Conditions and Diseases that may Require Oral and Maxillofacial Surgery

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An internationally recognized surgical specialty, oral and maxillofacial surgery (OMS) includes the diagnosis, surgical and related treatments of many diseases, injuries, defects, and aesthetic problems involving the head, neck, mouth, face, teeth, and jaws. Specialists in this field provide care options to patients experiencing such conditions as impacted wisdom teeth, facial pain, and misaligned jaws. They also offer reconstructive and dental implants, treat accident victims suffering facial injuries, and perform specific procedures for patients with tumors, cysts, and developmental craniofacial abnormalities.

The scope of OMS is wide and extensive. Specifically, it covers the following diseases or injuries, among other conditions:

• Dental implant surgery and associated bone grafting
• Dentofacial deformities
• Bone augmentation
• Oral and dentoalveolar surgery (removal of impacted teeth, cysts, etc.)
• Congenital craniofacial deformities
• Facial plastic surgery (rhinoplasty, rhytidectomy, blepharoplasty, etc.)
• Snoring and sleep apnea correction surgery
• Tumor or cancer surgery
• Facial trauma surgery (facial bone fractures and related soft tissue injuries)
• Reconstructive surgery of the face
• Cleft lip and palate surgery
• Temporomandibular Joint Disorder (TMJD)

Oral and maxillofacial surgeons do not work alone and often seek the advice, assistance, and even surgical support of other specialists such as dentists, orthodontists, pathologists, oncologists, prosthodontists, neurosurgeons, plastic surgeons, radiologists, ENT surgeons, and other medical professionals.

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Domenick Coletti, DDS, M.D., is certified by the American Board of Oral and Maxillofacial Surgeons. His practice at Central Maryland Oral and Maxillofacial Surgery, P.A. includes performing dental implants, removing impacted wisdom teeth, treating facial trauma, and administering corrective jaw surgery. For more articles on oral health, click here.

Oral Bacteria Linked to Esophageal Cancer

People who are infected with Porphyromonas gingivalis (P. gingivalis), a group of bacteria responsible for various gum diseases, are at higher risk for acquiring esophageal cancer. The esophagus is a muscular tube that connects the throat with the stomach.

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The correlation between P. gingivalis and esophageal cancer was made after a group of researchers from the University of Louisville (UofL) School of Dentistry found that 61 percent of patients with esophageal cancer were carriers of P. gingivalis.

"These findings provide the first direct evidence that P. gingivalis infection could be a novel risk factor for esophageal squamous cell carcinoma (ESCC), and may also serve as a prognostic biomarker for this type of cancer," revealed Dr. Huizhi Wang, assistant professor of oral immunology and infectious diseases at the UofL School of Dentistry.

Dr. Wang stated that their data, if confirmed, shows that the “eradication of a common oral pathogen may contribute to a reduction in the significant number of people suffering with ESCC.”

Using tissue samples from 100 patients with ESCC and 30 normal controls, the researchers measured the presence of the oral bacteria in the esophageal tissues of their subjects. At the end of their study, they found that bacterial count of P. gingivalis is higher among ESCC patients. The presence of these bacteria, they hypothesized, “facilitates the development of esophageal cancer.”

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Domenick Coletti DDS specializes in full-scope oral surgery at Central Maryland Oral and Maxillofacial Surgery P.A. Follow this Twitter page for more news in oral health.

Dental Plaque: A Daily Problem with Painful Consequences

In some advertisements for toothbrushes and toothpaste, plaque is sometimes incorrectly depicted as a particulate substance. Although particulate material in the form of food does accumulate in between teeth, they are not in themselves dental plaque, though they may eventually cause it.


Dental plaque is actually a biofilm, consisting of a thin yet visible film of filamentous microorganisms and particles stuck in between teeth. It is readily felt by the tongue and can even be scraped off by the fingernails though more effective methods of manual removal exist. When allowed to accumulate over the course of a day, it turns to tartar, which is evident as a visible yellow stain on teeth that can be removed only by dentist's instruments.

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Plaque is a natural result of the normal flora of the mouth and, thus, cannot be prevented. Cosmetic concerns surrounding teeth discoloration aside, dental plaque plays a role in tooth decay and eventual tooth loss. When exposed to high-sugar or high-carbohydrate environments—a particularly common occurrence in modern diets—dental plaque retains lactic acid, which can cause dental caries if exposed to teeth for prolonged periods.

