12: Oral and Maxillofacial Surgery, Oral Pathology, Oral Medicine: Diseases and Surgery Related to the Oral and Facial Areas

CHAPTER 12 Oral and Maxillofacial Surgery, Oral Pathology, Oral Medicine

Diseases and Surgery Related to the Oral and Facial Areas

Many diseases in various parts of the body have oral implications. In fact, the mouth is a mirror of overall body health. Dentists can tell about general body health by looking in the mouth, observing the condition of the soft and hard tissues, and repeating the examination over a period of weeks or months for comparison. The condition of the teeth and the bone and gums that support them are dependent on numerous conditions, including hereditary factors, diet, oral hygiene, and overall health. You should consult your dentist or dental specialist about any conditions or diseases of the oral cavity or related structures. These practitioners are the most educated and experienced of all health practitioners with regard to that part of the body. In the event that your dentist does not recognize your oral condition, he or she will refer you to the appropriate practitioner for further observation.

Most of the oral conditions, except for dental caries (tooth decay), periodontal disease (gum and bone degeneration), and malocclusion (bad bite and crooked teeth), are generally classified into oral medicine or oral pathology. The specialists treating these remaining conditions are usually oral and maxillofacial surgeons, other specialists, or general dentists with interest in this area. A significant number of these conditions require surgery. A small recognized dental specialty, oral pathology, exists but oral pathologists accomplish primarily microscopic recognition of oral diseases as assistance for other dentists.

Most general dentists extract teeth when that procedure is required. However, oral and maxillofacial surgeons have additional education and experience in all surgical aspects of this portion of the body, and many dentists prefer to refer the more difficult procedures, tooth extractions, and other surgical needs to specialists. Your general dentist will judge whether your situation should be referred to an oral and maxillofacial surgeon.

Teeth serve a vital function in the human body, and extraction of teeth should be avoided just as vigorously as amputation of a finger, toe, or any other part of the body. Satisfactory replacement of teeth with artificial ones is difficult and expensive. Only if the entire procedure is done at a high level of quality and skill will the artificial result resemble and function as well as natural teeth. Many conditions described in this book list tooth extraction as an alternative, but it is strongly suggested that teeth be extracted only as a last option.


Conditions, Signs, or Symptoms Related to Oral and Maxillofacial Surgery, Oral Pathology, or Oral Medicine

Some of the conditions discussed below have been listed in other chapters also, because their presence in a less severe form does not require surgery. In such cases you will be referred to the location in the book that describes the more conservative treatment.

1. Loose Teeth (Fig. 12.1): When you bite on your teeth, you feel movement, and when you grasp them with your fingers and apply force, you can feel and see movement. Sometimes the looseness may be so severe that you feel that you could extract a tooth yourself or force it out by eating.

Several conditions cause loose teeth. The most common ones are described below:

Periodontal disease (degeneration of the jaw bones and gums) (p. 129): Periodontal disease causes a reduction in the amount of bone support, and progresses to tooth loosening. This condition continues until it is stopped with help from a periodontist, general dentist, or dental hygienist; it will not heal itself. You have one or more of the following options:

F. Tooth extraction (p. 92) and artificial tooth replacements

Some teeth that have been repositioned after a severe blow require endodontics (root canal therapy). This is recognized by the patient or dentist because of continuing pain in the tooth over a period of weeks, and possible tooth discoloration. A few teeth that have received a blow bond to the bone and become ankylosed (solidly attached to the bone). These teeth may continue to function at an acceptable level; others resorb (degenerate). Tooth extraction is not usually indicated.

2. Gums Bleed Easily: Bleeding gums are described in the chapter on periodontics (gum and bone diseases) (p. 129). Usually this condition is a result of periodontal disease. Periodontal (gum) surgery may be possible (p. 135). Tooth extraction is the last and least desirable possibility.

3. Slightly Broken Tooth (Fig. 12.2): A break of the coronal portion of the tooth (tooth part that normally appears when you open your mouth) is usually repairable with relatively simple restorative methods (p. 142).

4. Moderately Broken Tooth (Fig. 12.3): If most of the coronal portion of the tooth is broken off, and the pulp (nerve) of the tooth is visible in the center of the tooth (it is red and may bleed), endodontics (root canal therapy) is usually required (p. 40), and a crown (cap) usually must be placed on the tooth.

5. Severely Broken Tooth (Fig. 12.4): Occasionally, teeth may be broken to the extent that none of the coronal portion shows when you open your mouth. The root portion of the tooth may be visible below the gum line. If such a tooth can be saved, it almost always requires endodontic (root canal) therapy (p. 40), a reinforcement post, and an extensive crown (cap) (p. 146).


FIG. 12.4 Severely broken tooth requiring endodontics (root canal therapy).

(From Tyldesley WR: Colour atlas of orofacial diseases, ed 2, St Louis, 1991, Mosby [Wolfe]. Copyright 1991 by WR Tyldesley.)

If the tooth has fractured vertically into the root (which is segregated into two portions), it almost always requires extraction and the necessary replacement procedures (p. 92). A few heroic bonding procedures may save the tooth.

