Los Gatos Oral & Facial Surgery
Periodontal disease (perio = around, dontal = the teeth) refers to a severe form of gum disease. Typically, periodontal disease is caused by a lack of regular brushing and flossing and can be made worse by bad diets, unhealthy lifestyle choices and/or existing medical conditions.
It’s a very serious condition because while it might not show up when you smile in the mirror at first, it will eventually affect your entire mouth, and can cause tooth loss. In addition to negatively impacting oral health, the plaque that causes periodontal disease can break away and lodge in your veins, arteries, the heart and even the brain (in fact, the existence of gum disease significantly elevates your risk of heart disease, and is associated with Alzheimer’s and other serious medical conditions).
Quick Note: Gingivitis is also called gum disease, but gingivitis is not the same as periodontal disease. Gingivitis means “inflammation of the gums.” It can happen at any age and is often a precursor to periodontal disease. Most patients with gingivitis and who start taking better care of their teeth will never develop periodontal disease.
Your dentist is usually the one who diagnoses periodontal disease, and the treatment is largely dependent on how serious the condition is when it’s noted as well as your age, your current health condition, and lifestyle.
What Causes Periodontal Disease (Periodontitis)?
Your mouth is filled with all kinds of bacteria – some worse than others. When you eat, breathe, talk, smile – these bacteria mix and mingle with saliva, mucous and other particles – forming a slick coating on your teeth. We call this coating plaque. When you brush and floss regularly, this plaque is almost completely washed away. When you visit the dentist for a checkup and cleaning, a thorough dental cleaning eliminates the rest of it.
If, however, you skip any of these important oral hygiene steps, plaque hardens and solidifies – becoming tartar. While visible plaque and tartar on the teeth are unsightly, the most dangerous plaque and tartar is the kind that becomes trapped between the teeth and gums (this is the stuff your dentist uses a metal pick and/or a water pick to dislodge before s/he cleans your teeth). Over time, the bacteria harbored there infect the gums and this condition is called periodontitis or periodontal disease.
Symptoms of periodontitis
While these are common symptoms of periodontitis, they do not mean you have gum disease. If any of these sound familiar to you, call your dentist and schedule a checkup.
- Bad breath with no other explanation
- Swollen, bleeding and/or tender gums
- Painful chewing
- Receding gums or teeth that look longer than they used to (looking through old photos and comparing them to your current smile is an accurate way to see if your gums have receded)
- Sensitive teeth
In mild cases, periodontitis causes inflamed gums. In more moderate to severe cases, inflamed gums begin to pull away from the teeth, forming pockets. These pockets allow plaque and tartar to form underneath the gum line, where further infections ensue.
In the meantime, your body launches an immune system attack to fight these infections. In doing so, the same bacterial toxins released to fight the bacteria also break down the connective tissue and bone that holds teeth in place. Ultimately, untreated periodontal disease can cause teeth to loosen and fall out. It will also continue to destroy the gums, bones and other tissues that hold teeth in place.
Who’s at Risk for Developing Periodontal disease?
Anyone who doesn’t take proper care of their teeth (brushing and flossing at least twice a day, and visiting a dentist at least twice per year) is at risk of developing gum disease. However, certain risk factors increase your chances even further. These include:
- Smoking and chewing tobacco
- Hormonal changes in girls/women – particularly during pregnancy
- Prescription and over-the-counter medications that cause dry mouth
How is Periodontitis Treated?
Periodontal disease is treated according to its severity, your health, and your lifestyle.
In the early stages
If caught in the early stages, you may be able to get by with a thorough dental cleaning and strict instructions regarding brushing, flossing and more regular visits to the dentist. Your dentist may also recommend lifestyle changes such as quitting smoking, minimizing sugary foods and beverages, etc.
In the middle stages
If infections are beyond the scope of good oral hygiene, your dentist will discuss other treatment options that include:
Deep teeth cleaning (scaling and root planning)
This type of cleaning goes beyond the normal dental cleaning – using specialized instruments that access teeth and roots underneath the gums. First, the dentist, periodontist and/or dental hygienist scale the teeth to remove tartar build-up. Then they plane both the tooth and the roots as needed, scraping away uneven patches that tend to harbor bacteria.
This treatment can result in swollen, bleeding and very tender gums that heal fairly quickly. Your dentist may also prescribe an antibiotic medication to eradicate existing – and prevent further – infection.
Dec 29th, 2017 12:59 pm
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Did you know the jawbone immediately begins reshaping and re-contouring the minute a tooth is extracted – or pulled? The body is a very efficient machine, and it doesn’t like to waste resources. Because of this we like to use a technique called socket preservation to counteract this natural occurrence.
When we extract a tooth from the jaw, the alveolar ridge – the strip of bone that surrounds the roots of teeth – begins to dissolve away and disappear. The body recognizes the tooth is gone, so it goes to work demolishing unnecessary tissues to conserve energy, materials and blood supply. Unfortunately, the alveolar ridge can’t be replaced without surgical intervention. So, oral surgeons use socket preservation – a form of bone grafting – to protect and preserve this essential ridge and the surrounding bone tissue until dental implants are inserted and established into the jawbone matrix.
What Happens During Socket Preservation?
Socket preservation is a type of bone grafting procedure designed to protect the alveolar ridge and empty tooth socket from decaying – simultaneously creating a stronger support system for the dental implant that will be put into place as scheduled. In addition to protecting the tooth socket from inevitable bone erosion, socket preservation can also correct or amend any deformity that may exist in the alveolar ridge or socket.
Once the socket preservation procedure is complete, the patient’s existing teeth – as well as the bone gaps between the teeth – remain firmly in place and are less susceptible to bone loss. While socket preservation can be done using synthetic materials, we prefer to use the patient’s own bone (or matching donor bone from a tissue bank) for the procedure. If we use your own bone material, we’ll harvest it from elsewhere in the jaw, from the hip or from the tibia (the bone blow the knee).
