Canterbury Oral & Maxillofacial Surgery

INITIAL CONSULTATION
Your initial appointment will consist of a consultation explaining your diagnosis and treatment options.  Surgery is not performed the same day as the consultation.  This will give the doctors time to do a thorough exam and evaluate your medical history so that we may provide the highest level of care possible.  When reporting to your consultation, please bring with you your medical and dental insurance cards as well as the completed medical history form and patient information form that is mailed to you prior to your appointment.  They can also be downloaded from the Patient Information page on this website.  All patients under the age of 18 must be accompanied by a parent or guardian.  

X-RAY
If your dentist or physician has taken x-rays, you may request they be forwarded to our office.  If no films are available, they will be taken in our facility.

ANESTHESIA
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort.  Dr. Martin, Dr. Miller, and Dr. Roholt have the training, licenses and experience to offer various types of anesthesia.  This allows patients to choose the best anesthesia option for their comfort.  These services are provided in an environment of optimum safety which utilizes modern monitoring equipment and staff that are experienced in anesthesia techniques.

DENTAL IMPLANTS
Dental implants are changing the way people live.  They are designed to provide a foundation for replacement teeth which look, feel, and function like natural teeth.  The implants themselves are tiny titanium posts which are inserted into the jawbone where teeth are missing.  These metal anchors act as tooth root substitutes.   The bone bonds with the titanium, creating a strong foundation for artificial teeth.  Small posts are then attached to the implant which protrude through the gums.  These posts provide stable anchors for artificial replacement teeth.  Implants also help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.

WISDOM TEETH (3RD MOLARS)
By the age of eighteen, the average adult has 32 teeth: 16 teeth on top and 16 teeth on the bottom.  Each tooth in the mouth has a specific name and function.  The front teeth (incisors, canine, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces.  The back teeth, or molars, are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth.  It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth.  These four other teeth are your wisdom teeth.  Wisdom teeth are the last teeth to erupt within the mouth.  The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth.  They may grow sideways, partially emerge from the gum and remain trapped beneath the gum and bone.  Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt.

These poorly positioned teeth can cause many problems.  When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection.  The result:  swelling, stiffness, pain and illness.  The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth.  The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth.  Removal of the offending impacted tooth or teeth usually resolves these problems. 

BONE GRAFTING
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed.  This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants.  In these situations, most patients are not candidates for dental implants.

We now have the ability to grow bone where needed.  This not only gives us the opportunity to place implants of proper length and width, but it also gives us a chance to restore functionality and esthetic appearance.  The bone graft procedures are referred to as the following:

Sinus Lift Procedure-This procedure involves elevating the sinus membrane and placing the bone graft onto the sinus floor, allowing implants to be placed in the back part of the upper jaw.

Ridge-augmentation-In severe cases the ridge has been reabsorbed and a bone graft is placed to increase the ridge height and/or width.

Nerve-repositioning-The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw.  

These procedures may be performed separately or together, depending upon the individual’s condition.  There are several areas of the body which are suitable for attaining bone grafts.  In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region, or in the upper jaw behind the last tooth.   In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee.

ORAL PATHOLOGY
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color.  Any alteration in this appearance could be a warning sign for a pathological process.  The most serious of these is oral cancer.  The following can be signs at the beginning of a pathologic process or cancerous growth:

*Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
*A sore that fails to heal and bleeds easily
*A lump or thickening on the skin lining the inside of the mouth
*Chronic sore throat or hoarseness
*Difficulty in chewing or swallowing

These changes can be detected on the lips, cheeks, palate and gum tissue around the teeth, tongue, face and/or neck.  Pain does not always occur with pathology, and curiously, is not often associated with oral cancer.  However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.  Perform oral cancer self-exams monthly and remember that your mouth is one of your body’s most important warning systems.  Do not ignore suspicious lumps and sores.

TMJ DISORDERS
Temporomandibular joint disorders are problems related to your complex jaw joint.  If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past.  Early detection and treatment are important.

No one treatment can resolve TMJ disorders completely and treatment takes time to become effective.  TMJ disorders develop for many reasons.  You might clench or grind your teeth, tightening your jaw muscles and stressing your TMJ.  You may have a damaged jaw joint due to injury or disease.  Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth or trouble opening your mouth wide.

There are various treatment options that we can utilize to improve the harmony and function of your jaw.  Once an evaluation confirms a diagnosis of TMJ disorder, we can determine the proper course of treatment.  

ORTHOGNATHIC SURGERY
Orthognathic surgery is needed when jaws don’t meet correctly and/or teeth don’t seem to fit with jaws.  Teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws.  This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly.  Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates.  The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance.

Injury to the jaw and birth defects can also affect jaw alignment.  Orthodontics alone can correct bite problems when only the teeth are involved.  Orthognathic surgery may be required when the jaws need repositioning.  If you have difficulty with the following areas, you should be evaluated:  

*difficulty chewing, biting, or swallowing
* speech problems
*chronic jaw or TMJ pain
*open bite
*protruding jaw
*breathing problems

Any of these can exist at birth or may be acquired after birth as a result of hereditary or environmental influences or the result of trauma to the face.  Before any treatment begins, a consultation will be necessary  to perform a complete examination with x-rays.  When you are fully informed about the aspects of your care, you and your dental team (dentist and orthodontist) will make the decision to proceed with treatment together.  This surgery can move your teeth and jaws into a new position that results in a more attractive, functional, and healthy dental-facial relationship.

SLEEP APNEA
When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat.  This blocks the upper airway and air flow stops.  When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp.  People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels.  OSA has been associated with cardiovascular problems and excessive daytime sleepiness.  The condition known as upper airway resistance syndrome (UARS) lies midway between benign snoring and true obstructive sleep apnea.  People with UARS suffer many of the symptoms of OSA but normal sleep testing will be negative.  Dr. Kurt Martin is a member of the sleep team at Hays Medical Center.  This team is made up of doctors and medical professionals from various disciplines.  The team meets monthly to put together custom treatment plans for their patients.  

MAXILLOFACIAL TRAUMA
Oral and Maxillofacial Surgeons are trained, skilled, and uniquely qualified to manage and treat facial trauma.  There are a number of possible causes of facial trauma.  Motor vehicle accidents, falls, sports injuries, and violence.  Our doctors are on staff at Hays Medical Center and provide emergency room coverage for facial injuries including the following:

*Facial lacerations
*Intra oral lacerations
*Avulsed teeth
*Fractured facial bones
*Fractured jaws

Injuries to the face impart a high degree of emotional and physical trauma to patients.  The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

When soft tissue injuries (skin and gums) occur they are repaired by “suturing.”  In addition to the concern for providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts.  

Fractures of facial bones are treated in a manner similar to the fractures in other parts of the body.  The specific form of treatment is determined by various factors which include the location of the fracture, the severity of it, the age and health of the patient.  

One of the options to stabilize facial bones involves wiring the jaws together for certain fractures of the upper and/or lower jaw.  Other types of fractures of the jaw are best treated and stabilized by the surgical placement of plants and screws.  This technique is called “rigid fixation” of a fracture.  This development improves the recovery period for many patients and allows them to return to normal function quickly.

Injuries to teeth are quite common and may require the expertise of various dental specialists.   Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth which have been displaced.  These types of injuries are treated by wiring or bonding teeth together.  If a tooth is displaced it should be placed in salt water or milk.  The sooner the tooth is re-inserted into the dental socket, the better chance it will survive.  Never attempt to clean the tooth.  Remnants of the ligament are vital to the success of replanting the tooth.  Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth.  In the event that injured teeth cannot be saved or repaired, dental implants are often utilized as replacements for missing teeth.