Oral and Maxillofacial Surgery (OMS)
Oral and maxillofacial surgery (OMS) includes various surgical procedures involving the teeth, jaws, and soft tissues. This ranges from simple tooth extractions to more complex procedures, such as:
- Corrective jaw surgery
- Bone grafting procedures
- Trauma
- Removal of pathology (e.g., tumors)
OMS is commonly referred to as oral surgery. “Maxillofacial” refers to the face and jaw, while “oral” refers to the mouth. Sometimes, OMS is called dentoalveolar surgery.
What is the Difference Between an Oral Surgeon and a Dentist?
Oral and maxillofacial surgeons are board-certified dental specialists. They perform both minor and invasive procedures within the maxillofacial region (mouth, face, and jaw). Oral surgeons typically work full-time at local private practices and hospitals.
Other types of dentists, like general and pediatric dentists, can also perform minor oral surgeries, such as extractions. They do not, however, perform more invasive surgical procedures.
Talk to your dentist about any problems you’re having with your teeth, jaws, or gum tissue. They may refer you to an oral surgeon for specialized care.
What Does an Oral Surgeon Treat?
People need oral surgery for a wide range of oral health concerns, including:
- Gum disease
- Broken teeth
- Missing teeth
- Excessive tooth decay
- Impacted teeth
- Jaw bone loss
- Oral cancer
- Noncancerous oral growths, such as cysts
- Sleep apnea
- Dental trauma
- Temporomandibular joint disorders (TMD)
Oral surgeons can perform plastic surgery for face or jaw reconstruction after an injury. Some specialize in facial cosmetic surgeries, such as facelifts and nose reconstruction.
Education and Qualifications
Oral surgeons require up to 15 years of formal education and surgical training to become board-certified surgeons. This schooling includes 2 to 4 years of undergraduate study (BS or BA) and 4 years of dental study.
Oral surgeons must also complete up to six years of training in a residency program. This includes an optional two additional years to receive a medical degree. Most maxillofacial surgeons have their own private practice. Some work at local dental offices or hospitals full-time.
Oral surgeons have a Doctor of Dental Surgery (DDS) or a Doctor of Dental Medicine (DMD) degree. The American Dental Association (ADA) considers these degrees to be equal.
When to See an Oral Surgeon
There are many oral and maxillofacial surgeries, such as implants and extractions. Patients typically require oral surgery due to:
- Accidental injuries
- Trauma
- Diseases
- Deformities
- Periodontal issues
- Dental caries
- Tooth loss
All oral surgeries use a local anesthetic. Depending on the procedure, your surgeon may also recommend conscious sedation or general anesthesia. Common oral surgeries include:
Wisdom Teeth Removal
Oral and maxillofacial surgeons have extensive training in wisdom teeth removal (third molars). They’re certified to use deeper levels of sedation than general or non-specialized dentists.
Your surgeon will administer I.V. sedation if you prefer to sleep through the surgery. Extracting all four wisdom teeth takes about 30 minutes.
Dental Implants
After a tooth extraction or loss, you may need a dental implant. This is an artificial tooth root that replaces your permanent tooth.
Oral surgeons are dental implant experts. They’re also qualified to use general anesthesia and other deeper levels of sedation.
During dental implant surgery, the restorations are surgically implanted into your jawbone. They create a sturdy base to support artificial teeth (dental crowns).
If you have a lot of missing teeth, your oral surgeon may recommend dentures instead of dental implants.
Periodontal Surgery
If you have moderate or severe gum disease, your dentist may recommend periodontal surgery. Oral surgeons perform a variety of procedures to treat gum disease, including:
- Bone grafts — This procedure uses pieces of your own bone, donated bone, or synthetic bone to restore areas of bone loss, especially before implant placement.
- Pre-prosthetic surgery — This procedure might follow flap surgery for people with excess, pointy bone. It involves smoothing and reshaping pits and craters in the bone where bacteria can collect. This is especially important before having dentures made.
- Guided tissue regeneration — This procedure promotes gum and bone tissue growth with a mesh-like fabric. Your surgeon might do this in combination with flap surgery before implant placement.