After we’ve placed the bone graft into the socket, we cover it with a special collagen membrane. In addition to protecting the socket and the newly placed graft, this special membrane dissolves and “nourishes” the bone graft, encouraging it to regenerate more quickly and solidly.
Emerging Evidence Shows There is Great Value in Socket Preservation
While bone grafting isn’t a new surgical procedure, socket protection is. For many years, mainstream dentists and oral surgeons felt it was an unnecessary procedure. Now that we have years of evidence and data behind us, the current industry consensus, “[supports] ridge preservation techniques as a whole. Multiple studies demonstrated less ridge resorption occurring when alveolar ridge preservation procedures were used versus the placement of no graft material in fresh alveolar sockets.”
If you are scheduled for a tooth extraction and your dentist does not consider socket preservation as a routine part of the procedure, we highly suggest you work with a dentist or oral surgeon who does. Failure to set the bone graft in place immediately or soon after an extraction can result in bone and soft tissue shrinkage that seriously compromises the functionality and aesthetics of dental implants.
Even those planning to get a bridge and/or dentures to replace their extracted teeth – rather than implants – benefit from socket preservation because it improves jaw health and structure as a whole – regardless of future implants or topical solutions. Either way, this specialized type of bone graft supports the integrity of your jaw and existing teeth as a whole.
What can happen if my dentist doesn’t use socket preservation?
If you skip this step, and don’t have a dental implant put in place immediately, your teeth can and will move in unpredictable ways. Once the jawbone begins to deteriorate, the surrounding mouth tissues are affected. This can cause teeth to shift and move in any direction. You can wind up with small gaps that become large ones, or go from having no gaps in your teeth to having visible gaps.
While the shape of your mouth and your smile are certainly important, this deterioration of jawbone and the movement of teeth in the jaw and gums can cause longstanding health issues. These result in your inability to bite and chew food properly, not to mention the higher risk of cavities and/or gingivitis since gaps between teeth or crooked teeth make it easier for bacteria to settle in.
Does dental insurance cover the cost of bone grafting for socket preservation?
All dental plans are different. Most insurance companies are beginning to partially or fully cover the costs of socket preservation as a result of the emerging evidence. That being said, not all dental plans are considered equal. The office staff at your dental or oral surgery office is happy to contact your insurance company to find out what is and isn’t covered so you can plan your procedure(s) accordingly.
Most major dental and oral surgery offices accept Care Credit. This vetted lender offers a range of credit options – including 0% financing options for those with a decent credit history.
Are you interested in learning more about the socket preservation procedures? Contact us here at Los Gatos Oral and Facial Surgery. While we always advocate for the services that lead to the healthiest overall results, we never encourage patients to participate in and/or pay for any procedure unless we feel it’s absolutely necessary.
Nov 29th, 2017 5:17 pm
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Your wisdom teeth get their name because they are the last teeth to come in, hopefully when you are older and wiser. In most cases, wisdom teeth begin their descent during the later teenage years or early 20s. At this point, your dentist may refer you to an oral surgeon, particularly if their eruption causes undue pain, crowding, or other complications that threaten your oral health.
Removing Wisdom Teeth is One of the Most Common Oral Surgeries
If you’re facing the removal of your wisdom teeth (extraction), never fear. You are not alone. In fact, only about 15% of the population have the healthy space and appropriate wisdom teeth positioning to let them come all the way in without extraction. The other 85% of us require one, two or even all four to be removed in order to keep our other teeth in proper alignment, and to prevent pain or discomfort in the mouth.
For many, the removal of wisdom teeth is the first “surgery” they will ever have. While most only require a local anesthetic to numb the general area and remove emerged wisdom teeth, some individuals require general anesthesia, allowing us to cut into the gum and remove the wisdom teeth before they begin causing further problems. This is typically the case for patients who have “impacted wisdom teeth” – which are wisdom teeth that can’t emerge properly and can even be positioned sideways – rather than upright.
Wisdom teeth can cause problems if they aren’t removed when they should be
If you’re not one of the lucky 15% who get to keep their wisdom teeth, the emergence of these teeth can cause:
- Pain, swelling and discomfort. If adult molars block wisdom teeth, they get stuck while trying to emerge. This can cause intermittent or chronic swelling, discomfort and pain.
- Infections. In many cases, wisdom teeth emerge partially and then stop because they can’t move any further. The skin around them becomes inflamed and irritated. This tissue can cause infection, causing further pain and discomfort (including swelling, stiffness and even illness). Over time, infections become much more serious if they spread.
- Crooked teeth. If wisdom teeth are able to emerge, they sometimes do so at the expense of your other teeth, causing crowding or a shifting of their natural position. Not only does this change how your smile appears, it can also affect your bite and make your teeth and gums more susceptible to bacteria build up that can lead to gingivitis.
- Tumors and cysts. Finally, and most serious of all, poorly positioned wisdom teeth can cause tumors and/or cysts to form. These are very dangerous because they eventually cause the jawbone to erode and can destroy your healthy teeth.
The good news is that absolutely none of that ever has to happen if you have your wisdom teeth removed when your dentist or oral surgeon recommends it.
Symptoms or signs that your wisdom teeth need to be removed include:
- Recommendation from your dentist or oral surgeon based on x-rays and general symptoms
- Pain, swelling or discomfort in the back of the mouth behind your molars
- Tenderness or redness around the wisdom teeth site(s)
- Unusual bad breath
- Stiffness in the jaw
- Pain or issues with an adjacent tooth/teeth
- Complications with orthodontic treatments used to straighten other teeth
- The development of cysts or tumors below the site
What Happens During a Wisdom Teeth Removal?
There are several, routine steps to wisdom teeth extraction. While the process might seem a bit daunting to patients – particularly those who haven’t required much dental or medical intervention in the past – it’s a very routine procedure from an oral surgeon’s perspective. It is very rare that there are complications from the extraction process as long as patients follow their doctor’s post-procedure instructions – and these complications can be addressed when they occur.
Consult with a dentist or oral surgeon
Most of the time, we receive referrals from dentists who’ve identified potential issues with their patients’ wisdom teeth via x-rays or their own examination. We’ll review the records to determine if the teeth need to be extracted and the best course of doing so.
