Dental surgery is a broad term for any medical procedure involving the teeth, gums, jaw, and surrounding facial structures. This treatment encompasses a wide range of complexity, moving from routine procedures performed in a dentist’s office to major reconstructive operations requiring a hospital setting. Surgical interventions are necessary for correcting various conditions, including trauma, disease, congenital defects, and preparing the mouth for restorative work. The procedures focus on diagnosing and treating issues within the oral cavity and the interconnected anatomy of the head and neck.
Oral and Maxillofacial Surgery: The Core Specialty
The primary field dedicated to the full scope of dental and facial surgery is Oral and Maxillofacial Surgery (OMS). These specialists diagnose and surgically treat diseases, injuries, and defects involving the functional and aesthetic aspects of the mouth, teeth, jaws, and face. The training pathway is extensive, beginning with a four-year dental degree, followed by a rigorous hospital-based surgical residency that typically lasts four to six years.
Many OMS professionals pursue a dual-degree path, completing both a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) and a Doctor of Medicine (MD) degree. This comprehensive training allows the surgeon to bridge the gap between medicine and dentistry, providing expertise for complex cases. Core areas of their practice include managing facial trauma, treating pathology like cysts and tumors of the jaw, and performing corrective jaw surgery, also known as orthognathic surgery.
Orthognathic surgery corrects skeletal and dental anomalies, such as misaligned jaws, which improves a patient’s ability to speak, eat, and breathe. OMS specialists also handle facial reconstruction following accidents or cancer treatment, often working in a hospital setting for extensive procedures. They also perform many procedures in an outpatient office setting, making their practice diverse and widely accessible.
Common Outpatient Surgical Procedures
Many common surgical procedures addressing the teeth and jaw are performed on an outpatient basis, often by an OMS specialist or a general dentist with advanced training. Tooth extractions are frequent, particularly the surgical removal of impacted wisdom teeth that have failed to erupt fully. Impacted teeth require an incision into the gum tissue to access and remove the tooth, followed by suturing the site closed to promote healing.
Dental implant placement is a routine surgical procedure that has become the standard for replacing missing teeth. This involves surgically inserting a titanium screw or post into the jawbone to serve as an artificial tooth root. The titanium post is biocompatible, allowing the jawbone to fuse directly with the implant surface, a process called osseointegration, before a crown or denture is attached.
Pre-prosthetic surgery prepares the mouth’s underlying structure for a removable dental prosthesis like a denture. This includes procedures such as alveoloplasty, which is the surgical smoothing and reshaping of the jawbone ridge to ensure a proper and comfortable fit. Removing bony growths known as tori, which can interfere with denture placement, is also part of this preparatory surgical work.
Other Specialized Dental Surgery Disciplines
While Oral and Maxillofacial Surgery covers a vast range of procedures, other specialized dental fields also incorporate surgical techniques. Periodontists specialize in the supporting structures of the teeth, including the gums, bone, and cementum. Their surgical procedures focus on correcting damage caused by advanced gum disease or improving the aesthetics of the gumline.
Periodontal surgery includes:
- Bone grafting to regenerate lost bone tissue around teeth or in preparation for implants.
- Soft tissue grafting to cover exposed tooth roots caused by gum recession.
- Crown lengthening, where excess gum and bone tissue are reshaped to expose more of the natural tooth structure for cosmetic reasons or to facilitate restoration placement.
Endodontists, who specialize in the dental pulp and tissues surrounding the tooth root, also perform specific surgical procedures. The most common is an apicoectomy, or root-end resection. This procedure is necessary when inflammation or infection persists near the tooth’s root tip after a standard root canal treatment. During an apicoectomy, the endodontist opens the gum tissue to expose the underlying bone, removes the infected tissue, and seals the end of the tooth root with a small filling material. This microsurgical approach eliminates the source of infection that a non-surgical root canal could not fully resolve.
Patient Preparation and Post-Operative Care
Proper preparation before surgery is crucial for ensuring a safe procedure and a smooth recovery, especially when intravenous sedation or general anesthesia is planned. Patients are typically instructed to fast, avoiding all food and drink for a period, often eight to ten hours, before the procedure to prevent complications with anesthesia. Reviewing all current medications with the surgical team beforehand is also necessary, as some, like blood thinners, may need to be temporarily stopped.
The day of the surgery requires arranging for a responsible adult to provide transportation home, as residual effects from sedation make operating a vehicle unsafe. Patients are advised to establish a comfortable recovery area at home, stocked with ice packs and soft foods, before the procedure. Post-operative care centers on managing the expected symptoms of pain, swelling, and minor bleeding.
Swelling commonly peaks around 48 to 72 hours after the operation and is initially managed by applying ice packs to the face in cycles. Pain is controlled using prescribed or over-the-counter medication, which should be taken as directed to maintain comfort. Patients must also adhere to a soft-food diet for several days and avoid actions that could dislodge the blood clot from the surgical site, such as spitting or using a straw. These actions can lead to a painful complication called dry socket.