Vero Beach Surgical Arts

Jaw surgery, as with any operation, is a very serious matter, one that takes careful thought by both the patient and the doctor. If you have been considering jaw surgery but aren’t sure what to do, you may want to take into account some of these interesting facts:

1. In Latin, “orthognathic” means to straighten (“ortho”) the jaws (“gnathia”).
2. The goal of reconstructive jaw surgery is to improve the bite and function. However, many patients also experience an improvement in appearance and speech after surgery!
3. Misalignment of the jaws can be caused by birth defects, injuries or because the upper or lower jaw have grown at different rates.
4. Aligning your jaws can also save your teeth by minimizing excessive wear and tear.
5. Jaw surgery is sometimes used to improve TMJ symptoms and provide relief for sleep apnea.
6. Jaw surgery can even improve “gummy” or “toothless” smiles!
7. An orthodontist can straighten teeth. So if your bite or smile is crooked because of the position of your teeth, an orthodontist can treat you. However, if your bite is off because of the position of your jaws, only an oral surgeon can thoroughly remedy the situation. We work with your orthodontist before and after surgery for a comprehensive approach to your bite and smile.
8. Some patients require a hospital stay for a few days, however the average patient returns home the day of surgery.
9. The time range for returning to school or work post-surgery is 1-3 weeks.
10. Healing is usually complete within 9-12 months.

Our patients often wonder why we recommend wisdom tooth extractions, or what the purpose of wisdom teeth even is. We are eager to help you better understand the benefits of removal and the extraction process! Read on for the answers to some frequently asked questions about those tricky third molars.

Why do we have wisdom teeth?
Human ancestors used their wisdom teeth to grind up food that was hard to digest. They had large jaws and powerful teeth with plenty of room for a third set of molars.

Modern humans, however, eat cooked foods and have a more effective digestive system, so we have evolved smaller jaws and teeth. This means less room in our mouths for wisdom teeth.

Why do I need to have my wisdom teeth removed? 
There are several reasons why you may benefit from having your wisdom teeth extracted, as wisdom teeth can cause a variety of short-term and long-term complications.

• Impaction: If there is not enough room for your wisdom teeth to erupt, they can become impacted, causing them to grow in at an angle. You may experience pain or discomfort while eating due to impaction.
• Damage to other teeth: Impacted wisdom teeth can push against your second molars, potentially damaging them and making them more susceptible to tooth decay.
• Disease: Narrowed spaces between molars due to impaction also allows for bacteria to form more easily, putting you at risk of inflammation, cysts, and periodontal (gum) disease.

When should I get my wisdom teeth out? 
Wisdom teeth usually erupt between the ages of 17 and 25, which means that many people get their wisdom teeth extracted before they graduate high school. The longer you wait, the more complications may arise. The roots of your wisdom teeth continue growing as you get older and may eventually come in contact with a nerve. At this point, nerve damage is a possible outcome of wisdom tooth extraction.

When are wisdom teeth okay to keep?
Sometimes, wisdom teeth have room to erupt healthily and do not need to be extracted. If this is the case, your dentist may recommend you keep your third molars.

Make sure you are coming in for regular check ups so our team can keep an eye on your wisdom teeth. Consult with our practice about the right course of action for your wisdom teeth, because everyone’s teeth are different.

Common symptoms of Temporomandibular joint (TMJ) disorder such as jaw pain, clicking or popping of the jaw and clenching are well known, but did you know that you can experience symptoms of TMJ disorders throughout your whole body? TMJ disorders can be difficult to diagnose when your symptoms are not restricted to the jaw area, so to make diagnosis easier we’ve listed some symptoms you might be surprised to find out are related to TMJ disorders!

1. Earache: Because the jaw muscles run from ear to ear, TMJ related jaw pain can also trigger ear pain, which is often mistaken for an ear infection. The pain actually doesn’t come from the ear at all, but originates directly beneath or in front of the ear.
2. Neck pain: The temporomandibular joint plays a major role in keeping the head balanced on top of the spinal chord. The head weighs roughly 8 pounds, but bad posture due to joint misalignment causes this weight to be distributed unevenly, putting added stress on the neck and spine and causing the head to have a 30-pound pull on your muscles. No wonder neck and back pain are symptoms of TMJ disorders!
3. Pinched nerves: When TMJ alignment is skewed, your muscles overwork themselves to compensate for the imbalance. The back is prone to TMJ related pain, as it becomes strained in order to maintain the body’s balance. This tension can lead to numbness in your extremities, so if you’re experiencing any tingling sensations in your arms, legs, fingers or toes, it could be a sign of a TMJ disorder.
4. Obstructed airways: The tongue is attached to the lower jaw, so the position of the tongue in the mouth depends on your jaw alignment. Misalignment of the lower jaw could cause your tongue to sit too far back in the mouth and obstruct your airways. If your breathing feels abnormal, especially while sleeping, a TMJ disorder could be the culprit.