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Thus, the regular removal of plaque and tartar play a key role in lasting dental health. Habitual brushing and flossing on a daily basis dislodge dental plaque while still in its soft film form, whereas annual teeth cleaning visits to the dentist remove accumulated tartar. Fluoridated toothpaste and drinking water also strengthen the tooth and create a surface that bacteria cannot readily cling on to, reducing the amount of plaque that forms and making it easier to remove subsequently.


Domenick Coletti, DDS, M.D., is an accomplished oral surgeon in Maryland. Visit this website for more on him and his practice.

Does Wisdom Tooth Xtraction Cause Sinus Infection?

Wisdom tooth extraction is a relatively common dental procedure. This process is done when the third molars become impacted, with many dental surgeons recommending early intervention to prevent gum disease and structural misalignment. Despite its general simplicity, wisdom tooth extraction is still considered a major operation and patients need to be reminded of the potential complication that may occur post-procedure. A certain amount of swelling is expected to occur, but this should ease after a few days.

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A less common side effect is a condition known as an oral-antral fistula, which happens when an upper molar is taken out. During the operation, a small cavity will be made from the mouth to the sinuses. Most of the time the tissue heals with no ill effects, but there is a possibility of infection. This is a recognized risk factor, and many dental surgeons warn patients to comply with their antibiotics treatment during the entire recovery duration. That said, many patients who have had their upper molars extracted are more likely to develop colds or a stuffed nose; although again, this should disappear within a few days. If the infection becomes severe, the individual may have to visit a general practitioner in tandem with his or her dentist to treat the cold while maintaining the stability of the wound healing.


Wisdom tooth extraction does not cause sinus infection though there are risks that are heavily emphasized before the operation. It is thus important for patients to have a clear understanding of the procedure, possible risks, and after-care.
 

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Dr. Domenick Coletti is a maxillofacial surgeon focused on wisdom tooth extraction. Learn more by following this Twitter account.

The Link Between Oral Health and Heart Disease

Tooth decay is an oral disease characterized by damage to the outer layers of the teeth. It occurs as a result of eating foods that are high in sugar and carbohydrates, not observing proper dental hygiene, and not getting enough fluoride. It can also be caused by diabetes, smoking, and not having enough saliva.

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Tooth decay not only causes unpleasant symptoms such as toothache, sensitivity, and bad breath: It has also been linked to heart disease.

A study published in the British Medical Journal found that people who reported having poor dental hygiene had a 70 percent risk of cardiovascular disease, compared to people who brush their teeth at least twice a day. Some researchers theorize that bacteria from the infected gums can become dislodged and enter the bloodstream. The bacteria can eventually attach to the blood vessels, causing clots to form.

Chronic gum disease often occurs alongside tooth decay and begins when bacteria in plaque build up (gingivitis). If left untreated, gingivitis progresses to periodontitis, a more advanced, destructive form of gum disease.

According to the Academy of General Dentistry (AGD), people with oral health diseases are at a higher risk for heart attacks, while the American Academy of Periodontology reports that individuals with periodontal disease (a more advanced and destructive form of gum disease) are nearly twice as likely to have heart disease than those who don't. Several experts in the field of dental health came together to create a consensus report, published in the Journal of Periodontology and the American Journal of Cardiology, which touches upon the link between oral health and heart disease. One of the main takeaways from the report is that chronic gum disease is a risk factor for coronary artery disease.

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While the jury is still out when it comes to finding a definite link between tooth decay and gum disease, and heart health, individuals who are concerned about their overall health should not neglect to pay attention to their teeth. Brushing teeth with a fluoride toothpaste at least twice a day, flossing, quitting smoking, and paying regular visits to the dentist can help prevent tooth decay and gum disease and their complications.

Domenick Coletti DDS, MD is one of only 60 oral and maxillofacial surgeous inducted into the American College of Surgeons. For more articles on oral health, subscribe to this blog.

Gauging the Risks for Tooth Loss

Although traditionally thought as an effect of aging, tooth loss or edentulism can take place at any age. Everyone from children to adults is at risk of tooth loss, in particular when oral hygiene habits are severely lacking.

Previous generations have been prone to tooth loss at the onset of senior years and recent trends suggest that this pattern may repeat itself among older adults today due to the prevalence of gum disease and high sugar diets, accompanied by poor dental hygiene.

