An Oral and Maxillofacial Surgeon (OMS) is a highly trained dental specialist focusing on the diagnosis, surgery, and treatment of injuries, diseases, and defects in the head, neck, face, and jaws. An OMS completes four years of dental school followed by a minimum of four to six additional years of rigorous, hospital-based surgical residency training. This extensive education includes rotations in general surgery, internal medicine, and anesthesiology. Their expertise allows them to manage complex conditions that extend beyond the scope of general dental practice, bridging the gap between medicine and dentistry.
Surgical Tooth Removal
A general dentist often refers patients to an OMS when a tooth extraction is deemed surgically complex. The most common reason for referral is the removal of impacted teeth, particularly third molars or wisdom teeth, which are often trapped within the jawbone or soft tissue. These extractions frequently require the removal of overlying bone or sectioning the tooth for safe removal, procedures that benefit from the surgeon’s specialized training and advanced anesthesia capabilities.
Other complicated removals include teeth whose roots are entangled with or lie close to vital structures, such as the inferior alveolar nerve in the lower jaw. An OMS is also consulted for extractions necessary to prepare the mouth for other treatments, such as removing severely diseased or fractured teeth. Furthermore, teeth may need removal to create adequate space prior to initiating orthodontic treatment or before a patient undergoes radiation therapy for head and neck cancer.
Addressing Jaw and Facial Structure Issues
The treatment of structural problems in the facial skeleton is a major component of an OMS’s practice, often involving trauma repair and corrective surgery. Following accidents, the OMS is the specialist responsible for managing facial and jaw trauma, including fractures of the mandible, maxilla, cheekbones (zygomas), and eye sockets (orbits). Their expertise in dental occlusion, or how the teeth fit together, is fundamental to restoring proper function and alignment of fractured jaw segments using plates and screws.
For patients with significant skeletal discrepancies, an OMS performs corrective jaw surgery, known as orthognathic surgery, to reposition the upper jaw, lower jaw, or both. This procedure addresses functional issues like difficulty chewing, chronic jaw pain, speech impediments, and obstructive sleep apnea caused by misaligned jaws. An OMS may also intervene surgically to manage severe temporomandibular joint (TMJ) disorders when non-surgical treatments have failed to alleviate chronic pain or restore joint function.
Advanced Dental Reconstruction
When teeth are lost, the jawbone begins to resorb or shrink due to lack of stimulation, causing a decrease in bone width and height over time. The OMS specializes in surgical procedures that prepare the jaw for the long-term replacement of missing teeth with dental implants. Implants are titanium posts surgically anchored into the jawbone, providing a stable foundation for prosthetic crowns or bridges.
If the bone volume is insufficient to hold an implant, the OMS performs bone grafting procedures to regenerate the lost bone. Common techniques include ridge augmentation to increase the width or height of the jawbone, or a sinus lift, which adds bone material to the posterior upper jaw near the maxillary sinus. These grafting surgeries ensure the implant achieves osseointegration, a process where the titanium fuses directly with the living bone, creating a durable foundation for the final restoration.
Diagnosis of Oral Pathology
An OMS plays a unique role in evaluating and treating abnormal tissues within the oral and maxillofacial region. If a persistent or unusual growth, lesion, or lump is discovered on the tongue, cheeks, gums, or jawbone, a referral to an OMS is necessary for professional evaluation. The surgeon’s primary action involves performing a biopsy, which is the surgical removal of a tissue sample for microscopic analysis to determine if the pathology is benign or malignant.
This diagnostic scope includes managing cysts and tumors that develop within the jawbone or soft tissues of the face and mouth. An OMS is also frequently called upon to manage severe, deep-seated infections of dental origin, known as odontogenic infections, that can spread rapidly into the facial spaces. These infections often require swift surgical intervention, including incision and drainage, sometimes necessitating a hospital stay to control the spread and administer intravenous antibiotics.