Types of Oral Surgery
Wisdom Teeth Removal
Of the many different types of oral surgery available, wisdom tooth extraction is among the most common. The average adult has 32 teeth, 16 on the top and 16 on the bottom. Each tooth in the mouth has a specific name and function. The 6 front teeth (incisors, canines) are designed for grasping and incising/biting food into smaller pieces. The molars and premolars, back teeth, are used to grind food up into a texture suitable for swallowing. Wisdom teeth, the third and final set of molars, usually erupt during the late teens to early twenties. In the majority of people, wisdom teeth erupt abnormally or remain impacted. Why Should I Remove My Wisdom Teeth?
If wisdom teeth aren't removed, they can cause the teeth to become malaligned, create periodontal problems, and in rare cases, they can develop into cysts or tumors. Because they are located so far back in the jaw, they create difficulty with oral hygiene, increasing your risk of cavities, periodontal disease and breath odor.
Orthognathic surgery is the process of realigning the jaws in order to obtain proper function and improve aesthetic appearance. It is needed when jaws don’t meet correctly and/or teeth don’t fit properly within the jaws. Orthodontic treatment is first required to properly position the teeth after which dental models and x-rays are taken for planning and discussion of treatment options.
Who Needs Orthognathic Surgery? People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and, in some instances, the upper and lower jaws may grow at different rates resulting in a host of problems that can affect chewing, speech, long-term oral health, and appearance.
Most individuals are referred to us by their orthodontist for a pre-operative consultation because they believe treatment results will be better if braces are offered in conjunction with orthognathic jaw surgery. During this consultation, Dr. Hopkin will evaluate your unique situation including: medical and dental history, facial proportions, occlusion (bite), teeth radiographs, and study models (molds of your teeth). Dr. Hopkin will then summarize the goals of surgery, the recommended procedure(s), the potential risks, and the alternatives to orthognathic surgery.
A summary of this evaluation and treatment recommendations will be sent to your orthodontist. Our office will request a predetermination of benefits from your insurance carrier(s). Your insurance company may cover orthognathic surgery depending on your particular situation. Always feel free to ask any questions that you have regarding your treatment. We will not proceed until you are satisfied and all questions have been answered.
While orthodontics alone can correct many bite problems, orthognathic surgery may be required if tooth movement alone is not enough. The following conditions may also benefit from treatment with orthognathic surgery: difficulty in chewing, biting or swallowing, speech problems, chronic jaw or TMJ pain, open bite (front teeth don’t overlap) protruding jaw, and sleep apnea.
Sleep apnea is a condition that can also benefit from orthognathic surgery. Those with sleep apnea experience breathing disruption while they sleep due to their airway becoming too narrow. Besides feeling fatigued and having difficulty concentrating, long term effects of this lack of oxygen can include: high blood pressure, heart disease, stroke, pre-diabetes, diabetes, and depression. Dr. Hopkin offers surgical and non-surgical treatment options to help open up the airway to help sleep apnea sufferers.
Many people in Utah seek dental implants to restore their lifestyles. When you lose a tooth, be it for any reason like decay, periodontal disease, trauma or age, it greatly affects your quality of life. If you are in the process of choosing an implant surgeon, consider that Dr. Dustin J. Hopkin is one of the most renowned oral surgeons in Salt Lake City who places dental implants for patients on a daily basis.
What is it that patients look for in dental implants when they lose a tooth? Knowing the ways tooth loss can affect one’s life can easily explain why people look for good oral surgeons in Salt Lake City to place their dental implants. A lost tooth means lost function. Patients find that they can’t chew their food as efficiently as they used to. It can greatly impair their ability to chew and digest their food adequately, requiring more effort and more chewing time. This causes added stress on other teeth and the muscles because they must shift the food to alternate teeth to chew it more efficiently, adding stress on the masticatory muscles and teeth being used excessively. Because the teeth help in the pronunciation of important speech sounds, even a single lost tooth can impair that ability, along with affecting one’s self-confidence.
Looking good always makes one feel good. If a lost tooth is visible, it can immensely affect an individual’s aesthetics and self-confidence which can literally damage self-esteem, creating psychological issues. By eliminating all of the above concerns for his patients, Dr. Hopkin has become one of the top oral surgeons in Salt Lake City. Known for his immense compassion, he treats his patients' implant needs with expertise, giving top priority to their happiness and satisfaction.