Simple extraction or surgical extraction
Whenever possible, we prefer to use simple extraction methods to minimize the time a patient spends under anesthesia. If we’re able to get the entire tooth out via a simple extraction, we’ll use a local anesthetic at the gum site and pull the tooth out.
If you have impacted wisdom teeth or a more complicated case, we may recommend oral surgery. In this case, we’ll use sedation anesthesia or general anesthesia, depending on the amount of time we’ll need to spend inside the gum area to extract the entirety of the wisdom teeth and the roots. We’ll make incisions as needed, remove the tooth/teeth in question and then use a series of dissolvable sutures to stitch the site up.
The hole, or socket, left after a tooth is extracted must be cared for in order to heal well and without infection. A blood clot forms in the socket and this protects the exposed nerves from pain. It’s imperative that you follow your surgeon’s instructions to keep that clot in place and to allow the empty socket to heal so the gum encloses it completely.
This includes careful attention to activity level, diet and hydration. It will also mean taking special care when brushing your teeth and using a special instrument we’ll provide you with to gently flush empty sockets after eating to prevent accumulated food particles that attract bacteria and cause infection.
In most cases, you won’t even need a post-operative visit with the doctor – which means your stitches have dissolved, the sockets have healed and you have a happier, healthier and more comfortable mouth.
Contact Los Gatos Oral & Facial Surgery to schedule your stress-free wisdom teeth removal.
Oct 30th, 2017 2:00 pm
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Distraction osteogenesis is a medical term for, “making a short bone grow longer.” While the technique was first engineered and used in 1903, it was perfected during the 1950s by a Russian orthopedic surgeon named Dr. Gabriel Ilizarov. At that time, the procedure was used to heal deformities of the arms and legs. In fact, you may be familiar with the idea of distraction osteogenesis since the media heavily covered it during the 1990s when the Chinese were using it as an elective cosmetic surgery to make people taller.
As of the 1990s, distraction osteogenesis (DO) is now being used to treat certain deformities, abnormalities or trauma affecting the jaw or facial bone structure.
How Does Distraction Osteogenesis Work?
We appreciate the ability to use DO because this minimally invasive surgical procedure leverages the body’s ability to regenerate and heal itself. Anyone who has ever broken a bone understands this rigid organ’s remarkable ability to grow and weave itself a new matrix. We harness this ability with DO by:
- Separating a bone into two pieces using a simple, straightforward cut
- Placing the two halves of the bone in the preferred location or position
- Inserting a distractor that very slowly pulls the bone apart over the course of two or more months
- Allowing the bone to grow back (osteogenesis) to fill the gap
Most of the time, this process requires about two months from surgical procedure to final outcome. While the initial procedure is done in our office, the rest of the healing takes place while you’re going about the rest of your daily life. In fact, after your initial post-surgical check-ups (more on that below) you are the one who will be controlling the device that pulls the bones apart – as per the doctor’s careful instructions and specific schedule.
In addition to taking advantage of your body’s natural growth and healing mechanisms, DO is an ideal treatment method for significant bone deformities because it allows for bigger corrections than most single surgeries. It also minimizes the amount of corrective surgeries most of our patients would have to endure to permanently correct their issues otherwise.
Distraction osteogenesis is virtually painless & scar-free
While the process itself may sound excruciating when you read about it, it’s actually quite the opposite. The DO procedure is performed using a general anesthesia, so there is no discomfort during the surgery. Once it is complete, patients are sent home with painkillers to keep them comfortable and antibiotics to minimize the risk of infection.
In fact, when all is said and done, the majority of our patients tell us that the slow stretching and growing of their jaw and/or facial bone(s) via DO is less painful than when they had their braces tightened. DO is considered a minimally invasive procedure and is almost always “outpatient,” meaning we perform it right here in the comfort of our office. The nature of the straightforward procedure also minimizes post-surgical swelling and pain.
Another benefit of DO is that it does not leave any visible scarring on the forehead, face or jaw line. Dr. Walker performs all of his incisions on the interior surface of the mouth, leaving your face free from scarring.
Who is a Candidate for Distraction Osteogenesis?
The most common reasons clients require DO surgery include:
- Cleft palate
- Crouzon syndrome
- Apert syndrome
- An improperly formed lower jaw
- Additional craniosynostosis syndromes
- Deformities resulting from traumatic injuries
- Those in need of bone graft surgery
While anyone of any age can qualify for DO, depending on their general health, younger patients typically have the shortest distraction and post-procedure healing times. Older adults may take longer to heal due to the fact that bone growth slows down as we age.
In almost all cases, your pediatrician, a general physician, or your dentist will refer you to our office. We will schedule you for a consultation and discuss the best treatment methods and schedule of treatment to facilitate the ultimate goal of a healthy, happy face and jaw structure.
Because this treatment is widely used to repair medical issues, health insurance providers almost always cover the procedure. The exceptions may include the use of DO for cosmetic procedures (changing your jaw structure for aesthetic, rather than medical, reasons) or those requiring bone grafting for dental implants. Since insurance carrier benefits vary from patient to patient, we’ll work with your insurance company to get you the maximum coverage possible if we establish DO is the best treatment for your particular diagnosis.
What are the drawbacks to DO?
The only disadvantage of DO is that you will have to return to the office several times in the first two weeks after your surgery. During the course of these visits, Dr. Walker will check that you are healing well, that there’s no infection, and that the bone is growing, as it should. He will also teach you how to activate the device so you can take over from there as per his instructions. Also, depending on the reason for the surgery, you may have to return a final time after your bone has grown to have the distraction device removed – but again, this is performed during an outpatient office visit.
In the bigger picture, these routine, post-surgical visits certainly beat the repeat surgical procedures that might have taken place had you opted to use a different surgical treatment.
Contact Los Gatos Oral & Facial Surgery
Do you or your child require distraction osteogenesis to heal an existing issue in the jaw or face? Contact us here and Los Gatos Oral & Facial Surgery and we’ll be happy to schedule you for a consultation.
