth may need to be pushed or pulling into place through orthodontic therapy. Sometimes an impacted tooth must be extracted when it cannot erupt normally due to insufficient space in the mouth, or if disease is found in the tooth. There are also occasions where an impacted tooth should remain impacted. Third molars (wisdom teeth) that are unable to erupt properly due to insufficient space are usually extracted. You are advised to seek the opinions of a few dentists before choosing treatment for unerupted teeth.
- Broken Jaw
Trauma such as a severe blow to the face can sometimes break the upper (maxilla) or lower (mandible) jaws and their associated bones. In such cases, oral and maxillofacial surgeons are usually the most suitable specialists for treating these bones, as they have extensive knowledge of the oral-facial anatomy, and know how the teeth should occlude (come together) better than any other dental or medical specialization.
- Lower Jaw Too Far Backward or Forward
Jaws that do not function correctly or appear as normal have excellent surgery options, and through orthognathic surgery, the upper or lower jaw may be repositioned backward or forward. Additional orthodontic (tooth movement) therapy may also be necessary for this type of treatment.
- Lower or Upper Jawbone is Unsuitable for Dentures
Tooth removal causes the supporting bone of the jaw to deteriorate, which may shrink by around 1/16 to 1/32 inch each year after the tooth has been removed. The jawbone eventually becomes inadequate for holding and supporting a denture. Ridge augmentation surgery is available for adding natural or artificial bone bulk to allow the jawbone to become suitable for dentures. The soft tissue on the jawbone can also be extended (vestibuloplasty) to create a larger space for the denture. If a jaw has experienced extensive shrinkage, two or more dental implants may sometimes be placed which may support the denture.
- Jaw Joints and Muscles are Painful
Temporomandibular joint syndrome (TMJ), which is more accurately described as Temporomandibular Dysfunction (TMD), is a commonly experienced condition – more so than many practitioners originally believed. This condition can sometimes be treated through more conservative means such as occlusal (bite) splints, physical therapy, or occlusal adjustment. More severe cases often need surgical treatment for proper correction.
- Hard Growths in the Mouth
The majority of hard growths in the mouth are often bone growths known as benign exostoses that are not usually harmful. The most common places for these growths to occur is in the roof of the mouth, beneath the tongue, and on the upper jaw on the cheek side of the molars. Unless such growths interfere with eating and speaking, there is no need for them to be removed.
- Cold Sores
Many people get irritating and sometimes painful cold sores on their lips. These are caused by the herpesvirus, meaning that they are almost impossible to completely cure. Surgery is not required for cold sores, and your dentist can suggest many medications you can use to reduce their occurrence and severity.
- Canker Sores
Many people develop canker sores (mouth ulcers) which are viral in nature, and cannot be completely cured. Some people may very rarely get them, and others may experience them on an almost consistent basis. Canker sores often seem to occur in the most irritating places (such as where the top and bottom lip meet) which can make eating and speaking painful. Surgery is not required, and your dentist can recommend a range of medications to prevent them from happening as often and less severely.
- Dry Mouth
There are many conditions that can cause xerostomia (dry mouth) such as normal aging, problems with salivary glands, numerous medications, chemotherapy, and radiation therapy. Dry mouth can affect speech, cause dental caries (decay to develop, and reduce the ability to retain artificial dentures. Surgery is not needed to treat dry mouth, and treatments include reducing, stopping, or replacing medications that are causing the condition, or frequently applying artificial saliva.
- White Spots on Soft Oral Tissues
There are many causes of the many types of white spots in the mouth. These include eating hot foods, smoking, and holding aspirin in the mouth. As some of these conditions can be dangerous to your health, you should definitely consult your dentist if you see white spots on any of your oral soft tissues.
- Hairy Tongue
A black hairy tongue may appear unsightly, but it is neither uncommon or dangerous. Your dentist can help you find ways of reducing the build-up of debris on your tongue.
- Spots on Tongue
This condition, also known as ‘geographic tongue’ because it can sometimes cause the tongue to look like a map, is a commonly occurring condition. Although spots on the tongue are is not dangerous, you should consult your dentist to rule out any other possible causes.
What your oral and maxillofacial surgeon or general dentist can do
The mouth and facial areas are incredibly complex, and so too are their related conditions and diseases. Due to the specialist skills and knowledge of oral and maxillofacial surgeons and general dentists, almost all oral diseases and conditions can be successfully diagnosed and treated. The types of treatments can range from simple home remedies you can apply yourself to extensive and complicated surgery. Here are some of the precoderes your oral and maxillofacial surgeon or general dentist can do to treat oral and facial conditions.