Dental implants become part of the body because they permanently integrate within the jaw bones, becoming naturally part of their structure. This allows for complete replacement of the lost tooth’s root while also giving extremely stable support to the dental prosthesis it is meant to hold, such as a crown, bridge or denture.
As the implant integrates with the bone completely, patients can’t tell they ever lost their tooth and feel as if the implant is one of their own natural teeth. The implants not only feel but look entirely natural in the mouth when done with the proper planning and treatment. The superior aesthetic results of implants compared to just crowns and bridges alone are what make dental implants the best and most cosmetic option for replacing lost teeth.
Implants require adequate jaw bone for their placement, hence there is no need to cut and shape the adjacent teeth as with bridges. Because implants are like natural teeth, brushing and flossing are just as simple as always, without the need for floss threaders or other oral hygiene devices gadgets. Patients who have had dental implants placed by Dr. Hopkin can smile freely, feel comfortable and chew as well as they could before they lost their tooth, ultimately restoring their lifestyle.
Once a tooth is extracted, the bone surrounding the area atrophies or is reabsorbed. This can result in insufficient bone for placement of dental implants. When this occurs, bone grafting may be needed to augment the area in preparation for placement of dental implants. The size of the bony defect often dictates from where the bone can be obtained. Small areas associated with the loss of 1 or 2 teeth can most times be grafted using bone obtained from the tissue bank.
These bone products are cleaned and sterilized and rendered safe for use and have a long track record of safety. Bone can also be obtained from other areas of the body including the chin, jaw and hip. We are happy to discuss all options with you and help you determine which option is best for you.
Major bone grafts are typically performed to repair defects of the jaws secondary to traumatic injuries, tumor surgery, or congenital defects. These defects are repaired using the patient’s own bone harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia) are common donor sites. These procedures are performed in an operating room and require a hospital stay.
The oral mucosa, the pink colored skin of the mouth, is typically smooth and shiny. Alteration in its appearance can be a sign of serious pathological processes, the most serious of which is oral cancer. Signs of the beginning of a pathologic process or cancerous growth include the following: a sore that fails to heal and bleeds easily, red patches or white patches in the mouth, a mass or thickening of the skin lining the inside of the mouth, difficulty with chewing or swallowing, or a chronic sore throat or hoarseness. These changes can be slight and can occur at any location inside the mouth including the lips, tongue, cheeks, the floor of the mouth and palate. Unfortunately, most oral pathology is not usually associated with pain and the only signs that something is occurring are these changes in the oral mucosa. Regular oral self-evaluation is recommended to check for these changes.
Pathology can also occur inside the jaws. Signs that tumors or cysts may be forming include widening of the jaws, increases in the spacing between teeth, and loss of sensation to the face and/or teeth. Dental radiographs along with an evaluation can often detect any problems. Biopsies are required to make a final diagnosis and to help in treatment planning. Biopsies can be performed under both local or general anesthesia. Dr. Hopkin will help you through the process of diagnosis and treatment. Please call us with any questions or for a consultation.
Dr. Hopkin is the premier TMJ specialist in Utah, finding most of his treatment success in providing non-surgical treatment modalities for his patients. By approaching treatment in this non-invasive way, Dr. Hopkin provides relief to many desperate people suffering from these disorders without the cost or recovery of surgery. Open TMJ surgery is not considered unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, and/or the patient has undergone appliance treatment unsuccessfully.
The TMJ (temporomandibular joint) is the hinge between the lower jaw and the skull. Disorders can develop for many reasons, including clenching or grinding of teeth or over-activity of the jaw muscles resulting in stress on the temporomandibular joint.
Trauma can also be the result of injury or disease to the joint. This in turn can result in damage to the interarticular disk, a cartilage disk located between the jaw and skull that functions as the “cushion” of the jaw joint. This damage can be in the form of holes or tears in the disk or retrodical tissue, the elastic tissue connecting the disk to the skull. This damage can then allow the disk to slip out of position resulting in popping, grinding, and pain. This in turn leads to difficulty with mouth opening, misalignment of the jaws and pain on chewing.