We hope that reading about these lesser-known symptoms will answer some of your questions about TMJ disorders. If you’re experiencing any of these symptoms, schedule a consultation with us to learn about your treatment options!

Your son is playing a championship game against the team he’s waited all season to play. The score is tied, and as the minutes wind down, the players have gotten more forceful in their actions. You blink, and all of a sudden your son is holding his mouth and a time-out has been called. You run down to him, and your mind is racing, “What happened? How hurt is he?” As you approach him, you see that in his hand he is holding an adult tooth that has been dislodged from the socket. As the sideline paramedics assess for signs of a concussion or hemorrhage you think, “Now what?”

The injury, and circumstances surrounding the injury may cloud your ability to choose your next action. You can rest assured knowing that when you mix today’s technology and the expertise you can expect from a coordinated team approach, the tooth’s fate is looking brighter already!

In the case of avulsion (when a tooth is out of the socket), the approach will most likely be a team effort. Your first course of action following the injury is to rinse off the tooth and try to place it back in the socket. If this is not possible, place the tooth in milk. If you’re expecting an injury like this (as a coach or school teacher etc. might), have Hank’s Balanced Salt Solution on hand to place the tooth in. Water should never be used to place the tooth in. Why milk? Milk maintains the correct fluid balance in the root of the dislodged tooth, which in turn increases the tooth’s chance of survival. Water causes the cells in the tooth to swell and die. If there is no option to place the tooth in any of the approved solutions, place the tooth in between the injured person’s cheek and gum to keep it moist.

After you have arrived at our office, it’s time for us to take over. The investigation phase begins. If a concussion or hemorrhage has not been ruled out, now is the time. When the coast is clear, it is time to move onto a gathering of both radiographic evidence of the injury and clinical documentation about the patient and the incident. From that extracted information, we can make a diagnosis and a subsequent treatment plan. As we mentioned before, depending on the type and severity of the injury, the process may involve a dental professional team.

The aim of treating a tooth trauma case is always to maintain or regain pulpal vitality in the affected tooth/teeth.

In the next few months we will cover other types of tooth injuries and treatments. Stay tuned!

Sometimes jaw problems may require more than orthodontic treatment. Jaw surgery, also known as orthognathic (or-thog-NATH-ik) surgery, can be a great choice for moderate to severe jaw issues. Oral and Maxillofacial Surgeons (OMS) are specially trained in orthognathic surgery that can dramatically improve chewing, speaking, breathing, and in the process enhance a patient’s appearance. If you are considering orthognathic surgery, here are some important things to know.

Why You May Need It. Most conditions that require corrective surgery are the result of abnormal growth of the jaws as they develop. These conditions are often inherited. Other less common causes are facial injury or arthritis of the jaw joints.

Orthognathic surgery may be indicated for the following conditions:

-Difficulty biting, chewing or swallowing food

-Excessive wear or breakdown of teeth

-Chronic jaw or jaw joint pain caused by TMJ (temporomandibular joint disorder) or other jaw problems

-Improve “gummy” smiles, where the lips don’t fully close and show large areas of the gums or “toothless” smiles, where the lips cover all of the teeth

-Facial imbalance, including underbites, overbites, crossbites, and deficient chins

-Sleep apnea

Treatment Team. While we will plan and perform the actual surgery, we will also be working with your dentist and orthodontist for the full course of treatment. Most treatment includes braces for 9 to 18 months before surgery to level and align your teeth. After your jaw heals from surgery, which typically takes about 6 weeks, your orthodontist will finish your alignment and remove the braces. Depending on the severity of your jaw problem, the entire treatment process can take from 12 to 24 months. We know that this is a long-term commitment and we will do our best to minimize the length of treatment and provide you with the best estimates of what will be required.

What to Expect. Jaw surgery can be performed on the upper jaw, lower jaw or both. It is best to perform the surgery after growth stops, usually ages 13 to 15 for females and 16 to 18 for males. Jaw surgery usually can be performed entirely inside your mouth, so no facial scars show. Once your jaws are properly aligned, screws and bone plates secure the bones into their new position. In some cases, extra bone may be added to the jaw. In this case, we transfer the bone from your hip, leg or rib and secure it with temporary wires.