If a visual or radiographic (x-ray) observation cannot successfully diagnose a suspicious growth on the soft oral tissue (gums, lips, tongue, etc) or hard tissue (bone), then a biopsy is required. This involves removing a small sample of the tissue either surgically or with a stiff brush and then examining it under a microscope.
Advantages of biopsy
The condition can be successfully diagnosed when observed microscopically.
Disadvantages of biopsy
A surgical biopsy may cause some discomfort and incur a cost to the patient.
Risks of biopsy
Although very low, there is always a slight risk a biopsy may stimulate further growth or spread of the condition. However, growth can often be completely removed during a biopsy if it is small.
Alternatives to biopsy
Complete surgical removal of a suspicious growth is a good alternative to a biopsy. Another option is to do nothing and see if the condition worsens, although this is strongly discouraged.
Cost of biopsy
Although a biopsy is surgical in nature, the cost is relatively low.
Result of Nontreatment
If a suspicious growth is found but a biopsy is not performed, the nature of the growth will remain unknown, and appropriate treatment cannot be performed.
- Tooth Extraction
When needed, extracting an erupted tooth from a healthy patient is a relatively simple and nontraumatic procedure, and healing usually takes only days or weeks. Teeth that are in good condition, or that can be restored using methods such as fillings or crowns should not be removed. However, extraction is usually required for teeth that are causing bone degeneration, are highly diseased, and could potentially affect overall bodily health.
Teeth that are impacted (not erupted) that are likely to cause problems when they do erupt are usually extracted. This is to prevent issues such as the development of cysts that can lead to disease, or negatively affecting the other teeth. Not all impacted teeth need to be extracted, and some may remain in the mouth without causing any problems.
Advantages of tooth extraction
Extracting a problem tooth can stop or prevent pain and discomfort, disease of the gums or bone, and improper tooth development or positioning.
Disadvantages of tooth extraction
If a tooth that is otherwise functioning well is extracted, it can lead to a number of issues such as reduced ability to chew food, and affect facial structure. A tooth that has been extracted should be replaced. However, there is no disadvantage to extracting impacted teeth that are currently serving no functional or esthetic purpose.
Risks of tooth extraction
Extracting teeth, placing implants, and any other oral surgery presents a health risk, ranging from minor to major. There are few risks in removing a tooth from a healthy patient, other than the usual, infrequent, and expected risks of anesthesia incompatibility, or developing ‘dry socket’ which can cause healing to be slow and painful. Extracting a tooth from an unhealthy patient can be complicated which increases the risk involved. Complicated surgical procedures can sometimes cause the jawbone to break, numbness after healing, soft and hard tissue defects, and other problems. If you require a tooth to be extracted, you should discuss the potential risks with your dentist or oral surgeon.
Alternatives to tooth extraction
There are no alternatives if your teeth, bone and gums have degenerated to the level where extraction is the only option. If impacted teeth are not causing any problems, then postponing a tooth extraction and periodically undergoing radiographic observation (x-rays) is another option.
Cost of tooth extraction
A simple and straightforward extraction of an erupted tooth is not expensive, and has a similar cost to a simple tooth restoration (filling). Extracting impacted or broken teeth can be complicated, time consuming, and much more expensive.
Result of Nontreatment
Choosing not to extract diseased teeth or teeth that are in diseased gums and bone can lead to a serious threat to your health, and also increases the risk of pain and infection.
Nondiseased impacted teeth may often remain in the mouth with little to no risk of developing any problems, and can be extracted at a later date if required. However, the difficulty and complication of extracting impacted teeth increases the older a patient becomes.
- Fracture Reductions (Setting Bones – Closed or Open Reduction)
Broken bones can be set back into place without needing to open the skin (closed reduction), or if the break is bad then opening the skin and muscles may be required to manipulate the bones back together (open reduction). In most cases, a broken jawbone must be stabilized for several weeks using wires, splints, screws, or other methods.
Advantages of fracture reduction
When broken bones are replaced into their proper position before healing takes place, they usually develop amazingly close-to-normal function and form.
Disadvantages of fracture reduction
There are no disadvantages if bones are set back into place before healing occurs. However, broken bones that are allowed to heal without proper resetting almost always results in abnormal and improper function and form.