The initial goals of treatment are to relieve joint pain and relax the muscles. This is usually accomplished with an anti-inflammatory pain reliever and/or muscle relaxant. Additional treatment can also involve injections into the joints to reduce pain and inflammation. Joint rest can also play an important role in resolving the pain and include: eating soft foods, applying ice and heat, and practicing good jaw posture. Physical therapy can also be helpful, as well as splint therapy with a clear plastic appliance to allow for joint rest. An occlusal splint or night guard that fits over your teeth helps keep your teeth apart allowing the joint to rest and resulting in muscle relaxation and pain reduction. Occlusal splints are typically worn during the sleep hours and can help reduce the grinding and clenching that result in joint inflammation and pain.
TMJ disorders resulting in misalignment of the jaws or teeth may require treatment such as occlusal equilibration (bite adjustment), restorative dental work, orthodontics and/or jaw reconstruction. Surgical options such as arthroscopy and open joint repair are sometimes needed.
Oral and Facial Trauma
Oral and maxillofacial surgeons evaluate and treat injuries resulting from sporting accidents, motor vehicle accidents, and interpersonal violence. Dr. Hopkin treats fractures of the upper and lower jaws, fractures of other facial bones including cheeks, nose, eye sockets and forehead, avulsed or missing teeth, lacerations and soft tissue injuries to the facial region. Injuries to the face and the associated structures can result in significant alterations in the appearance of the face and functions of the teeth and jaws. Proper treatment of these injuries requires preservation and reconstruction of involved structures with the focus on an aesthetically pleasing and functional result.
Dr. Hopkin is committed to achieving the most aesthetic and functional outcome and has successfully treated many trauma cases. Complex injuries often require a staged approach in order to achieve ideal results, this may include multiple surgeries in order to reconstruct post traumatic bony defects and aid in reduction of post traumatic scaring. Injuries to the teeth and supporting structures often require the combined effort of multiple dental specialists. Oral and maxillofacial surgeons primarily work to fix broken jaws, the supporting bony structures and work to stabilize and/or replace avulsed (knocked out) teeth.
Teeth and jaws will typically be stabilized with dental wires and/or tooth colored restorative material. This stabilization will be maintained for 2-6 weeks depending on the injury, during which time root canal therapy may be needed in order to prevent infection and failure of the replanted tooth. Any chips or fractures of the teeth will then be restored by the general dentist. Knocked out/fractured teeth cannot always be replaced. It depends on how long the tooth was out of the mouth or how the tooth was fractured, and may require additional extraction of any remaining portion of the tooth and reconstruction of the resultant defect with a dental implant or bridge. Dr. Hopkin will evaluate the situation and recommend the best treatment options.
Replacing missing teeth with complete or partial dentures often requires alteration of the underlying bone and or gum tissues in order to allow for proper fit and function. Things that cause problems with a comfortable prosthesis include exostosis, which is a developmental bulge of normal bone on the cheek side of the teeth that may interfere with the seating of a prosthesis. These will sometimes slowly enlarge over many years and require excision. Mandibular tori, an exostosis that typically is found along the gum line on the tongue side of the teeth, and palatal tori, exostosis that is found on the roof of the mouth, may also impede the comfort and function of dentures if not appropriately removed.
An epulus is an excessive thickening of the gum tissue that can develop under a chronically loose-fitting denture. This tissue is typically inflamed and painful. Once excised, the denture should be relined or remade in order to prevent recurrence. The goal of these procedures is to maximize the fit and comfort of the prosthesis. Adjustments of your prosthesis may be required after surgery. Dr. Hopkin works closely with your general dentist to provide coordinated and timely care.
Dr. Hopkin determines the level of sedation based on the needs of each patient, not his personal preferences. Anesthesia options include:
Local anesthesia – Numbing injections are given in the appropriate area(s). It is not necessary to change your eating habits before your appointment. Please take any prescription medications as you normally would. If you are pregnant, then local anesthesia is recommended.
Nitrous oxide and local anesthesia – Nitrous oxide gas is administered to produce a relaxed, awake state. Numbing injections are then given. It is not necessary to change your eating habits before your appointment unless you are instructed otherwise.
Intravenous anesthesia – Intravenous (IV) medications are given to produce a IV conscious sedation or IV general anesthesia which is a unconscious condition.