Surgery can take place in an in-patient or outpatient setting, depending on the procedure required. Facial swelling, while variable, is common and increases for a couple of days following surgery before it subsides. More subtle changes in your appearance will continue for up to a year. For this reason, our students generally choose to have the surgery during school vacations. For adults, one to three weeks is usually required before returning to work.

Jaw surgery can enhance your comfort, appearance, and improve your overall health. We are here to answer any questions you have. Please make an appointment for a consultation so we can review the potential of this life changing treatment with you!

Oral cancer has a bad reputation for being more deadly than some other forms of cancer that you hear of more commonly. We are here to tell you that it doesn’t have to be that way. Oral cancer goes unnoticed, not because it is difficult to see or feel, but because the idea of regular oral cancer screenings (either at home or in our office) is rather new. It simply has not been on the public health radar until now.

That is why we want to get the word out, and we need your help! Examining the neck, throat and oral cavity is a relatively simple task when compared to other parts of the body such as internal organs. Early diagnosis leads to better prognosis!

We recommend that once a month, you give yourself the following exam. It should only take 2-3 minutes and could save your life, or the life of a loved one!

First, a word about the ever-changing mouth: We know that many patients avoid self-exams because the mouth is one area of the body that has constant change going on. For example, you may have a recent burn, bite or cold sore and probably don’t want to bother us every time you notice these things! That is why we offer this rule of thumb: any suspicious area that is not better after 14 days should be brought to our attention.

How to perform an Oral Cancer Self Exam:

1. Use a mirror and a bright light.
2. Remove dentures.
3. Look and feel lips and front of gums. Grasp lips with your thumb and forefinger and feel for lumps.
4. Tilt your head back and inspect the roof of your mouth
5. Pull your cheek out to see the inside surface and gums in the rear.
6. Pull out your tongue and look at all surfaces.
7. Feel your neck and under the lower jaw for enlarged lymph nodes, swelling or lumps.

What are you looking for?

1. White patches
2. Red Patches
3. Combination of red and white patches
4. Sores
5. Abnormal lumps or thickening
6. Chronic sore throat/hoarseness
7. Difficulty chewing/swallowing
8. Masses or lumps in the neck

Injuries to the face and mouth are emotionally upsetting as well as physically damaging. It’s extremely important to have medical and dental care by experts who know how to address the psychological, medical, and aesthetic elements of recovery. This blog will cover the most common causes of facial trauma and the types of injures that may occur. As with most injuries, prevention is the best medicine, so we will cover tips in avoiding facial trauma all together!

Most Common Causes of Facial Trauma: There are many ways in which the face can be damaged. Accidents, falls, automobile crashes, work related injuries, and interpersonal violence are among the most common causes for adults. For children, sports related injuries are the leading cause. Children who participate in contact sports, cheerleading, and gymnastics are especially at risk, especially for dental trauma. Dental trauma accounts for 17% of injuries to the body for children, according to the American Dental Association, compared to 5% across all ages. It is most frequently observed in males compared to females, and usually involves the front teeth.

Types of Injuries: Every year about 3 million people are treated for facial trauma according to the American Association of Oral and Maxillofacial Surgeons. Soft tissue trauma includes any cuts to the face or gums. Avulsed, or knocked out teeth are another type of injury, and must be dealt with immediately to increase the chances for reimplantation. Bone injuries, such as fractured jaws, cheekbones, and noses can also occur as well as damage to the nerves in the eyes, face and salivary glands. It is extremely important to have facial trauma assessed and treated by an expert in facial trauma. Besides the aesthetic reasons, serious health complications can occur, even from a small amount of damage. Depending on the location of the injury, speech, swallowing, and breathing can be affected. For dental injury, teeth that are loose in their sockets can make eating difficult and cause speech impediments. Chipped, broken, or misaligned teeth can cause TMJ and other functional problems, in addition to the loss of confidence in your appearance.

What You Can Do to Prevent Injuries: Using a mouthguard during sports or other high-risk activities is the most effective way to prevent injury. Studies in high-risk populations for facial trauma show relatively low compliance in using mouthguards. We can also recommend helmets, face shields, and protective eyewear that can further reduce your risks. The spring season seems to bring an increase of children to the emergency room as kids are eager to get on their bicycles, skateboards, and swing sets. As a parent, educate your child in safety measures and supervise their activity.

When facial trauma does happen, quick action is important. Please call us as soon as possible so we can best advise and support you in your recovery. Accidents happen, and when they do, we want to help!

It seems like something out of a science fiction movie, but with our help, you can easily re-grow bone to treat many common disorders in the mouth and make it dental-implant ready! Bone grafting is a common procedure done right in our office. Here is a simple explanation of this effective treatment option.

