Oral Surgeon: Procedures & Considerations
Updated: January 30, 2023
By: Dr. Advocate
Oral surgeons are essential members of the dental community as they’re also the last line of defense when treating dental disease, pathology, or malformations. Oral surgeons’ scope of practice encompasses multiple procedures and settings. Extractions, including wisdom teeth, and dental implants, are the most commonly performed procedures; however, they also perform biopsies, treat TMJ, manage myofascial pain, expose impacted teeth for orthodontic-assisted eruption and diagnose oral pathology.
Oral surgeons also have hospital privileges to perform reconstruction and cosmetic surgery, treat maxillofacial trauma, correct cleft and craniofacial deformities, correct maxillofacial deformities, and perform orthognathic surgery. After completing dental school, oral surgery accreditation requires 4-6 years of further education and training.Recommended Reading: Five Qualities of a Great Dentist
Clinical practice procedures
The most common procedures in a clinical setting are extractions, including wisdom teeth, and placing implants. They routinely use conscious, deep, or general anesthesia for pain and anxiety control. Most oral surgeons have their practice; however, some will travel to the general dentist’s office for satellite care. They’re equipped with essential equipment and supplies to perform procedures, including sedation. Pathology biopsies are not routinely performed when satellite care is provided, as patient follow-up is difficult.
Let’s take a look at these common procedures.
Wisdom teeth extractions
Wisdom teeth, also known as third molars, are commonly removed due to limited space in the mouth. Impacted teeth can lead to infection if the tooth partially erupts and bacteria enter below. If there’s enough space in the mouth, wisdom teeth will begin to
erupt around 18 years of age. If the tooth is ideally positioned and has an unobstructed path to erupt, it will erupt as planned if adequate space is present.
Although an ideal eruption may occur, many patients will have challenges keeping these teeth clean because of their location in the mouth, often leading to decay and infection. It’s recommended to have your wisdom teeth removed between the ages of 15 and 25 to prevent this and prevent forward pressure on the remaining teeth.
Wisdom teeth extractions are a standard procedure performed under anesthesia. It will take 30-60 mins and best be completed early in the morning as fasting will be required 8 hours prior. It’s recommended to have this procedure performed over a school break or time off, as recovery will take 1-2 weeks. Most patients require removal because their wisdom teeth are impacted and growing in the desired direction. If surgery is performed after 25, patients may have more challenges recovering because the roots will be further embedded deep in the bone.
The inferior alveolar nerve (IAN) runs adjacent to the wisdom teeth, so the surgeon will evaluate the position of the nerve before the procedure. Most of the time, the IAN is a safe distance away from the tooth; however, occasionally, the roots can wrap around the nerve leaving tooth removal impossible. In this case, the surgeon will leave a portion of the root not to damage the nerve during removal. In addition, your provider will administer general or IV sedation during the procedure to aid in pain and anxiolytic relief. But first, let’s take a closer look at the differences between these techniques.
- High level of sedation
- Effects are felt quickly
- Shorter recovery time compared to general anesthesia
- Produces temporary amnesia (patients don’t remember treatment)
- Reduces gag reflex
- Allows patient to remain conscious
- Highest level of sedation
- Used when tolerance to IV sedation is high
- Best for impacted wisdom teeth
- Unable to respond or feel any pain
- Produces amnesia
- Gag reflex is eliminated
If sedation is being performed, the patient will need someone to drive them home after the appointment. Patients will be encouraged to bite on gauze for 30-60 mins to promote blood clot formation. The dentist will likely provide pain medication and antibiotics to prevent infection. It’s essential to begin taking pain medication before the anesthetic wears off. Be cautious when eating, avoiding biting cheeks and lips.
Soft food diet is recommended for 1-2 weeks, depending on extraction severity and recovery. Avoid smoking, spitting, sucking, or anything that could dislodge the blood clot and lead to a dry socket. The dentist may provide an antibacterial rinse (Chlorhexidine) to aid in food removal and limit bacteria growth.
Lightly brush around extraction sites to prevent food buildup from occurring. Patients may have difficulties opening and closing their jaw for a few weeks until the muscles have recovered. After two weeks, contact your provider for follow-up care if pain, infection, or swelling is still present.
Implants have become increasingly popular over the past 20 years because of technological advances, research, and development. Implants are the best option to replace missing teeth as they best resemble natural teeth. However, many implant systems exist, so it’s essential to document the brand and specifications to provide your general dentist with accurate crown fabrication. Also, in the future, if a problem arises and you need to replace the crown, the clinician will need the information to order the correct parts for accurate fitting.
Implants are classified as immediate or delayed depending on their placement stage. For example, if the implant is placed on the same day as tooth removal, it’s considered an immediate implant. On the other hand, an implant will be placed four months after the extraction if extraction is performed and a bone graft is placed for healing. Learn more about the pros and cons of the two implant techniques.
If an immediate implant is placed, the surgeon will also place a bone graft and secure the site with a resorbable membrane to encourage osseointegration. After four months, the surgeon will confirm that integration has occurred by torquing the implant to a specific degree. If stability and health are ensured, the general dentist will take an impression, fabricate the crown, and secure it to the implant body. Strict protocols are in place for each implant system regarding torque specifications. If a delayed implant is planned, the implant will be placed four months after the extraction.
Oral surgeons are trained to manage oral pain and ease anxiety. They’re equipped with skills and techniques to navigate these challenges. Many oral surgeons desire a consult before any procedure to verify the medical history and answer any questions or concerns. They also specialize in extracting multiple teeth before denture placement. It’s not uncommon for patients to have full-mouth extractions during a single visit.
Oral surgeons are exceptional at managing dental disease; they’re also skilled at handling complex health issues. They are greatly valued for treating patients that are medically compromised or too challenging for a general dentist.Related: Best MDA Recommended Products
Oral surgeons are highly-trained specialists in the dental community. Most patients will need their services between 15 and 25 years of age. Have you recently been diagnosed with needing extractions or dental implants? Are you concerned about your planned treatment? My Dental Advocate’s team of board-certified dentists can provide a second opinion on your planned treatment. We look forward to bringing you peace of mind by verifying your treatment plan, suggesting an alternative, or answering your questions.
The more you know, the more healthy habits you can develop, saving you and your family from avoidable and potentially expensive dental procedures. Talk to your dental professional for more suggestions on improving oral health and check back for more blog posts and relevant information. Please share this site and let us know what else you’d like to know!