Risks of fracture reduction
If closed reduction is required, there are few risks involved other than potential further injury of muscles, ligaments, and blood vessels. Situations that require open reduction carry the normal risks associated with any surgical procedure.
Alternatives to bone reduction
There are no acceptable alternatives.
Cost of fracture reduction
The cost of non-surgical closed reductions is usually moderate, and open reductions that require surgery are more expensive.
Result of Nontreatment
Broken bones that are allowed to heal without being manipulated into their proper position will usually have poor form and function.
- Replanting Teeth
A tooth that has been knocked out of the mouth and immediately replanted into its original position may, but also may not resume normal function.
Advantages of replanting teeth
If a tooth is replanted soon enough, it can often remain as functional as a normal tooth, reducing the need for a replacement.
Disadvantages of replanting teeth
There is no guarantee that a replanted tooth will heal properly and resume a normal relationship with the mouth. The more time a tooth has been out of the mouth, the more contaminated it becomes, and the less likely it is to heal and resume proper function.
Risks of replanting teeth
If a replanted tooth is not accepted by the body, the following can occur:
- Resorption (degeneration) of the tooth root, which is similar to what happens to our primary (baby) teeth when they’re ready to come out of the mouth. If this happens, replacing the tooth is necessary.
- Sometimes, ankylosis can happen, which bonds the tooth to the jawbone. Normal teeth have a thin ligament separating them from the jawbone to allow some movement. Ankylosed teeth can be rigid and misaligned, and can be difficult to extract if necessary.
Alternatives to replanting teeth
The tooth may be discarded and replaced with a prosthesis such as an implant or bridge. While not recommended, the resulting space can also be left open.
Cost of replanting teeth
Replanting a tooth has a low to moderate cost, and usually also incurs a tooth stabilization cost.
Result of Nontreatment
The space of the missing tooth will result in reduced function and appearance.
- Bone or Ridge Augmentation
Jawbones tend to shrink quickly after teeth are extracted, and the bone becomes inadequate for supporting a denture after many years of having no teeth. Other factors can also lead to bone loss, such as periodontal (gum) disease. To allow dentures to be adequately supported, artificial or real bone can be added to the jawbone. When real bone is used, it can either be taken from the patient’s own body or from a donor.
Advantages of bone or ridge augmentation
The jawbone can be restored to almost-normal form, allowing dentures or implants to be placed, stability of mobilized teeth caused by the bone loss, and improved appearance.
Disadvantages of bone or ridge augmentation
As this is a surgical procedure, some discomfort may be experienced, and healing can take weeks to months.
Risks of bone or ridge augmentation
In addition to the usual risks of surgery, bone grafts are occasionally rejected by the body.
Alternatives to bone or ridge augmentation
The defect can be left untreated and simply accepted. If there is sufficient supporting bone, metallic implants may be placed. In some cases, a vestibuloplasty can allow the soft tissue (gums) to be extended enough to support a denture.
Cost of bone or ridge augmentation
Both real and artificial bone for grafting come at a high price, and the procedure itself can be expensive due to its complex nature.
Result of Nontreatment
The condition will remain and almost certainly worsen.
Surgery is required for many conditions for removing cysts, tumors, and other growths. While general dentists, periodontists, or endodontists are able to perform many types of surgery, most of the more complicated surgical procedures are performed by oral and maxillofacial surgeons.
Advantages of surgery
If a diagnosed cyst, tumor, or other undesirable growth is negatively affecting function or appearance, or is malignant, it should be surgically removed. Surgery is the only acceptable method of removing such growths and prevent further destruction of tissue.
Disadvantages of surgery
All surgical procedures carry a certain amount of risk. Varying levels of discomfort is usually experienced, and healing can take weeks to months. Form and function may inadvertently become defected, which requires future restoration.
Risks of surgery
While there are many risks associated with surgical procedures, many of them can be anticipated and controlled, such as:
- Allergic reaction to medication or anesthetic
- Unavoidable injury to surrounding parts of the body
- Numbness caused by inadvertent or necessary nerve damage
- Developing defects in appearance and function
- Slow healing or lack of expected healing
- Infection leading to further destruction
- Recurrence of the growth
Cost of surgery
As surgical procedures are typically complex and time consuming, and the dentist must assume liability of the outcome, a moderate to high cost should be expected.
Result of Nontreatment
Large growths that are left untreated will continue to destroy tissue, which reduces the possibility of adequate future rehabilitation.
