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Oral Surgery

Oral surgery refers to the treatment of various types of injuries or defects to the jaw, head, and neck areas, such as an impacted tooth.

Impacted Wisdom Teeth: The Major Warning Signs

Deep in the back of the mouth lie the third molars, more commonly called the wisdom teeth, and despite their friendly-sounding moniker, these teeth are notorious for causing pain and potentially dangerous dental complications. For this reason, most dental experts actually recommend removing the wisdom teeth, even if they have not caused any discomfort.

Not everyone decides to take the immediate removal route, so knowing the potential of dangerously impacted wisdom teeth is important; they could damage adjacent teeth, lead to gum disease or tooth decay and even cause cysts to develop. While there are not always noticeable signs of impacted wisdom teeth, these are a few of the warning symptoms that could indicate the need for dental intervention:

1. Jaw Pain – While there are many different dental issues that can cause jaw pain, the discomfort from impacted wisdom teeth can lead to pain through the jaw and into the skull, often resulting in terrible headaches. The pain could be more intense while chewing, especially if the pain shoots to the back of the mouth or into nearby teeth.

The jaw pain could also lead to swelling of the entire jaw area. This can indicate an especially dangerous impaction, as the tooth may be causing infection or damage to the nerves around it. A visibly swollen jaw line is a definitive way to tell that something is wrong with the tooth.

2. Sore or Bleeding Gums – Impacted wisdom teeth can be a very serious affliction, and a person’s overall dental health may begin to deteriorate. Because jaw and tooth pain often extends throughout the entire area, the gums can also be affected. Sore or bleeding gums, especially when the bleeding occurs with very little provocation, is a definite sign that something is going wrong with the teeth. Tenderness and swollen gums in the back of the mouth generally indicate that the problem is in the wisdom teeth area.

3. Bad Tastes and Smells – When wisdom teeth are impacted, bacteria often becomes trapped in the soft folds of the teeth and gums. This bacteria grows rapidly in dark, damp areas, such as the back of the mouth, and infections may begin. These infections can fester, potentially leading to cysts and decay. A person experiencing tooth decay or excessive bacteria will notice a bad taste in his or her mouth, even while chewing other food. In addition, it can lead to exceptionally bad breath that may be noticed by other people.

Other possible but less common signs of impacted wisdom teeth may include:

  • Shooting pain in the back of the mouth
  • Swollen glands
  • Difficulty opening the mouth
  • Ongoing earaches

Because impacted wisdom teeth can cause many complications, including irreversibly damaged nerves and necessary orthodontia, it is important that these warning signs be taken very seriously. Allowing the damage to continue without dental intervention can be very dangerous to overall health, so an appointment must be scheduled as soon as any of these potential symptoms are observed.

Oral Cancer

Mention the word ‘cancer’ and most people shudder. A common human response, we try to bury our heads in the sand or wish the concept away unless we actually have to deal with a diagnosis personally. But many cancers are curable when detected early – and oral cancer is no exception. Detecting oral cancer symptoms early can be instrumental in treatment.

Often beginning as a small white or red spot or sore – known as leukoplakia – anywhere in the mouth, oral cancer symptoms don’t necessarily require oral surgery to be detected. Most regular dental checkups include a visual and palpating check for early signs of oral cancer.

If cancerous, these cells can spread to neighboring healthy tissues and grow into a tumor. Later stages of oral cancer can then take hold in lymph nodes, bone, muscle, or other organs. Left untreated, oral cancer can cause disfigurement and even death.

Other potential oral cancer symptoms include the following:

  • Changes in the way your teeth fit together
  • Oral sores that bleed easily or don’t heal
  • Lumps, thickening, rough spots, or crusty or eroded areas in the mouth
  • Difficulty swallowing, chewing, speaking, or moving the jaw or tongue.

Maintaining regular dental visits is the first and best defense against oral cancer. Your dentist is trained to detect oral cancer in its earliest stages and can test further for suspicious growths or conditions. Should something appear abnormal, a simple brush test may be ordered, which collects suspect cells for further analysis in a lab. Oral surgery may be necessary to biopsy the area later.

