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Wisdom Teeth
Oral Pathology
Temporomandibular Dysfunction
Dental Implants
Jaw surgery

Pre-Operation Information
Pre-Anesthesia Instructions

General Information

Q: Do I have to be referred by a dentist to schedule an appointment?

A: You are not required to have a referral; however it is strongly recommended. Unnecessary visits can be avoided if you first see a general dentist for a full evaluation, x-rays and cleaning. Your dentist can develop a treatment plan for you and determine if a visit to our office is needed.

Q: Will I need to have x-rays taken?

A: Yes. Current x-rays are required for any dental surgical procedure or exam. Your general dentist or orthodontist can provide you with current x-rays to bring if they have them available. Otherwise, our skilled staff can take the films at your appointment.

Q: Do I need someone to drive me home after surgery?

A: If you are receiving IV sedation, you will need a responsible adult to drive you home and to remain with you for several hours following surgery. You should not operate any vehicle or hazardous device on the day of surgery. Patients receiving local anesthetic or nitrous oxide can drive home or have a driver whichever is preferred.

Q: May I eat before I come in for surgery?

A: If you are receiving IV sedation for your procedure, you can have nothing at all to eat or drink for a minimum of six full hours prior to your appointment. Persons receiving local anesthetic and nitrous oxide may eat a light meal prior to the appointment.
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Wisdom Teeth

Q: What are wisdom teeth and why should they be removed?

A: Wisdom teeth, or third molars, are the last teeth to develop and appear in the mouth. Because the teeth usually appear during a person’s late teens or early twenties — “the age of wisdom” — they are called “wisdom teeth.” They are normally positioned behind the 12-year molars and many times the human jaw is not large enough to accommodate the four wisdom teeth. This is why wisdom teeth cause more problems than any other teeth in the mouth. In fact, for nine out of ten people at least one wisdom tooth remains underneath the gum due to lack of space in the mouth.

Q: If I have impacted teeth, why should they be removed?

A: Teeth that are embedded in the tissue of the jawbone are termed impacted. They are in an abnormal position. The body intended for the wisdom teeth to erupt into the oral cavity and be used for chewing. When there is insufficient room for this to occur certain problems are often encountered. These problems include infections, damage to the adjacent teeth, and development of cysts. The attempt of the wisdom teeth to move into a useful position may be at least a small factor in the crowding of the front teeth.

Q: If my wisdom teeth aren’t bothering me, when should I have them removed?

A: First of all, not all problems in our bodies cause symptoms. For example, it is unusual for high blood pressure to cause symptoms, especially in the early phases. However, it can be very destructive to the blood vessels. In the same manner, just because wisdom teeth are not causing pain, it doesn’t mean that they are not causing problems. In addition to the factors mentioned above, the roots of the wisdom teeth can grow around a nerve in the lower jaw or into the sinuses. The risk of complications increases significantly with age. If the wisdom teeth are impacted when a patient is 14-20 years of age, depending on development and other factors, and if it is anticipated that they will require removal in the future, we usually recommend the removal of the teeth as soon thereafter possible. This will minimize the risk of after effects and most people heal much faster when they are younger.

Q: Is the process of removing wisdom teeth painful?

A: Because of the safety of modern techniques and medications, most people elect to have intravenous anesthesia so they can sleep through the procedure to remove the wisdom teeth. In this case, the removal of wisdom teeth is absolutely painless.

Q: What about the after effects?

A: Naturally, there is some discomfort during the healing phase, however patients who follow instructions carefully often have fewer problems. Of course, each individual’s case may differ — we usually relate the recovery process to an inconvenience that is similar to recovering from a bad cold or the flu.

Q: What should I do if I think I have impacted wisdom teeth?

A: We usually recommend that your first ask the dentist for his/her opinion. If the dentist feels there is a problem or if he/she would to obtain a second opinion, he/she will suggest you visit an oral and maxillofacial surgeon. If you do not have a dentist or of you wish to contact our office directly for an appointment, we would be happy to see you on a consultation basis and discuss your situation with you.
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Oral Pathology

Q: What mouth problems cause oral surgeons a lot of concern?

A: Oral surgeons are seeing more and more patients with the development of white areas in the mouth which can become pre-cancerous or on some occasions even cancerous. There are many other types of pathology that oral and maxillofacial surgeons treat on a regular basis. Perhaps the most common and the frustrating problem occurs secondary to tobacco use, either smoking, dipping snuff or chewing. The reason that this is frustrating is because it is entirely preventable. The use of tobacco products can cause very serious problems to the tissues of the mouth.

If you have any suspicious areas in your mouth or on your lips, please call it to the attention of your dentist or call our office for an evaluation.
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Temporomandibular Dysfunction

Q: What are TMJ (temporomandibular or jaw joint) problems?