The numbing injections and surgery are accomplished while you sleep. Following the surgery, you should plan to rest at home for the remainder of the day. Please note the following if you prefer IV anesthesia: Do not eat or drink anything for at least six hours before the appointment. You may take prescription medications with a small amount of water. If the patient is diabetic and uses insulin or other medication to help manage the condition, he or she should call the office for guidance as to how to take the medication the day of surgery. Have a responsible adult with you to drive you home. This is a must! Your escort must be present before and during your procedure, and should plan to stay with you the remainder of that day. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience. Wear comfortable, loose-fitting clothing which can be rolled up past the elbow, and low-heeled shoes. Please remove dentures, all jewelry and nail polish before your appointment. If you wear contact lenses, please remove them and wear your eyeglasses instead. Please call us with any questions at 801-277-3942.
Local anesthetic injections last about 2 hours and it is recommended that you take the prescribed pain medication prior to the anesthesia wearing off. Surgical pain typically peaks at 24 hours and slowly becomes better over the next 4-5 days. Ibuprofen is a useful addition to the prescribed pain medications for most patients. Dr. Hopkin will discuss appropriate medication doses at the time of surgery. We are always available to answer questions. If the pain is not decreasing or is getting worse, please give us a call as this may be a sign of a dry socket.
All major bleeding will be controlled prior to your leaving the office though minor seepage will continue for the next 24 hours. It is common for your saliva to be pink for the first day or two. You will leave the office with gauze packs in your mouth and they should be changed every 30 minutes for the first 2-3 hours after which further packing usually will not be required. If you are able to see blood welling up from the extraction sites, this is a sign that replacing the packing is required. Continue to use the gauze packed over the sockets and use firm biting pressure on them for the next 30 minutes. If at the end of this time, bleeding is still occurring, a moistened tea bag in place of the gauze pack may help. If after 30-60 minutes you are still unable to control the bleeding, please call the office.
Do not rinse or brush your teeth on the day of surgery. Proper healing depends on a blood clot forming and staying in the socket. On the day after surgery, regular oral hygiene may be resumed with gentle brushing in the area of surgery.
Swelling of the cheeks and face can be significant over the first 3-4 days with maximum swelling occurring on the 3rd or 4th day after surgery. Swelling will then typically resolve over the next week. Swelling is very individual and can be different from side to side and patient to patient. In order to decrease swelling, ice packs should be applied to the face for 30 minutes then taken off for 30 minutes over the first 24 hours. Frozen peas and corn also work well as they easily conform to the face. Keeping the head elevated on the day of surgery can also help decrease swelling. Medications may also be prescribed to reduce swelling and should be taken according to the prescription.
Bruising on the cheeks, neck and beneath the eyes is normal and does not represent a problem. Maintaining good nutrition is important after surgery. Following oral surgery, drinking and eating can be difficult until the numbness wears off which usually occurs in about 2 hours. Once recovered from the numbness, soft foods such as mashed potatoes, apple sauce, soups, and milkshakes are appropriate. It is recommended that a normal diet be resumed as you feel comfortable.
It can take as much as 10-14 days before you feel like eating foods such as chips. Common sense goes a long way... if your surgery was on one side of your mouth, feel free to chew on the other side. Drinking with straws and smoking should be avoided for the first 72 hrs following surgery as the negative pressure can dislodge the blood clot resulting in bleeding and possibly a dry socket.
You should avoid brushing your teeth in the area of surgery for the first 24 hours. The morning following surgery, it is appropriate to begin rinsing with warm salt water (1 tsp of salt in 8oz of water is appropriate). Mouthwashes with alcohol can inhibit healing and should not be started until the third day following surgery. Once brushing is resumed (after the first 24 hours) it is common to see minor bleeding for the next week. Do not be alarmed. This is normal.
Most patients do not experience nausea or vomiting following surgery. Anesthesia and pain medications can, however, cause some unfortunate individuals to have an upset stomach and make it difficult to maintain proper nutrition and hydration. If you have a history of nausea following surgery we will administer medications during the surgery to help eliminate these effects. If the nausea is associated with the pain medication, ibuprofen and plain acetaminophen can be used and will usually eliminate these effects. Occasionally, additional medication must be prescribed to alleviate nausea. If nausea and vomiting continue beyond 6-8 hours, please give us a call.