Other tests, such as a white light test and multi-spectral light test may be used on patients pre-disposed to cancers or at risk for oral cancer. Referral to a pathologist may be recommended for an accurate assessment.

Should an oral cancer diagnosis result from your tests, oral surgery will likely be a necessity. Oral surgeries for oral cancer can include removal of the tumor and surrounding tissues, removal of all or part of the jaw, lymph node removal in the neck, removal of bone in the roof of the mouth, tracheotomy, tooth removal, or plastic surgery to restore removed tissue.

In addition to oral surgery, radiation therapy or chemotherapy may be ordered to shrink tumors or increase the effectiveness of the other procedures.

The best advice for preventing oral cancer is to avoid using tobacco and alcohol. Visit your dentist regularly to ensure proper examination and catch oral cancer as soon as possible. More than half of all patients diagnosed with oral cancer are already experiencing its spread to other parts of the body, complicating recovery. Avoiding that spread is as simple as showing up for a checkup.

Opioid Epidemic: What Dentists and Oral Surgeons are Doing

America’s opioid epidemic has killed more than 180,000 since 2000. Unfortunately, many of the victims became addicted after doctors prescribed them drugs like Oxycontin and Percocet. These prescriptions, however, were likely not their first exposure to powerful painkillers.

According to the New York Times, most opioid prescriptions for people ages ten to nineteen are written by dentists and oral surgeons. This is largely due to the tradition of prescribing opioids after wisdom tooth removal. This procedure is performed on millions of patients under the age of 25 every year. Almost every patient who undergoes this procedure is prescribed opioids.

When health pros prescribe opioids for high school students, they are one-third more likely to abuse the drugs in the future.

“They don’t develop their addiction from that experience,” says psychiatrist and addiction specialist Dr. Andrew Kolodny. “But because of it, they’re no longer afraid of the drug and they like the effect. They’re getting their first taste of the drug from a doctor or dentist, and that increases the likelihood they would use it recreationally.”

Reducing Opioid Addiction

The first step towards reducing opioid addiction is prescribing “more cautiously,” according to Dr. Kolodny. Increasingly, oral health professionals are heeding this advice.

Leading this initiative is Dr. Harold Tu, director of the division of oral and maxillofacial surgery at the University of Minnesota School of Dentistry. Last year, he successfully lobbied the school to implement a new, mandatory protocol that teaches students to avoid opioids for their clinical patients.

The first-line treatment now consists of non-steroidal, anti-inflammatory drugs. These include ibuprofen (or NSAIDs) and acetaminophen. Tu’s students only prescribe opioids if the patient is allergic to one of these or needs stronger pain relief.

So far, Tu told the Times, “we have not seen an increase in patient complaints or patients returning saying ‘the NSAIDs are not working; I need something stronger’.”

Relief Equal To or Better Than Opioids

The notion that ibuprofen combined with acetaminophen could ever treat pain as effectively as opioids might seem a bit farfetched. However, a 2013 study found that the former treatment provides equal or better relief than the latter.*

Minneapolis oral surgeon Dr. Angie Rake used to give young patients “10 to 15 Vicodin” only to hear her parents’ ask for more. She has since reduced her opioid prescriptions by about 60%. She now makes an effort to speak to parents about addiction. “Now I have parents thanking me for taking time to educate them,” Dr. Rake said. “And a lot of times they say, ‘We’re really going to try to avoid these.’”

Dr. Rake is a firm follower of Dr. Tu along with Dr. Douglas Fain, president of the American Association of Oral and Maxillofacial Surgeons. He recently conducted a survey that found that half of his members have reduced opioid prescriptions. They now prescribe just three to four days’ worth of the drugs.

In addition to the number of prescriptions written, Dr. Fain has reduced dosage levels at his practice. “They’re here if you need them,” he says, but only for those in unbearable pain.

*Article Citation: JADA, Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions, August 2013Volume 144, Issue 8, Pages 898–908.