Oct 24th, 2017 3:53 pm
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As oral surgeons, we love the mouth. We’re amazed by all of the processes that take place as the result of the complex anatomy found there. While most people can identify things like the soft and hard palate, teeth and tongue, we want to expand your knowledge a bit as we explore all the parts of the mouth and provide a brief explanation for each.
Can You Name All the Parts of the Mouth?
Also referred to as the oral cavity, the mouth is considered the first part of the digestive tract. It’s also considered the second part of the respiratory tract since – along with the nose – your mouth allows you to breathe. The mouth’s shape and parts modify the sounds produced by the vocal chords so you can speak, and it’s also a chemosensory organ, which means it’s a processing center for sensory information that is then sent to the brain for translation.
With all of these responsibilities, it makes sense that the mouth contains so many important parts.
Apex of the tongue: This is the very tip of your tongue. It’s the most dexterous part of the tongue, allowing you to control and move food around in your mouth, and helping you to enunciate words.
Body of the tongue. Just past the apex of the tongue is the body, or the corpus linguae. It stretches from the tip to the base of the tongue, where it’s anchored in the back of the mouth. The tongue is covered in tiny little bumps, papillae. Some of them help to clean and disinfect the tongue, others house the taste buds.
Fun Fact: Contrary to what we used to think, taste buds are not divided up in sections of the tongue- sweet, salty, sour, bitter, etc. Instead, we’ve learned every taste bud has the ability to taste the various flavor profiles to some degree.
Gums (gingiva). The gums form the soft tissue that surround and support the teeth’s roots and bases. Contrary to what you might think, the roots are actually embedded into your jawbone, and while the gums hug the teeth, the teeth are actually pocketed in v-shaped grooves in the gums, called sulcuses.
Teeth. Teeth are used for so much more than chewing (masticating). They give your face shape and they create resonance and definition in your speech. Losing teeth is detrimental to both your confidence and your health, which is why dental implants are so important in maintaining oral and overall health if you do lose teeth for whatever reason.
The crown is the portion of the tooth above the gum, and the root is the portion below. Adults have 32 teeth, including the wisdom teeth. However, many people have to have all or some of their wisdom teeth removed to prevent crowding – so many adults have only 28 teeth.
Fun Fact: Each of your teeth is considered an organ.
Hard and soft palate. The hard palate is part of your skull, and is made from two different bones – maxillary bones in the front and palatine bones in the back. The soft palate is a muscular contraption that is designed to pull down with the uvula, and the base of the tongue moves up so the airway (trachea) is completely blocked whenever you swallow. Sometimes, this palate doesn’t close all the way when a baby is forming in utero. This contributes to a cleft palate, one of the most common birth defects.
Lingual glands. There are several different lingual glands in the mouth, all designed to secrete saliva onto your tongue. While it keeps the mouth moist, saliva also contains enzymes that begin digesting food before it ever reaches your stomach. Saliva washes all of the tissues and organs in the mouth and it also contains antimicrobial substances to keep foreign bacterial at bay. This is why dry mouth is such a problem, leading to gingivitis and tooth decay among other things.
Fun Note: If you look in a mirror, open your mouth a bit and lift your tongue up and back, you’ll see two of these glands very prominently right at the base of the mouth, between your lower teeth and the tongue. These two glands are called Nuhn’s glands, Buahin’s glands, or Blandin’s glands. Sometimes, these glands get so active saliva actually shoots out of them if you’re not careful.
Tonsils. Most people know they have tonsils because they have felt and seen them respond to infection. Part of the lymph system, tonsils help to gather and move bad bacteria out of harm’s way. The tonsils you see well on each side of the back of your throat are the palatine tonsils. Your other tonsils are called lingual tonsils, and they’re visible on your tongue, in the back – one on each side. They look a little different from the papillae covered portions of your tongue, with larger, smoother bumps.
Sometimes, the palatine tonsils are chronically enlarged, particularly in people who’ve had multiple throat infections. If this is the case, and it’s causing sleep apnea, snoring or other problems, we may recommend a tonsillectomy.
Uvula. The uvula is that small cone or U-shaped projection that hangs from the middle of the soft palate in the back of the mouth, dangling over – but not touching – the tongue. Our patients often refer to it as, “that wiggly thing at the back of my throat.” To be honest, the uvula is a bit of a mystery and we’re not 100% sure what it does. Our theories are that it helps with speech, guiding food/liquids down the throat, protecting your nasal passages from inadvertently sucking up food/liquid, help trigger the gag reflex and may help your immune system out.
Epiglottis. This flexible flap of skin is located at the upper end of the larynx. If you open your mouth wide and peer down, past the uvula, you can probably see or even touch the epiglottis (although that will cause you to gag). In addition to keeping food out of the trachea (wind pipe) when you swallow, the epiglottis causes a cough or gag reflex if a piece of food gets stuck at the mouth of the trachea.
These are some of the main parts of the mouth’s anatomy. You can click here to view an interactive mouth model to learn even more.
Are you experiencing problems with some of the parts in your mouth? Are you looking for an oral surgeon to fix them? Contact the Los Gatos Oral & Facial Surgery office and we’ll schedule an appointment.
Sep 27th, 2017 2:46 pm
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The full title for an oral surgeon is oral and maxillofacial surgeon. Holding degrees as both a dentist and a medical doctor, including a surgical residency, oral surgeons specialize in the maxillofacial region of the body. This includes the bones and connective tissues that comprise the forehead, cheekbones and face, as well as their surrounding soft tissues.
In some cases, they provide relatively minor oral surgery, extracting teeth or designing and placing dental implants. In other cases oral surgeons are called upon to treat malformations of the maxillofacial region as the result of birth defects, or to treat and heal traumatic injuries from sporting injuries or a car accident.
As a result, the same surgeon who removed your wisdom teeth today might have saved the life of an accident victim the day before.
What Does it Take to Become an Oral Surgeon?
