Great Bay Oral Surgery Associates, P.A.

Services

We specialize in the diagnosis, surgical and adjunctive treatment of diseases, injuries, deformities, defects and cosmetic aspects of the mouth, face and jaws. We strive to provide comprehensive and innovative treatment in a comfortable environment. We offer a variety of sedative methods to ensure patient comfort which includes: nitrous oxide, intravenous sedation and general anesthesia. Listed below or in the pull down menu above (under services) you can learn more about the services we offer.

Wisdom Teeth

Removal of third molars (wisdom teeth) is the reason most people first visit us. Currently, there is little or no current known function to wisdom teeth and due to their position in the mouth, they can be difficult to keep clean. Debris and bacteria can gather around wisdom teeth causing pain. Additionally, wisdom teeth are frequently blocked from entering the mouth because of lack of space — a condition known as impaction. More than 90% of the population has or has had at least one impacted tooth. Varying degrees of impaction in which teeth are completely or partially covered by bone and gums can cause multiple problems if not removed. Problems arising from impacted teeth include pain, infection, crowding of teeth, loss of bone and gums, damage to adjacent teeth or other structures, and can contribute to health problems. Cyst or tumors may arise from a developing wisdom requiring larger, more extensive surgery.

Recommendations and Treatment

A short consultation involving an oral and radiographic exam should be done to evaluate the position of the wisdom teeth and potential issues. Your surgeon will explain the procedure and the recovery from wisdom teeth extraction as well as answer any questions you may have. Removal of wisdom teeth is an outpatient procedure routinely done in our office under general anesthesia. To perform surgery, your updated health history is required. Patients must not eat or drink for at least six hours prior to the procedure and need an adult escort for transportation to and from the surgery site.

Outcomes are good and complications are difficult to predict;however, the longer the wisdom teeth remain the more likely they are to cause problems. The best prevention is removal of wisdom teeth during the teen years while the roots are developing, which tends to create less discomfort and reduced healing time.

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Jaw Surgery

Corrective jaw, or orthognathic, surgery is performed by Oral and Maxillofacial Surgeons to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth, which, in turn, can improve chewing, speaking and breathing. While the patient’s appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems.

Following are some of the conditions that may indicate the need for corrective jaw surgery:

difficulty chewing, or biting food
difficulty swallowing
chronic jaw or jaw joint (TMJ) pain and headache
excessive wear of the teeth
open bite (space between the upper and lower teeth when the mouth is closed)
unbalanced facial appearance from the front, or side
facial injury or birth defects
receding chin
protruding jaw
inability to make the lips meet without straining
chronic mouth breathing and dry mouth
sleep apnea (breathing problems when sleeping, including snoring)

Who Needs Corrective Jaw Surgery?

People who may benefit from corrective jaw surgery include those with an improper bite resulting from misaligned teeth and/or jaws. In some cases, the upper and lower jaws may grow at different rates. Injuries and birth defects may also affect jaw alignment. While orthodontics can usually correct bite, or “occlusion,” problems when only the teeth are misaligned, corrective jaw surgery may be necessary to correct misalignment of the jaws.

Evaluating Your Need for Corrective Jaw Surgery

Your dentist, orthodontist and Oral and Maxillofacial Surgeon will work together to determine whether you are a candidate for corrective jaw, or orthognathic, surgery. The Oral and Maxillofacial Surgeon determines which corrective jaw surgical procedure is appropriate and performs the actual surgery. It is important to understand that your treatment, which will probably include orthodontics before and after surgery, may take several years to complete. Your Oral and Maxillofacial Surgeon and orthodontist understand that this is a long-term commitment for you and your family.They will try to realistically estimate the time required for your treatment.

Corrective jaw surgery may reposition all or part of the upper jaw, lower jaw and chin. When you are fully informed about your case and your treatment options, you and your dental team will determine the course of treatment that is best for you.

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Dental Implants

Did you know that dental implants are frequently the best treatment option for replacing missing teeth? Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone.

A Solution of Choice for Replacing Missing Teeth

Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.

Twenty years ago, these patients would have had no alternative but to employ a fixed bridge or removable denture to restore their ability to eat, speak clearly and smile. Fixed bridges and removable dentures, however, are not the perfect solution and often bring with them a number of other problems. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking. Of even greater concern, fixed bridges often affect adjacent healthy teeth, and removable dentures may lead to bone loss in the area where the tooth or teeth are missing. Recurrent decay, periodontal (gum) disease and other factors often doom fixed bridgework to early failure. For these reasons, fixed bridges and removable dentures usually need to be replaced every seven to 15 years.