6. Tooth Knocked Out of Mouth: A severe blow to the face and mouth can dislodge a tooth completely from the mouth. If this happens, try to find the tooth immediately. Place it in a cup of milk or in the mouth under the upper or lower lip. Find a dentist immediately, and have the dentist decide whether the tooth should be replanted into its socket. Such replanted teeth often become functional again. The longer the tooth remains out of the mouth, the less chance there is for success when it is replanted.

If the tooth is lost, or if replanting is considered unacceptable, the same replacement procedures for an extracted tooth are necessary (fixed prosthodontics, p. 139).

7. Tooth Appears Gray or Pink (Fig. 12.5): A gray tooth usually has a dead pulp (nerve) and requires endodontic (root canal) therapy (p. 40). A pink tooth may have an enlarged pulp (nerve) and may require endodontic (root canal) therapy (p. 40). In severe situations in which teeth appear gray or pink, extraction may be necessary (p. 92).

8. Swelling in the Jaws or Neck (Fig. 12.6): Swelling in the mouth, upper or lower jaw, or neck that has come on rapidly is probably associated with a diseased tooth. Treatment of the swelling probably requires drainage and endodontics (root canal therapy) on a specific tooth (p. 40). Severely diseased teeth that have caused swelling may require removal of one or more teeth (p. 92).


FIG. 12.6 Swelling in palate related to diseased tooth.

(From Tyldesley WR: Colour atlas of orofacial diseases, ed 2, St Louis, 1991, Mosby [Wolfe]. Copyright 1991 by WR Tyldesley.)

Swelling that slowly develops (Fig. 12.7) in the upper or lower jaws or the neck over a period of months or years is usually some form of tumor or cyst, and it should have professional observation as soon as the swelling is recognized. Such swellings are usually not associated with teeth, but they may require a biopsy (small piece of tissue to be observed under a microscope) (p. 91) and/or surgery for removal.

9. Pain in Tooth: A carious (decayed) tooth can cause pain (Fig. 12.8), but it may require only a restoration (filling) or endodontics (root canal therapy) (p. 40) and a restoration (filling), or an extraction (p. 92). Pain in a tooth does not necessarily require an extraction.


FIG. 12.8 Decayed teeth, resulting in severe toothache when the person eats sweets.

(From Tyldesley WR: Colour atlas of orofacial diseases, ed 2, St Louis, 1991, Mosby [Wolfe]. Copyright 1991 by WR Tyldesley.)

10. Sensitivity to Pressure on a Specific Tooth: A pressure-sensitive tooth usually calls for endodontics (root canal therapy) (p. 40). However, the tooth may have had root canal therapy already and may need further endodontic treatment or extraction (p. 92). Pressure sensitivity can also be caused by a heavy occlusion (bite) (p. 74), excessive bruxism or clenching (grinding teeth) (p. 76), or a crack in the tooth (p. 142).

11. Pus Oozing From Gums (Fig. 12.9): Pus oozing from gums usually indicates teeth that are in the late stages of periodontal disease. Such teeth require either periodontal (gum and bone) surgery or tooth extraction.


FIG. 12.9 Oozing pus from gums caused by periodontal disease (bone and gum degeneration).

(From Tyldesley WR: Colour atlas of orofacial diseases, ed 2, St Louis, 1991, Mosby [Wolfe]. Copyright 1991 by WR Tyldesley.)

12. Pimple Protruding From Gums (Fig. 12.10): A pimple on the gum usually indicates a dead pulp (nerve) of a tooth; the pimple provides an escape of pus from the root end of the tooth. Such teeth can usually be treated by endodontics (root canal therapy) (p. 40), apicoectomy (surgical removal of a small piece of tooth root and filling of the root canal on the root end) (p. 41), or, in extreme cases, extraction of the offending tooth (p. 92).


FIG. 12.10 Pimple on gum caused by diseased tooth.

(From Tyldesley WR: Colour atlas of orofacial diseases, ed 2, St Louis, 1991, Mosby [Wolfe]. Copyright 1991 by WR Tyldesley.)

13. Decayed Teeth (Fig. 12.11): Dental caries (decay) whether small, medium, or large, can usually be treated by simple restorations (fillings) (p. 170) or crowns (caps) (p. 146). Only long-neglected dental caries (decay) destroys teeth sufficiently to require extraction (p. 92).

14. Crooked Teeth (Fig. 12.12): Crooked teeth should be straightened by orthodontic therapy (p. 107). However, occasionally there are too many teeth for the size of the jaws, or the teeth are too large for the space present, and some teeth must be extracted before orthodontics can be accomplished.


FIG. 12.12 Crooked teeth in a child, requiring extraction of primary (baby) teeth.

(From Cameron A, Widmer R: Handbook of pediatric dentistry, London, 1997, Mosby-Wolfe.)

15. Chronic Tooth Pain (Fig. 12.13): Long-standing chronic pain in a tooth requires definitive diagnosis. The tooth/>

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Jan 3, 2015 | Posted by in General Dentistry | Comments Off on 12: Oral and Maxillofacial Surgery, Oral Pathology, Oral Medicine: Diseases and Surgery Related to the Oral and Facial Areas
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