First and foremost, sticking to the path to become an oral surgeon requires a tremendous amount of drive, determination and a fierce work ethic. The education and experience required to become an oral surgeon is greater than that required of virtually any other medical profession.
From an academic perspective, as a younger student, oral surgeons typically excelled in math and science courses in high school. Odds are s/he already felt a call to become either a doctor or dentist, even if oral surgery was not yet a part of the plan. As a result, these students have to remain ahead of the pack early on in order to gain acceptance at colleges that have superb science programs.
Post-Graduate Dental Programs
Since post-graduate dental programs require students to have passed several science courses, as well as their typically innate interests in science, most oral surgeons have a science-related, undergraduate degree.
During their senior year of college, prospective oral surgeons must apply to the dental school(s) of their choice. Admittance to these very competitive programs requires a number of prerequisites, as well as stellar transcripts from their undergraduate university. In most cases, students will have completed courses in college-level calculus, biology, physics, and chemistry, including biochemistry and organic chemistry. In addition to having the base knowledge required to continue their education, completing these challenging courses with an A-grade demonstrates to graduate-level admissions counselors that the student can handle the academic rigor expected of them once admitted into a dental program.
Finally, interested candidates must pass the DAT (dental admissions test) before they can commence their education at the dental program to which they’ve been admitted.
The Medical School Program
Once they complete their four-year dental program, prospective oral surgeons can take two different paths.
- Based on the surgical residency list approved by the American Dental Association’s Commission of Dental Accreditation, dentists can apply for a surgical residency. A residency to become an oral and maxillofacial surgeon lasts between four and six years, depending on the areas of expertise a surgeon is interested in. These residencies are the same surgical residencies attended by any other type of general or specialty surgeon – but without the medical degree component. At this point, surgeons can take their written and oral exams and, upon completion, they become board certified oral surgeons.
- The second option is to be accepted by one of the several training programs and residencies that provide both medical education and the oral and maxillofacial surgical residency, combined into one program. In most cases, it takes at least six years for oral surgeons to complete both degrees and their surgical residency. As expected, the workload is intense, but afterwards, students graduate with both DDS and MD after their name.
What Work Does an Oral Surgeon Perform?
Oral surgeons work in a variety of facilities, from public clinics and private practice offices, to hospitals, emergency rooms and larger dental practices. Their degrees and skillsets ensure they never get bored because their scope of services is very broad, including things like:
- Repair of cleft palates
- Surgical treatments of TMJ (temporomandibular joint disorder)
- Treating structural abnormalities of the head, face and neck due to birth defects, cancer and/or trauma
- Both minor and major tooth extractions
- Pediatric dental and maxillofacial surgical treatments
- Removal of impacted teeth
- Providing dental implants
- Treatment of oral cancers as well as surgical removal of tumors affecting the maxillofacial areas
- Bone grafting
- Treatment of sleep apnea
- Jaw surgery
- Cosmetic dental procedures
While patients can independently seek treatment from an oral surgeon, most patients are referred to an oral surgeon by their primary dentist, orthodontist and/or physician after an initial diagnosis has been made, particularly if their health insurance carrier will be supplementing or covering the treatment costs.
Interested in Working With a Passionate Oral Surgeon?
The work of an oral surgeon isn’t easy – and the complex nature of the maxillofacial skeletal structure can make for very intricate, long and demanding surgeries. However, most oral surgeons are extremely passionate about what they do, and are grateful for their ability to answer their calling on a daily basis,
That is certainly the case for Dr. Lee Walker and his staff at Los Gatos Oral and Facial Surgery. We care for our patients on both the personal and professional level. We always strive for the least-invasive option of treatment so our patients can enjoy the lowest procedural risk possible.
Would you like your mouth, jaw or face to be treated with the utmost care and expertise? Contact Los Gatos Oral & Facial Surgery and we look forward to making you smile.
Sep 8th, 2017 12:28 pm
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Not only are dental implants safe for diabetics, forgoing dentures for more permanent dental implants can improve the health of those with diabetes.
In addition to helping you comfortably maintain a well-balanced diet, implants eliminate the inflammation, irritation and infections that are more common with dentures. This minimizes the risk of dangerous periodontal disease as well as post-implant infections and complications.
While it’s true that those with diabetes may require special pre- and post-implant care, in order to minimize complications, recent studies show that dental implants are safe for those with controlled diabetes as long as their overall health complies with standard, pre-procedure health guidelines.
If you have diabetes, feel free to reach out to us at Los Gatos
How Does Diabetes Affect My Ability to Get Dental Implants?
According to a 2016 systematic review of studies on dental implants and diabetes, researchers found that, “When diabetes is under well control, implant procedures are safe and predictable with a complication rate similar to that of healthy patients.” This great news for adults with diabetes who want a safe and more lasting alternative to dentures.
Here are some of the considerations for those who want to ensure dental implants are a safe choice for their mouths:
Do you have type 1 or type 2 diabetes?
Type 1 diabetes can be more difficult to control. This means the risks and failure rates associated with type 1 diabetes and dental implants is slightly higher than it is for those with type 2 diabetes. That doesn’t mean those with type 1 diabetes can’t have dental implants. However, your oral surgeon will be even more diligent in reviewing medical and dental records, assessing your general health and learning more about your history of infection and your body’s typical timeline when it comes to healing.
Also, in patients with diabetes – age may matter more than usual. This is because the longer you’ve had diabetes, the more prone you are to infections and slower healing processes. If you have diabetes and are interested in getting dental implants, sooner is definitely better than later in most cases.
Is your diabetes under control?
While the systematic review of multiple studies showed patients with controlled diabetes have no more risk of complications or failures than their non-diabetic counterparts, it also shows that patients with un-controlled diabetes had higher rates of both post-procedure infection and implant failure.
Dental implants are embedded into the gums and the bones of the jaws. They rely on the body’s natural healing processes to rebuild jaw bone tissues, which fuses the bone around the posts (osseiointegration). Then, the gums must heal as well. This complete integration into the jaw and gums is what makes dental implants so much like real teeth, and a much more permanent solution than dentures.