Today there is another option for patients who are missing permanent teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that "fuses" with the jawbone through a process called "osseointegration," dental implants never slip or make embarrassing noises that advertise the fact that you have "false teeth," and never decay like teeth anchoring fixed bridges. Because dental implants fuse with the jawbone, bone loss is generally not a problem.

After more than 20 years of service, the vast majority of dental implants first placed by oral and maxillofacial surgeons in the United States continue to still function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice. If properly cared for, dental implants can last a lifetime.

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Dental Transplants

A significant number of patients have premature loss of their first and second molars because of dental caries or dental crowding (or both). Often, these patients are not candidates for replacement of these edentulous areas with titanium dental implants because of their age or simply for financial reasons. As advocates for our patients, we in the dental community should be aware of the benefits of tooth transplantation.

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Facial Injury: Treating & Preventing

Maxillofacial injuries, also referred to as facial trauma, encompass any injury to the mouth, face and jaw. Almost everyone has experienced such an injury, or knows someone who has. Most maxillofacial injuries are caused by a sports mishap, motor vehicle accident, on-the-job accident, act of violence or an accident in the home.

If a person is unconscious, disoriented, nauseated, dizzy or otherwise incapacitated, call 911 immediately. Do not attempt to move the individual yourself. If these symptoms are not present but the injury is severe or you are uncertain about its severity, take the person to the nearest hospital emergency room as quickly as possible.

Oral and Maxillofacial Surgeons Treat Injuries to Teeth, Mouth, Jaws and Facial Structures

At the hospital, the individual will most likely be seen by several medical personnel, one of whom will probably be an oral and maxillofacial surgeon. Oral and maxillofacial surgeons, the surgical specialists of the dental profession, are specifically trained to repair injuries to the mouth, face and jaws. After four years of dental school, oral and maxillofacial surgeons complete four or more years of hospital-based surgical residency training that may include rotations through related medical fields, including internal medicine, general surgery, anesthesiology, otolaryngology, plastic surgery, emergency medicine and other medical specialty areas.

At the conclusion of this demanding program, oral and maxillofacial surgeons are well-prepared to perform the full scope of the specialty, which includes emergency care for the teeth, mouth, jaws, and associated facial structures.

Treating Facial Injury

One of the most common types of serious injury to the face occurs when bones are broken. Fractures can involve the lower jaw, upper jaw, palate, cheekbones, eye sockets and combinations of these bones. These injuries can affect sight and the ability to breathe, speak and swallow. Treatment often requires hospitalization.

The principles for treating facial fractures are the same as for a broken arm or leg. The parts of the bone must be lined up (reduced) and held in position long enough to permit them time to heal. This may require six or more weeks depending on the patient's age and the fracture's complexity.

When maxillofacial fractures are complex or extensive, multiple incisions to expose the bones and a combination of wiring or plating techniques may be needed. The repositioning technique used by the oral and maxillofacial surgeon depends upon the location and severity of the fracture. In the case of a break in the upper or lower jaw, for example, metal braces may be fastened to the teeth and rubber bands or wires used to hold the jaws together. Patients with few or no teeth may need dentures or specially constructed splints to align and secure the fracture. Often, patients who sustain facial fractures have other medical problems as well. The oral and maxillofacial surgeon is trained to coordinate his or her treatment with that of other doctors.

During the healing period when jaws are wired shut, the oral and maxillofacial surgeon prescribes a nutritional liquid or pureed diet, which will help the healing process by keeping the patient in good health. After discharge from the hospital, the doctor gives the patient instructions on continued facial and oral care.

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Oral Diseases

Oral Cancer

Because the mouth is a region where changes can be easily seen, oral cancer can be detected in its early stages. Performing a self examination regularly will help in the early recognition and detection of oral cancer, and increase the chance for cure.

Factors That May Cause Cancer

Research has identified a number of factors that may contribute to the development of oral cancer. The most common are the use of tobacco and alcohol. Others include poor oral hygiene, irritation caused by ill-fitting dentures and rough surfaces on teeth, poor nutrition, some chronic infections and combinations of these factors.

Studies have shown that the death rate from oral cancer is about four times higher for cigarette smokers than for nonsmokers. It is also widely believed in the medical field that the heat generated by smoking pipes and cigars irritates the mouth and can lead to lip cancer.

Those at an especially high risk of developing oral cancer are over 40 years of age, heavy drinkers and smokers, or users of smokeless tobacco, including snuff.

Perform a Self-Exam Monthly

Oral and maxillofacial surgeons recommend that everyone perform an oral cancer self-exam each month. If you are at high risk for oral cancer — smoker, consumer of alcohol, user of smokeless tobacco, or snuff — you should see your general dentist or oral and maxillofacial surgeon for an annual exam.