Oral, Neck, or Head Cancer
Oral surgeons play a direct role in diagnosing and treating oral cancer. Doctors and physicians also play a role. Oral cancer begins with the development of abnormal cells. It results in the growth of mouth sores (cancerous lesions).
Oral cancer can develop in many areas, including:
- Mouth
- Cheeks
- Gums
- Tongue
- Lips
- Palate
- Sinuses
- The floor of the mouth
OMS may also be involved in the treatment of neck cancer and esophageal cancer. Without early treatment, the disease is life-threatening.
Reconstructive Jaw Surgery
Another type of OMS surgery is called reconstructive or corrective jaw surgery. It’s used to:
- Correct facial contours after trauma or injury
- Reconstruct the jaw (for example, after removing cancerous tissues)
- Fix soft tissue problems caused by injury
Reconstructive surgery restores the function and form of your natural features. These surgeries often require skin, nerve, or bone grafting from another part of your body.
The same skills are necessary for cosmetic surgeries. These are elective procedures that improve facial features from aging or trauma.
Cleft Lip and Palate
Cleft lip and cleft palate are congenital conditions that form when a baby’s lips or mouth don’t grow properly. This condition happens early in pregnancy. The lip and palate develop separately, which means a cleft lip, palate, or both can occur.
Cleft palate surgery usually occurs when a child is between 6 and 12 months old. Older patients can also benefit from surgery, but it’s less common.
Orthognathic Surgery
Orthognathic (jaw) surgery involves oral and maxillofacial surgery, as well as orthodontics.
Orthognathic translates to “straight jaw.” It combines orthodontic treatment with surgical intervention to correct misalignments and discrepancies in the jaw.
Jaw surgery may include correcting the position and size of the jaw. It can also fix severe malocclusion (incorrect bite) in those who cannot benefit from minor treatment alone, such as braces or clear aligners.
Sleep Apnea Surgery
Sleep apnea is a common disorder caused by a blockage in the upper airway. Symptoms of sleep apnea include:
- Loud snoring
- Gasping for air
- Feeling like you didn’t get enough sleep
Surgery is considered the “last resort” for people with obstructive sleep apnea.
Cosmetic Surgeries
In addition to dental implants, oral surgeons perform many different cosmetic surgeries.
Cosmetic procedures can change the shape/look of your face, improving your appearance and self-confidence. These surgeries are elective, which means they aren’t covered by insurance.
Other Skeletal Discrepancies
Jaw misalignment is the most common skeletal discrepancy oral surgeons treat. In particular, if you have temporomandibular joint dysfunction (TMD), your dentist will likely refer you to a maxillofacial specialist for treatment.
TMD is the most common temporomandibular joint and muscle disorder. People with TMD typically suffer from difficult symptoms, such as:
- Headaches
- Earaches
- Pain when opening or closing the mouth
Lifestyle changes and custom mouthguards often relieve symptoms and pain over time.
For serious cases of TMD, a dental surgeon may perform a TMJ surgery.
Common TMJ surgeries include:
- Arthrocentesis — This procedure uses sterile fluid to wash out the TMJ to remove any debris from inside the joint.
- Arthroscopies (“keyhole surgeries”) — These minimally invasive procedures use a small camera (arthroscope) to diagnose and treat TMD. During the procedure, your surgeon inserts the arthroscope into a keyhole-sized incision in front of your ear. Then they remove any scar tissue around the joint to relieve pain and discomfort.
- Total joint replacement – In severe cases, the entire TMJ may need to be replaced with an artificial joint.
Summary
- An oral and maxillofacial surgeon is often called an oral surgeon
- Maxillofacial refers to the jaws and face, while oral refers to the mouth
- Oral surgeons perform surgical procedures on the mouth, face, and jaws
- Your dentist may refer you to an oral surgeon for many reasons, ranging from dental bone grafts to cleft palate repair
- An oral surgeon plays a key role in treating oral cancer as well as cancers of the face, head, neck, and esophagus
- They can also perform plastic surgeries, including facial reconstructive procedures following injury and cosmetic surgeries to alter your appearance
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