Because the healing process can be slower for those with diabetes, patients with un-controlled diabetes have a more difficult time healing. Thus, your oral surgeon will help you get back on track, creating a plan to get your diabetes under control and ensuring you’re doing all you can to prevent gum disease. Once those pieces of the puzzle are in place, we’ll meet again to see whether or not your mouth is ready for dental implants.
Are you generally healthy?
One of the most common questions we get from patients is, “am I too old for dental implants?” In fact, it’s your health – rather than your age – that qualifies you as a dental implant candidate. Your oral surgeon may not be able to schedule dental implants at this time if you:
- Have existing gum or periodontal disease
- Have very low bone density (although we can discuss bone grafting options with you if you’re a good fit for that procedure)
- Seem unwilling or unable to patiently navigate the post-implant period, which requires diligent care and careful attention to what you eat and put in your mouth, allowing the implants to heal completely
- Are a smoker – not only is it harder for smokers to heal, the sucking action required to smoke can create issues that compromise healing and the implants’ ability to be successful. In most cases, smokers must be committed to quitting for the duration of the process – which could mean a matter of months. But hey, if you make it without smoking for that long you might as well keep the momentum going –and we’ll consider ourselves part of the inspiration for kicking the habit once and for all!
- Have been treated for oral cancer or taken bisphosphate medications in the past
- Have a condition or disease that compromises your ability to heal
All of these and other considerations are discussed during your initial dental implant consultation. Whenever possible, we work with patients unable to immediately move forward with dental implants, co-creating an actionable health plan that works up to eventually getting the dental implants they desire when their mouths and body are ready.
Dental implants can help you maintain a diabetes-healthy diet
Have you noticed that the healthiest diets for individuals with diabetes include lots of fresh, whole foods that require extra chewing and grinding mechanics? The permanent nature of dental implants – which are securely anchored in your jaw and gum – makes it as easy and painless to eat the foods you want when compared with dentures.
Dentures are much more prone to moving around, causing gum tenderness and/or making it more difficult to eat foods that require stronger resistance when it comes to pulling, tearing or grinding certain foods – like nutritious, high-fiber vegetables, for instance. When people suffer from the poor fit, irritation and discomfort caused by dentures, they’re more apt to eat less or eat the wrong foods (softer, processed, higher-carb options), which can make it more difficult to keep blood sugar levels in check.
Are you interested in learning more about whether dental implants are safe with your diabetes diagnosis? Contact us here at Los Gatos Oral & Facial Surgery and schedule a consultation. We’ll do our best to get your mouth and body in ship shape so you are an ideal candidate for implants.
Aug 29th, 2017 8:00 am
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Ideally, oral surgery to remove baby teeth would be rare. The reality is tooth extractions are considered the most common surgical procedure in the United States. Most of the time, this surgery is very simple and is performed by a pediatric dentist; this is the case when a simple extraction is recommended, requiring only the use of local anesthesia, forceps and a gentle but firm tug.
Sometimes, however, the process required to remove a baby tooth entails the removal of gum tissue and some cutting into the jaw bone. If so, oral surgery may be necessary, and preparing your child for all the steps ahead will relieve his or her anxiety and help the process move forward smoothly.
The type of extraction required depends on what is found via dental x-rays. This is one reason why bi-annual dental checkups are so important. Waiting too long to perform certain oral surgeries can have more long-standing repercussions.
Why Is Surgery Required to Remove My Child’s Baby Tooth?
There are several reasons why your dentist, orthodontist and/or oral surgeon will recommend oral surgery to remove – or extract – a baby tooth. Some of the most common include:
In most cases, with routine bi-annual dental checkups, pediatric dental decay is caught and repaired before it progresses to an irreparable place. When tooth decay progresses to the point that it cannot be removed, filled and crowned, dentists may opt to remove the tooth.
Dental decay is a serious condition. In addition to causing physical discomfort or pain for your child, decaying teeth may also be a source of embarrassment – particularly if the tooth in question is visible when they talk or smile – becoming a source of teasing. More importantly though, unchecked tooth decay can lead to more serious complications including:
- Severe pain and discomfort
- Tooth abscesses
- Swelling and/or pus around the tooth/teeth
- Difficulty chewing food, which can lead to malnutrition
- An adjusted bite, which can affect jaw muscles and structure
- Repositioning of teeth that alters how adult teeth come descend
- Tooth loss
- More serious and complicated infections if rot gets into the root or becomes more systemic
Once the baby tooth, or teeth, in question are removed, your child’s adult teeth will fill in. A proper diet and routine dental checkups should prevent further decay.
A Broken Tooth
If a tooth was broken during a simple extraction, oral surgery is often required to remove gum tissue, and potentially bone fragments, and to access the rest of the tooth. If the tooth was broken as a result of an injury, the dentist may opt to remove the tooth – rather than repair it – especially if the adult tooth is due to emerge sooner rather than later.
This is simpler than going through the expense of the tooth repair process – which probably isn’t worth the investment if the baby tooth would have fallen out soon anyway. However, if a broken tooth is so damaged the dentist can’t use simple extraction procedures, anesthesia and oral surgery would be the solution.
A Baby Tooth Is Impacted
Most people are familiar with wisdom teeth extractions. Although these aren’t technically baby teeth, the process remains the same for any baby teeth that may be impacted and aren’t breaking through like they should. For example, if a child has impacted canines (cuspids) and the dentist feels they aren’t moving in as they should or their location compromises the function or health of the mouth, extraction may be recommended.
Similarly, a dentist may determine that the child’s jaw structure is simply too small to accommodate the full spectrum of baby teeth, in which case certain teeth might be flagged for extraction. This would minimize crowding and possibly the need for complicated orthodontics. Then, the hope is that time and diligent attention to tooth location and more standard orthodontic approaches will be all that’s necessary for adult teeth to fill in as they should.
Your Child Is Getting Braces
After the first round of baby teeth are lost (or not) and adult teeth are making their way into place – the dentist or orthodontist may feel extractions of existing baby teeth are the best course of action to facilitate the healthy emergence and movement into place of the adult teeth.
