Oral & Maxillofacial Surgery

Wisdom Teeth

What are wisdom teeth?
These are the most back teeth in your jaws. They are the last teeth to erupt and there is one in each side of both the upper and lower jaws, so that makes them a total of 4 wisdom teeth.

What are impacted wisdom teeth?
It is not uncommon for one or more of your wisdom teeth to be missing, they either have not developed at all or that they have not got enough space to erupt in their place and so are still inside the jaw bones, this is when we call them "impacted". Impacted teeth lost their potential to erupt due to different reasons such as:
-Insufficient space in the dental arch.
-Improper alignment.
-Tough jaw bones or gums that are difficult for the tooth to penetrate.

Can impacted teeth cause any problems?
Impacted teeth can reside harmlessly inside the jaw bones for variable periods of time and can at one point or another start to cause any of the problems below:
-Inflammation of the overlying gums:
This is what we call "pericoronitis" and it is particularly true when the tooth is partially covered by the gums. Food and bacteria start gathering beneath the gums causing pain and inflammation. The pain is of the cyclic type with typical episodes of remission and exacerbation; it is of the "on and off" type.

-Tooth decay of the impacted or adjacent teeth:
Being inaccessible for tooth brushing, food may accumulate between impacted teeth and their adjacent ones starting a process of tooth decay.
-Referred pain:
As a source of chronic deep pain input, impacted wisdom teeth can cause jaw, muscle and temporomandibular joint pain (TMD). Pain can also be referred other nearby structures such as the ears or teeth in the same or opposing jaw.
-Pathological lesions:
In some cases, cysts may start to form around impacted teeth destroying the surrounding bone. Such cysts can remain unnoticed till they reach large sizes and start threatening vital structures such as nerves or weaken the jaw bones. In rare cases, a transformation can occur inside such cysts whereby they change into some kind of a benign tumor and the situation becomes more complicated.

Do I have to remove my impacted teeth?
This is a subject of a great worldwide debate, but there is currently a general consensus that wisdom teeth should be removed once enough evidence exists that they are impacted for the following reasons:
-Impacted teeth are non-functional and so removing them will do you no harm.
-Removal of impacted teeth can save you their potential problems later on.

When should I remove them?
Impacted teeth can be removed at any stage in life, but it is generally agreed that it is better to remove them early in life for the following reasons:
-During the late teen years or early twenties, the bone is still soft enough and the teeth roots may still not be completely formed allowing easy removal of impacted teeth.
-Younger persons are healthier and can better tolerate the postoperative period than older persons.
-The shorter the time impacted teeth remain in your jaw bones, the less the incidence of their potential complications.

Is it a big surgery?
In most cases, impacted teeth are relatively simple to remove under local anesthesia. The decision of whether to do them under local or general anesthesia depends on their degree of impaction, the number of impacted teeth, the patient's health status and the patient's will. General anesthesia is generally recommended whenever four impacted wisdom teeth are to be removed together.

Are there any hazards to removing impacted wisdom teeth?
In most cases, there procedure is to more or less complication free. However as in any surgical procedure, there is always the potential risk of injuring some vital structures; particularly the lingual nerve in the case of impacted wisdoms. In more severe cases, the roots of the impacted tooth may encroach on the inferior alveolar nerve that might become injured during the procedure, these are the type of cases where we will order a special dental CT scan to allow a better treatment plan to minimize the risk of nerve injury.

Cysts and Tumors

The oral cavity and jaw bones are affected by a great number of different cysts and tumors. Management of such cysts or tumors range from simple excision to more aggressive surgical procedures. It is advisable to consult us if you notice any of the following:
-A lump or swelling inside your oral cavity or affecting your cheek.
-Constant pain for no obvious reason.
-Sudden or progressive looseness of some teeth.
-Numbness of your lip or tongue.

If needed, our oral and maxillofacial surgeon will take part of that abnormal tissue and send it for histological analysis to specifically identify its type and then discuss with you the possible treatment modalities.

It is always better to suspect and manage such pathological conditions as early as possible.

Jaw Deformities

If you ever notice that your teeth, jaw bones or face are asymmetric or mismatching; or if you have problems chewing and speaking because of your misaligned teeth or jaws; please consult our clinic. Our specialized team of orthodontists and maxillofacial surgeons will work out a full evaluation of your situation to formulate a treatment plan that fulfils your needs. Whenever possible, we try to solve the problem by simple orthodontic measures i.e. brackets and wires, but in some cases surgical intervention is a must to achieve the ultimate results.

Facial and Jaw Fractures

Facial and jaw bones as well as teeth may sustain fractures due to trauma or accidents. Please consult our clinic if you received any kind of trauma to the face and you have any of the following signs or symptoms:
-Pain at the site of trauma.
-Any facial or oral cavity lacerations.
-Bruises or swelling at the site of trauma.
-Inability to bite your teeth properly.
-Difficulty opening or closing your jaw.
-Facial disfigurement.

Clinical and radiographic examination performed by our maxillofacial surgeon will identify the problem and enable us to discuss the best treatment with you.