Orthognathic Surgery (Surgical Repositioning of Teeth/Jaws)
Surgery is sometimes the best treatment for teeth that are unacceptably positioned. Certain cases require the affected teeth (or the entire jaws, in some cases) to be separated from the remaining gums and bone, and repositioned in a more suitable location or position. After healing has taken place, there is an improvement in form, function, and appearance. Additional orthodontic treatment can be performed before orthognathic surgery, or afterwards when healing has taken place.
Advantages of orthognathic surgery
There are situations where orthognathic surgery is the only suitable procedure for correcting the relationship between the upper and lower jaws, establishing a correct occlusion (bite), or improving appearance. Both the procedure itself and the time to heal are relatively short.
Disadvantages of orthognathic surgery
There is some discomfort involved, although many patients report that their levels of discomfort weren’t as high as they thought they’d be. Orthognathic surgery also has the moderate to high cost associated with most surgical procedures.
Risks of orthognathic surgery
Normal surgical risks are involved. Occasionally, the desired effect is not achieved and further treatment is necessary.
Alternatives to orthognathic surgery
In some situations, treatments such as orthodontic therapy, or extraction followed by a fixed or removable prosthesis can achieve the desired result. Speak with your dentist to see if these alternatives would be suitable for your situation.
Cost of orthognathic surgery
This type of therapy typically comes with a high fee.
Result of Nontreatment
If no therapy is applied, the condition will remain. As many orthognathic surgeries are for improving appearance, the defect in appearance will also remain. Function may or may not be affected.
- Temporomandibular Joint (TMJ) Surgery
Conservative therapies for temporomandibular joint (TMJ) disorders are always preferable. However, between 1% and 5% of cases require surgery for correcting bone, ligament, or muscle attachments of the jaws. Several professional opinions should be obtained before undergoing this type of treatment. Practitioners involved in treating TMJ include prosthodontists, periodontists, some general dentists, oral and maxillofacial surgeons, and some ear, nose, and throat specialists.
Treatment should not be rushed into as TMJ syndrome is incredibly complex. TMJ surgery can currently be divided into two main categories:
- Conventional TMJ surgery involving an incision, correction of affected TMJ areas, and healing.
- Arthroplasty, which involves making a minimal incision, inserting an arthroscope for observation, minimal repairs, and relatively quick healing.
Advantages of TMJ surgery
This therapy is quick, highly effective, and can successfully correct long-standing problems.
Disadvantages of TMJ surgery
As with most surgical procedures, some discomfort can be experienced, and the surgery may not fully correct the condition.
Risks of TMJ surgery
Usual surgical risks are present.
Alternatives to TMJ surgery
The only alternative is to wait and see if symptoms improve on their own.
Cost of TMJ surgery
As this surgical procedure is usually complicated and has significant liability, the cost is often moderate to high.
Result of Nontreatment
Degeneration of the joints will continue and worsen which will eventually require surgery to correct.
When teeth are removed and not replaced, the gums and supporting bone shrink at an incredibly rapid rate. After many years, the bony ridge may have shrunk so much that it cannot support a denture. One option for improving this condition is to surgically reposition the soft tissue (gums) which provides more space either side of the remaining ridge of the jawbone – known as a vestibuloplasty. This results in an adequate ridge for placing and supporting a denture.
Advantages of vestibuloplasty
A vestibuloplasty creates a larger and more stable ridge for supporting a denture.
Disadvantages of vestibuloplasty
Enough bone may not be present to hold a denture, resulting in the need for implants.
Risks of vestibuloplasty
Normal surgical risks are involved.
Alternatives to vestibuloplasty
Other options include ridge augmentation or implants. In some situations, all three of these treatments – ridge augmentation, vestibuloplasty, and implants – are required.
Cost of vestibuloplasty
A moderate cost is to be be expected.
Result of Nontreatment
The inability to support dentures will continue and worsen. Function and appearance will remain unimproved and most likely deteriorate.
The main goals of oral and maxillofacial surgeons and other dentists that perform surgery are:
- Eliminating the pain and discomfort caused by diseased teeth, gums, and bone
- Remove a variety of undesirable and potentially dangerous growths, and
- Altering the function and appearance of the teeth, jaws, and related facial structures
As oral and general health are interlinked, some diseases of the mouth and face can indicate an issue that is seemingly unrelated. Your dentist and/or oral maxillofacial can diagnose and treat these conditions.