What Happens During Pediatric Oral Surgery
The more prepared your child is the better. A few things to consider are:
- Make sure someone who specializes in, or has a reputation for, being great with kids does the work. Kids are understandably more wary of surgical procedures because it’s difficult for them to logically understand the whats or whys of it. Patience is a must, and your children should be told – in age-appropriate language – exactly what will happen and that extra care is taken to minimize their discomfort.
- Know the difference between a local anesthetic and anesthesia. A local anesthesia blocks pain/feeling in a very specific area. This is administered topically to the gum, and then via a shot. Ideally, the child should feel zero pain from the shot since the gum is locally numb. For more invasive surgeries – where we have to cut into gum and/or bone material – we may use general anesthesia that fully sedates the patient. This requires a mask with nitrous oxide to calm the patient and to help him/her drift off, while the IV anesthesia creates a state of unconsciousness such that we can work quickly and efficiently. It also ensures the child avoids pain, discomfort or the trauma of hearing the more intense sounds and motions associated with more complicated extractions.
- Honor the doctor’s post-surgical instructions. For sensitive children, it’s easy to follow the post-extraction surgical instructions – eat soft foods, take care when brushing, etc. – because the discomfort they feel ensures they not overdo things. Other children have much higher pain thresholds and may be stubborn about the restrictions – which involve taking pain meds/anti-inflammatories for at least 48 hours after the procedure, taking it easy and eating softer foods until comfort levels permit other options, brushing and flossing very gently the following day, etc. Any unusual pain, bleeding and/or swelling should be reported to the oral surgeon or dentist as soon as possible in case there is a post-surgical complication.
Have questions about recommended surgical extraction to remove your child’s baby teeth? Contact us here at Los Gatos Oral & Facial Surgery. We’ll be happy to discuss your concerns and schedule a consultation.
Aug 22nd, 2017 11:45 am
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Dental implants are not permanent, but they are the most permanent form of prosthetic dental replacement available for patients who suffer from severe tooth decay, infection, have lost a tooth or teeth in an accident, face extraction of permanent teeth, or who are tired of the pain, irritation and discomfort associated with dentures.
When compared with dentures or partial dentures, which must be replaced every five to eight years or so, dental implants are a much healthier and long-term solution to tooth loss. They are stronger, do not shift or move in the mouth, and dental implants also allow you to speak, eat and smile naturally.
Dental Implants Mimic Your Natural Teeth
Unlike dentures or bridges (partial dentures) that sit on top of your gums, dental implants are actually inserted into your jawbone where they become integrated with the bone matrix itself (a process called osseiointegration). When osseiointegration is complete, the bone and titanium implant post are fused together – very similar to the way your original, adult teeth are anchored into the gums and jaws via their roots.
This is what makes dental implants so much better than dentures. The integration of the implant’s post into the gum and jawbone helps support these tissue structures so they are stronger and keep their original anatomical shape.
In the case of dentures, which sit on top of the gums, the holes where teeth roots once lived do not fill in all the way. Permanent tooth loss and/or removal causes the jawbone to deteriorate over time, and this has a dramatic effect on the shape of your face as you age, as well as your ability to speak and eat. The gums also lose their shape, which means more routine visits to the dentist in order to have denture refitted and reshaped.
Many people find that replacing their dentures with dental implants transforms the way they feel and smile, restoring a confidence they haven’t felt in years. Do keep in mind that dental implants are best when fixed into the jaw sooner – rather than later – after a tooth is removed in order to give the implant’s post the strongest bone foundation possible. Bone grafting is also an option if bone deterioration has already begun, but this will require a few extra visits with the oral surgeon before the dental implants are completely finished and healed.
How Are Dental Implants Installed?
Dental implants are placed by an oral surgeon; this process requires a gentle surgical procedure. Patients have a full consultation and examination by the oral surgeon before determining whether or not they’re a candidate for dental implants, and to determine which types of implants and procedure are best for you. Your health, rather than your age, is the most important consideration.
Depending on the health of jawbone, the dental implant procedure can take place in just a single, gentle surgical procedure, or it may require two or more separate visits, depending on your body’s ability to heal after the procedure. Your well-being is always our top priority.
There are several different options when it comes to dental implants:
- Single tooth implants, where each implant post has a single, prosthetic tooth attached on top.
- A fixed, full or partial denture implant, where posts are fixed at certain locations along the jaw and then a bridge of prosthetics is cemented to the posts.
- Removable dental implants, where the anchor posts are implanted into the jaw but the prosthetic bridge is designed to snap off and on for easier cleaning and repair.
Your oral surgeon will be able to discuss which of these options makes the most sense for you based on the number of teeth that need to be replaced, the location of the replacements, your health and your budget.
Once the tooth is extracted (if necessary), we can implant the titanium post in the same visit, after which it will be capped with a temporary crown. Over the next 12-weeks, you’ll take it easy, relying on soft, nutritious foods as your newly embedded post has time to heal and integrate with the jawbone. Patients are able to go back to work within one to two days after the initial implant procedure.
After the 12-week healing process, we’ll use an innovative, digital white light camera to take a picture of your mouth (no need for that gunky, yucky mold stuff) in order to create permanent implant crowns that are artistically designed, shaped and colored to match your existing teeth. If you’re replacing all your teeth, we’ll design crowns that look attractive and are proportioned to your mouth, jaw and face shape so your smile is both natural and radiant.
Once the temporary crowns are removed and the “new teeth” are cemented or snapped in place, your diligent care of the teeth, oral hygiene habits, and bi-annual dental visits will insure the dental implants last for 25-years or more.
While dental implants are more expensive than dentures, you have the option of financing them through the oral surgeon’s office, using Care Credit or via other, similar financing options. Los Gatos Oral & Facial Surgery works closely with medical and health insurance providers in order to make the dental implant option as simple and affordable as possible.
Are You Interested in Getting Dental Implants?