A: We refer to TMJ problems as being like “arthritis in the jaw.” We use this since most people associate arthritis with joint or muscle stiffness and soreness. These are usually the main symptoms of TMJ disorders. The symptoms of TMJ are usually easy to spot, but finding the cause can sometimes be quite complex. In many patients, several different things may contribute to the problem. The confusing aspect of TMJ is that it can cause symptoms in so many different locations. Patients with TMJ problems sometimes have acute and very severe pain and require the most careful attention that we can provide.
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Dental Implants

Q: What are dental implants?

A: Dental implants are high-tech metal titanium inserts that are placed in the jawbone to replace missing teeth. This process can be very simple or quite complicated depending on your individual case. As a first step in obtaining information as to whether or not you are an implant candidate, we suggest that your see your general dentist. If your dentist evaluates your mouth and thinks you would be a candidate, he may suggest that you see an oral and maxillofacial surgeon to obtain a second opinion.

Q: What are some of the more common ways that implants can be used?

A: Some people with lower dentures find that dentures cause pain and move around too much when they chew. Perhaps the simplest and one of the more common ways of using implants is to hold a lower denture firmly in place. Another common use for implants is to replace a front tooth which was lost due to an injury or severe decay. Implants are also commonly used to create a dental bridge, especially in the back of the mouth to improve the patient’s chewing ability. In some cases, implants can be used to restore all of the missing teeth, but as you can imagine this can be quite complex.
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Jaw surgery

Q: What types of jaw surgery do oral and maxillofacial surgeons do?

A: Occasionally, Mother Nature plays “tricks” on a person’s jaws. One jaw may grow too large or too small for the opposing jaw. If the jaws are not the same size or do not relate well to the size of the face, significant problems with chewing, swallowing and digesting food can occur. In addition, TMJ problems can occur and not infrequently, the abnormality can be noticed in the facial appearance.

Q: What can be done if this occurs?

A: Oral and maxillofacial surgeons are trained to rebuild the jaws. If the jaw is too short it can be lengthened and if the jaw is too long, it can be shortened. While these procedures are usually accomplished in the hospital, this is a recognized medical problem, and many medical insurance agencies pay for the treatment.

Q: Is other treatment necessary other than surgery?

A: Frequently, when a jaw grows to an inappropriate size, the teeth are also crowding or spaced too far apart. For this reason, it is frequently necessary for a patient to require orthodontics prior to surgery. This ensures that the bite fits appropriately after surgery and enhances the benefit of the treatment.

Q: What does maxillofacial mean?

A: Maxillofacial refers to the face and jaws, which along with the mouth comprise the areas of expertise of an oral and maxillofacial surgeon.
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Corrective Jaw Surgery
Dental Extractions (Wisdom Teeth)
Facial Pain
Dental Implant Surgery
Jaw Joint Therapy
Tumor Removal & reconstruction
Facial Trauma
Orthognathic Surgery
Bone Grafting
Oral Pathology
Temporomandibular Joint disorders
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Pre-Operation Information

Same Day Surgery
When a minor procedure is planned, occasionally the surgery can be performed on the same day as your examination/consultation. If such minor procedures are performed it is with a local anesthetic or “numbing” medication. This may be completely appropriate for uncomplicated extraction of teeth, biopsy or removal of small lesions of the mouth.

Other more complicated procedures such as the removal of impacted wisdom teeth, multiple extractions, implant placement and bone graft jaw augmentation are more appropriately treated with IV sedation or IV anesthesia. This requires special preparation and often is scheduled for a day other than your consultation.
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Pre-Anesthesia Instructions

For patients who have had prior consultation and will be utilizing IV sedation or IV anesthesia, it is important to follow these instructions. Deviation from these instructions can result in a situation that can cause harm or injury to the patient and could cause prolonged healing after the surgery.

• The patient must have nothing to eat or drink for six hours prior to surgery and anesthesia.

• The patient must be accompanied by a responsible adult to the office who can remain in the office during the procedure and is able to drive the patient home after surgery/anesthesia.

• It is advisable to have the parent or responsible adult remain with the patient for several hours after surgery and anesthesia.

• The patient should not operate dangerous equipment or drive a motor vehicle for 24 hours after receiving anesthetic medications.

• The patient should wear loose-fitting clothing with short sleeves and button-down-the-front shirt/blouse (or t-shirt) to allow optimal placement of monitors and IV line.

• The patient should wear low-heeled or flat-sided shoes. Do not wear high heels or platform shoes.

• Patients should NOT wear jewelry or make-up for surgery.

• The patient must remove all oral piercing type jewelry including tongue, lip posts and rings.

• DO NOT bring valuables to the office. Leave any purses, wallets, cell phones, watches at home or with your adult escort. Do not bring unneeded valuables to the office.

• We encourage patients to practice normal hygiene including tooth and tongue brushing prior to surgery. DO NOT swallow any of the water or take a drink of water when you cleanse or rinse your mouth.

• Patients should remove contact lenses prior to coming to the office for surgery — bring your eyeglasses instead.

• DO NOT wear or apply body lotion or powder. This can affect lead connection for the heart monitors used during sedation and anesthesia.
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