Reasons for Bone Grafting. There are many different reasons that a person loses bone support in the jaw. Sometimes it is due to injury, sometimes it because of missing teeth, and other times it is a due to a developmental defect or periodontitis. Bone graft surgery, also called regenerative surgery, is used to replace bone and soft tissue by actually stimulating the body’s natural ability to re-grow the lost tissue. If your jawbone is inadequate to support dental implants, bone grafting can be used to build a sturdy foundation for implant-supported teeth.

It’s A Natural Process. With bone grafting surgery, a piece of bone is removed from another area of your jaw or your body, often the hip, and is transplanted into your jawbone. Sometimes we may use donor or synthetic graft material. Your body uses the implanted bone graft material as a frame on which it can grow new bone. Over time and with your body’s own healing mechanisms, the grafted bone fuses and becomes an integrated part of your existing bone. Bone grafting is a safe and very successful procedure that can be done in the office under local anesthesia. After the procedure, you will be given antibiotics and pain medication if needed. Swelling can be treated with ice packs applied to your face. Most patients proceed with their normal life the next day. Be sure to follow medication instructions and keep your mouth as clean as possible while you heal.

Healing Times. Healing time following bone grafting depends on the amount of bone loss and the location of the graft area. Maintaining a healthy amount of bone tissue around your teeth is crucial to keeping up your oral health. We are more than happy to explain different materials and techniques that can be used for an optimal outcome.

Bone grafting allows your body to rebuild itself. It can be a great way to restore your natural jaw line and smile. Let us help you decide if bone grafting is the right procedure for you!

It’s important to know what to do when you or someone close to you has been injured, especially when it comes to facial injuries. The inside of your mouth is made up of delicate soft tissues that when cut can become infected and easily damaged if the wound isn’t taken care of quickly. Anyone who has had a facial laceration knows that there is a high degree of emotional and physical pain involved when it comes to a facial laceration. So what should you do?

A laceration is a tear or jagged wound and is usually caused by blunt trauma. If you’ve been in an accident and there is any kind of trauma to your face, it is important to seek emergency assistance right away. Lip lacerations are one of the most common types of facial injuries and require careful repair. Lacerations are closed using silk or gut sutures and are done carefully in order to prevent any cosmetic damage. If a tooth is knocked out you should place it in salt water or milk as soon as possible. The sooner the tooth is placed back into the dental socket, the better chance it has of surviving. Do not clean or wipe off the tooth since there are crucial parts of the tooth that could become damaged.

Replanting teeth and treating tooth fractures can be handled by an oral surgeon along with facial trauma but if you have been involved in a serious accident you should go to the closest hospital emergency room as soon as possible. Facial bone fractures cannot be treated with a cast like other parts of the body. The surgical placement of plates around the affected area is a recent development in medicine that allows for a faster recovery time and involves the fewest incisions necessary.

Any kind of traumatic injury to your face is serious and should be addressed immediately to prevent further damage and scaring. If you’ve had a recent injury and think you may have a facial bone fracture, call us immediately to schedule a consultation.

Regular oral pathology exams are extremely important when it comes to preventing head and neck cancer. When you visit us, make sure to ask about the exam if you haven’t had one before or have noticed anything strange on the inside of your mouth.

It’s also good to perform an oral pathology check on yourself from time to time. Let’s go over how to do an at-home check and what you should be looking out for.

Step 1: Know what you’re looking for. Oral cancer signs include:

• A difference in color in one particular area
• A change in texture
• Lumps of any kind (especially if it’s something you haven’t noticed before)
• Lesions

Step 2: Take a bright light such as a flashlight and while looking in a mirror, check the following:

• Tongue
• Lips
• Cheek walls
• Top and bottom of mouth
• Back of throat

If you notice any of the above signs, give us a call immediately to schedule an appointment. It’s also beneficial to perform an extra-oral screening. When performing an extra-oral exam on yourself, you want to feel for any lumps or bumps. Here are the steps for doing this exam at home:

Step 1: Place your hands on the back of each side of your jaw under your ears. Open and close your jaw while feeling for any bumps.

Step 2: With your hands in the same position work your way down your neck.

Step 3: Turn your head to the right and feel your left side-neck muscles. Turn your head left and feel your right side neck muscles.

Step 4: Grab your gullet and swallow.

Step 5: Put your chin down and with your palms facing away from you feel the underside of your jaw with your fingers.

We hope we don’t have to see you in the office if you’ve discovered something wrong, but we are here to help. We can catch the early signs of oral cancer!