Why deal with the discomforts and hassles of dentures when you don’t have to?
Contact Los Gatos Oral & Facial Surgery to learn more about dental implants during a consultation. We look forward to giving you a completely natural look and feel with your new teeth. We look forward to giving you a smile you can be proud of – and a mouth that is strong and fit enough to eat all of your favorite foods. Give us a call to schedule your consultation or contact us directly online. 408-412-8400.
Jul 31st, 2017 1:01 pm
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From a professional standpoint, dental implants are better than dentures because they maintain the anatomic and aesthetic structure of your face, mouth and jawbones. Also, dental implants are more comfortable because they very rarely cause pain and irritation in the gums and/or jaw, and implants work to maintain the jaw bone’s structural integrity, typically compromised by tooth loss or extractions – and the subsequent use of dentures. However, implants are more expensive than dentures and they’re rarely covered by dental insurance (yet). As a result, most dentists and oral surgeons make recommendations on a case-by-case basis.
The Basics of Dentures Versus Dental Implants
First, let’s review the general ins-and-outs of dentures and dental implants, which illustrates why we feel implants are the better choice whenever possible.
Dentures and partials (bridges) explained
Dentures and bridges (partial dentures) are used when one or more teeth have to be pulled and replacements are required. While most adults can survive with a single tooth pulled here or there, the loss of these teeth makes it more difficult to eat, leading to malnourishment, and can also affect the way an individual speaks. Also, if a person’s looks are affected, missing teeth can negatively impact an individual’s self-esteem. By replacing pulled, broken or missing teeth with partial or full dentures, we eliminate these issues.
Before teeth are extracted, the dentist makes molds of the existing teeth and the tissues that support the tooth in order to get a good fit. While a temporary denture is used immediately after teeth are extracted, the permanent dentures are slowly built by the dentist and lab techs. Patients visit weekly for the four to five weeks during this process so the molds can be carefully fitted, adjusted and tweaked to accommodate the patient’s comfort and a healthy, balanced bite.
Over time, however, the gums continue to morph and change shape as they fill in the holes where teeth were once rooted. Because the roots of your teeth are anchored into the jaw bone –helping to support the jaw bone’s integrity – the jaw bone begins to deteriorate after they’re removed. Dentures will become too loose, too tight or will shift uncomfortably, requiring an adjustment of the fit. If dentures aren’t properly maintained or if they aren’t wearing well, patients can wind up with very sore gums or – worse – infected gums, compromising their overall health.
While today’s dentures – made from a combination of metal, hard acrylic and/or nylon resins for the plate and porcelain for the teeth – are tough, they can still crack, chip or break. Without proper care, dentures also harbor bacteria which puts the wearer at higher risk for infection.
One of the benefits of dentures is that they are affordable and they are often partially or fully-covered by dental and/or medical insurance plans. Because of the way the jawbone and gum lines change over time as the result of jawbone loss and degeneration, most dentists recommend replacing dentures every five to eight years.
PLEASE NOTE: Some patients think, “I’ll get dentures now and then implants later…” This is NOT a good idea. If your jawbone deteriorates too much, it can compromise your ability to get dental implants later on. If cost is prohibitive, speak to the oral surgeon about financing options or a phased plan that prioritizes certain teeth at first and slowly integrates the others as you can afford it.
Dental implants explained
Dental implants work much differently – and more naturally – than dentures. Rather than resting on the healed gums, dental implants are surgically installed directly into your jawbone. This is done using a very strong, titanium metal post that resembles a screw. The post is screwed into the jaw bone, mimicking the way your natural teeth are rooted into the same structure. This adds stability to the jaw bone, minimizing deterioration resulting from natural teeth being extracted without a replacement.
Once the posts are installed, it takes time for the bone to fill in and integrate around the spiral screws, a process called osseiointegration. Healing can take anywhere from weeks to a month or more. In the immediate period after the titanium posts are placed, you’ll need to treat your mouth the same as you did when your wisdom teeth were removed – adhering to careful cleaning and brushing, soft nourishing foods, avoiding suction, etc. If the implants are replacing teeth that are visible when you smile, you’ll be given a temporary partial denture that is removed and cleaned each night.
When the posts are secure and the osseiointegration process is complete (the time period for this depends on your personal rate of healing, and whether or not you required a jawbone graft for secure placement of the post(s)), a second surgery is required to attach the abutment to the titanium post. The abutment is the anchor for the porcelain tooth – or crown – that will eventually be installed.
Patients have two choices when it comes to the porcelain crowns.
- Removable crowns: These look similar to dentures but they snap on to the abutment, eliminating the fit, bite or discomfort issues associated with dentures. Removability makes them easy to remove for cleaning, whitening and/or repair when necessary. If affordability is an issue, we typically recommend removable crowns.
- Fixed crowns. Fixed crowns are permanently screwed or cemented onto the abutment. They cannot be removed the same way as their removable counterparts, which makes it more expensive to handle if the crown cracks or breaks down the road.
Once the porcelain crown, molded to match your original teeth’s structure, is installed – you will feel like you have your own teeth again. No uncomfortable fit or poor bite to worry about, no resizing or re-fitting at routine visits, and no worries about jawbone degeneration. Unlike dentures, dental implants last an average of 25-years or more with proper cleaning and care.
Dental Implants Are the Next Best Thing to Your Original Teeth
Because they are firmly rooted in the jawbone, are more comfortable, better maintain your original mouth and face shape, and are less prone to frequent, dental implants are considered better than dentures in almost all circumstances.
Always schedule a consultation with your dentist or oral surgeon to discuss whether you’re a good candidate for dental implants. Because it’s a surgical procedure, and because the implants depend on your body’s ability to facilitate the osseiointegration process, your overall health – rather than age – is the primary factor in whether or not you’re a good candidate for having dental implants.
Are you looking for a permanent solution to tooth loss and/or decay? Contact us here at Los Gatos Oral and Facial Surgery to learn more about dental implants and to schedule a consultation to determine whether dental implants are the right move for you.
Jul 24th, 2017 6:28 pm
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