An oral and maxillofacial surgeon (OMS) is a highly specialized professional. This specialist manages the diagnosis and surgical treatment of diseases, injuries, and defects involving the functional and aesthetic aspects of the hard and soft tissues of the mouth, jaw, and face. Training for an OMS extends far beyond standard dental school, requiring a minimum of four years in a hospital-based surgical residency program. During this rigorous training, the surgeon gains experience alongside medical residents in areas like general surgery, anesthesiology, and internal medicine, preparing them for complex procedures. General dentists refer patients to an OMS when a condition requires surgical expertise or hospital-based anesthesia options not available in a typical dental office.
When Complex Tooth Removal Is Needed
General dentists routinely perform simple extractions, but complicated tooth removals require the focused expertise of an OMS. The most frequent reason for referral is the removal of impacted wisdom teeth, or third molars, which are often trapped beneath the gum line or jawbone. These procedures involve complex anatomical considerations, such as the tooth’s proximity to the inferior alveolar nerve or the maxillary sinus.
An extraction is also considered complex when a tooth is badly broken below the gum line or involves deeply fractured root fragments. Patients with significant medical complications, such as those on certain therapeutic medications or with compromised health conditions, often require surgery in a specialized setting. The OMS is trained to manage these complex cases, often utilizing intravenous sedation or general anesthesia for patient comfort and safety.
Surgical Solutions for Missing Teeth
When a patient loses one or more teeth, the OMS plays a direct role in restoring function and appearance, primarily through the placement of dental implants. Implants involve surgically placing a titanium post into the jawbone, which acts as an artificial tooth root to support a crown or bridge. This procedure requires precise planning and execution to ensure the implant integrates successfully with the surrounding bone tissue.
A lack of sufficient bone volume often complicates implant placement, especially in the posterior upper jaw. When bone height is inadequate, the surgeon may need to perform pre-prosthetic surgeries, such as a sinus lift or bone grafting. A sinus lift involves carefully elevating the membrane lining the maxillary sinus and placing graft material beneath it to create the necessary height. Bone grafting uses materials like the patient’s own bone, donor bone, or synthetic substitutes to provide a scaffold for new bone development before the final implant is seated.
Managing Jaw Structure and Facial Trauma
The OMS is the specialist responsible for treating injuries and structural issues affecting the facial skeleton. This includes the repair of facial bone fractures resulting from accidents, encompassing the jaw, cheekbones, eye sockets, and forehead. In trauma cases, the surgeon restores the patient’s pre-injury function and appearance by realigning the fractured bones and securing them with small plates and screws.
The correction of severe jaw misalignment, known as orthognathic surgery, is another area of expertise. This procedure is needed when skeletal discrepancies, such as an overdeveloped or underdeveloped jaw, cannot be corrected by orthodontics alone. Common types include the maxillary osteotomy (upper jaw) and the mandibular osteotomy (lower jaw), which reposition the bones to achieve proper bite and facial balance.
Complex disorders of the temporomandibular joint (TMJ) that do not respond to conservative treatments may also require surgical intervention. Treatment options range from minimally invasive procedures like arthroscopy to open-joint surgery for conditions such as advanced arthritis or joint dysfunction. These structural interventions improve the patient’s ability to chew, speak, and breathe.
Identification and Biopsy of Oral Disease
Oral and maxillofacial surgeons play a significant role in the detection and management of pathology affecting the mouth and face. When a general dentist or physician discovers a suspicious lesion, growth, or ulcer that does not heal, the patient is referred to an OMS for specialized diagnostic procedures. These specialists evaluate abnormal tissue, including cysts, tumors, and lesions that may indicate conditions like oral cancer.
To establish a definitive diagnosis, the OMS performs a biopsy, which involves surgically removing a tissue sample for laboratory examination. Biopsy types vary based on the lesion: an excisional biopsy removes the entire growth, while an incisional biopsy samples a representative portion of larger lesions. Other techniques include fine needle aspiration for deeper lesions or a punch biopsy to extract a cylindrical core of tissue. The analysis determines whether the pathology is benign or malignant and guides the appropriate course of treatment.