Oral, Dental and Maxillofacial Surgery - Private Eliz Dent Oral and Dental Health Polyclinic

Oral, Dental, and Maxillofacial Surgery is a surgical branch of dentistry that deals with the diagnosis and treatment of diseases, injuries, and deformities related to the mouth, teeth, and jaws.

Jaw (Maxillofacial) Surgery procedures include the following:
1. Removal of teeth and tooth roots embedded in the jawbone
2. Extraction of impacted wisdom teeth (third molars)
3. Removal of dental or soft tissue abscesses, cysts, and tumors related to tooth roots or gum tissue
4. Diagnosis and treatment of jaw fractures
5. Placement of implants into the jawbone
6. Treatments for facial paralysis, jaw joint (TMJ) and muscle pain, and neuralgias
7. Apical resection surgeries (root-end resection) in cases where root canal therapy has failed, aimed at saving the tooth
8. Planning and performing jaw and facial aesthetic operations—often in conjunction with orthodontic treatment—for older patients to complete an orthodontic treatment plan

Wisdom Teeth – Impacted Tooth Surgeries:
The third molars are the last teeth to erupt in our mouths. They usually begin to erupt between the ages of 17 and 25. If they erupt in the correct position and do not harm surrounding tissues, there is no issue in keeping them.

The reason impacted wisdom teeth pose a problem is that, genetically, these teeth are no longer necessary, and our jaws are getting smaller. As our jaws become smaller, wisdom teeth struggle to find space and therefore cannot fully erupt like other teeth. When wisdom teeth cannot find space, they exert pressure on the adjacent tooth, which can lead to crowding. Because they are located so far back and the gum tissue around them is not in normal anatomical form, they are also prone to infection.

Fully impacted wisdom teeth (completely under the gum and bone) usually do not cause problems. However, they should be monitored with X-rays. Even though they are fully impacted, they can sometimes exert pressure on the roots of the neighboring tooth, damage it, or lead to cystic formations in the surrounding area. In such cases, they must be surgically removed.

Partially erupted wisdom teeth cause the most problems. Because they cannot fully erupt, a flap of gum (operculum) forms over them, and food debris and bacteria can accumulate under this flap, leading to inflammation. When the gums around the tooth become inflamed, pain, swelling, and abscess formation occur, creating an environment favorable for tooth decay. In such situations, surgical removal is necessary.

Fully erupted wisdom teeth generally do not pose issues; however, as they are located so far back in the mouth, they are difficult to brush. Consequently, patients with poor oral hygiene may be advised to have them removed as a preventive measure.

Treatment of wisdom tooth infection:
First, antibiotic therapy is used to manage the acute inflammation and transition it to a chronic state. (The inflammation in this area becomes chronic with antibiotic use; it is not completely eradicated. Therefore, one should not be misled into giving up on tooth extraction simply because the symptoms resolve after antibiotics.)
Wisdom teeth may remain fully or partially impacted in the jaw if they cannot erupt into the mouth.
Impacted wisdom teeth can cause cysts and tumors in the jawbone where they reside.
Partially impacted wisdom teeth are partly erupted into the mouth and can cause pericoronitis, a condition characterized by infection of the gum flap and surrounding tissues (throat and tonsils).
Patients often present with symptoms related to periodontitis in this area.

The bacteria causing periodontitis (Str. viridans, Staph. aureus, beta-hemolytic streptococci) can also settle on heart valves and compromise their function. Hence, extraction or coronectomy (removal of the crown portion of the tooth) of partially impacted wisdom teeth is very important. Impacted wisdom teeth should be removed under sterile surgical conditions.

Tooth Extraction:
Tooth extraction is performed in the following cases:
• When the tooth is severely decayed and cannot be treated or restored
• In advanced periodontal (gum) disease or in the presence of untreatable infections and abscesses in the tooth roots
• During orthodontic treatments to create space in the dental arch
• When the tooth or tooth roots are broken beyond repair
• When the tooth is so far forward or backward that it does not contribute to the dental arch or chewing function
• In impacted teeth that cannot erupt into the mouth