An oral examination is performed using a bright light and a mirror:

remove any dentures
look and feel inside the lips and the front of gums
tilt head back to inspect and feel the roof of your mouth
pull the cheek out to see its inside surface as well as the back of the gums
pull out your tongue and look at all of its surfaces
feel for lumps or enlarged lymph nodes (glands) in both sides of the neck
including under the lower jaw

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TMJ Disorders

The temporomandibular joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet. It permits the lower jaw (mandible) to move and function.

TMJ disorders are not uncommon and have a variety of symptoms. Patients may complain of earaches, headaches and limited ability to open their mouth. They may also complain of clicking or grating sounds in the joint and feel pain when opening and closing their mouth. What must be determined, of course, is the cause.

What Causes TMJ Disorders?

Determining the cause of a TMJ problem is important, because it is the cause that guides the treatment.

Arthritis is one cause of TMJ symptoms. It can result from an injury or from grinding the teeth at night. Another common cause involves displacement or dislocation of the disk that is located between the jawbone and the socket. A displaced disk may produce clicking or popping sounds, limit jaw movement and cause pain when opening and closing the mouth.

The disk can also develop a hole or perforation, which can produce a grating sound with joint movement. There are also conditions such as trauma or rheumatoid arthritis that can cause the parts of the TMJ to fuse, preventing jaw movement altogether.

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Sleep Apnea

People who snore loudly are often the target of bad jokes and middle of the night elbow thrusts; but snoring is no laughing matter. While loud disruptive snoring is at best a social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder: obstructive sleep apnea, or OSA.

Snoring Is Not Necessarily Sleep Apnea

It is important to distinguish between snoring and OSA. Many people snore. It's estimated that approximately 30% to 50% of the US population snore at one time or another, some significantly. Everyone has heard stories of men and women whose snoring can be heard rooms away from where they are sleeping.

Snoring of this magnitude can cause several problems, including marital discord, sleep disturbances and waking episodes sometimes caused by one's own snoring. But, snoring does not always equal OSA; sometimes it is only a social inconvenience. Still, even a social inconvenience can require treatment, and there are several options available to chronic snorers.

Some non-medical treatments that may alleviate snoring include:

Weight loss — as little as 10 pounds may be enough to make a difference.
Change of sleeping position — Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.
Avoid alcohol, caffeine and heavy meals — especially within two hours of bedtime.
Avoid sedatives — which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.

Your doctor has other treatment options, including the following:

Radio Frequency (RF) of the Soft Palate uses radio waves to shrink the tissue in the throat or tongue, thereby increasing the space in the throat and making airway obstruction less likely. Over the course of several treatments the inner tissue shrinks while the outer tissue remains unharmed. Several treatments may be required, but the long-term success of this procedure has not as yet been determined.

Laser-Assisted Uvuloplasty (LAUP) is a surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This procedure is generally used to relieve snoring and can be performed in the Oral and Maxillofacial Surgeon’s office with local or general anesthesia.

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Nutrition

Nutrition, in its basic sense, refers to the intake of nourishment; specifically the fluids and fuels we need to survive. Following illness or surgical procedures, our nutrient needs are increased in order to facilitate healing. For oral and maxillofacial surgery patients this need may be particularly challenging for several reasons. The presence of surgical incisions in or around the mouth and postoperative swelling may make it more difficult to chew and swallow normally. Additionally, the type of surgical procedure may further necessitate a diet limited in consistency. These factors, in combination with the increased nutrient needs following surgery, mean it may be difficult to ensure that you are well nourished following your surgery.

Surgical Nutrition

The single most important nutrient is water. In general, the average adult should drink six to eight glasses of fluids per day. While this amount may be increased following surgery or due to illness, fever, etc., it is a good rule of thumb. Our total calorie needs may be estimated as 15 calories per pound of body weight per day. Again, for the average adult, this translates into about 2,000 calories a day. Protein needs may further increase following surgery as well, to promote healing.

Surgery in the mouth, such as removal of teeth, placement of dental implants, biopsies and similar procedures, do not require a significant increase in nutrients. Your oral and maxillofacial surgeon may suggest a liquid or soft diet for a short time to make you more comfortable and to avoid inadvertently injuring your surgical site. Often, following tooth removal, it is suggested that activities that may physically disrupt clotting and healing should be avoided. This may include consumption of carbonated beverages, drinking through a straw, vigorous tooth brushing and mouth rinsing. Questions regarding when you may resume these activities should be directed to your oral and maxillofacial surgeon.

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