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Risks for tooth loss, however, vary significantly with age. For instance, while tooth decay and poor dental hygiene and healthcare are universal factors afflicting the general population, other causes are functions of the different stages of a person's life. Children, for instance, risk losing baby teeth prematurely to injury or neglect, whereas adults are more likely to increase risks of tooth loss due to smoking or serious health conditions like heart disease and diabetes.

In addition, poor dental health habits also contribute to the risks of edentulism. Some adults and children neglect to go to the dentist as needed out of either financial constraints or fears of the resultant pain accompanying the procedure.

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The fundamentals of keeping teeth health for a lifetime include ingrained habitual good dental hygiene and regular dental checkups and recommended procedures. Preventing tooth loss is a lifelong commitment that can pay off well into the golden years.

Dr. Domenick Coletti is one of the head surgeons at Central Maryland Oral and Maxillofacial Surgery. Visit this website for more on the practice's many oral health procedures.

REPOST: Seniors with dementia eased into dental care

Seniors with dementia are a very difficult patient group to treat, dental care-wise. They easily get confused, may fail to follow instructions properly, and are confronted with other health problems. Read the following article to know how dentists are addressing this challenge:

Video source: cbc.ca


When Monte LeVernois is wheeled into a dental clinic at a long-term care home in Halifax, saying "Good morning" to him provokes no response. He has dementia and it's not clear what he understands. But his dentist is equipped to deal with the challenge.

Dr. Stu Kirby is the dentist who makes biweekly visits at Northwood, the largest long-term care home in the Maritimes. He provides dental care to the residents, many of whom have dementia

"It's a very challenging population to work on for a number of reasons," says Kirby.

Depending on the stage of dementia, patients may refuse care or even bite Kirby, mistaking what's in their mouth as food. He doesn't blame the patients.

"They are no longer able to follow instructions. They're confused. Things are out of the ordinary for them, which makes them very, very difficult. So the key is to get in there early. Find the problems. Deal with the problems when things are able to be taken care of."

Sometimes though, it's not possible to fix a patient's dental problems before his or her dementia has taken hold. Kirby then relies on techniques he's learned.

"You've got to be very careful in terms of how you're dealing with these patients in terms of the way you speak to them, your hand movements, your gestures. You want to make sure that they're always feeling secure and comfortable."

Sedation is an option for some patients who are particularly anxious or unco-operative. But the frail health condition of dementia patients sometimes precludes sedation.

Kirby takes advantage of the newer design wheelchairs, many of which tilt back, so he doesn't have to cause distress by moving the patient out of his or her wheelchair.

Kirby says serious — even deadly — health problems can begin in the mouth, including in dementia patients.

"You can have life-threatening infections which travel from the floor of the mouth to the brain and so people think, you know, it's just a minor abscess. Well, a minor abscess can turn into a significant problem."

Dr. Mary McNally, a professor at Dalhousie University's School of Dentistry, is passionate about improving dental care for seniors at the school's elder care clinic. She spearheaded a large research and training project, called Brushing up on Mouth Care, which outlines what dementia is and how it can affect a patient's behaviour during dental care visits.

"I think you just need to stay calm. I mean, these people are sick. They need your help. They're not doing things to cause a problem. They're doing them because they have a cognitive impairment and are declining."

McNally says a reality we need to understand about dementia is that these patients perceive their surroundings in a very different way.

"You might have someone coming into your dental operatory and they're walking over a black mat and they might think it's a puddle of water. They might not recognize what the chair is. So what's manifesting as natural losses associated with dementia is, in fact, them responding to the reality in their world … Their behaviour is a result of their lived experience. That's what makes them challenging. We don't understand what those realities are for them."

Her research and training document includes tips for dealing with dementia patients, such as:

-Set a routine time and place for oral care.
-Have the caregiver identify him or herself and what he or she is going to do.
-Use visual or verbal cues, short sentences and simple words.
-Maintain a calm and quiet atmosphere.
-Use positive reinforcement, such as nodding the head or giving a thumbs up.
-Provide oral care after a meal when a patient is most content and co-operative.
-Distract the patient by singing or giving them something to hold, such as a toothbrush.
-Put the toothbrush in their hand and guide it with your own to encourage toothbrushing.

McNally says it's also useful for dentists or caregivers to mimic an action. In other words, don't just say, "Open your mouth." You have to open your own mouth and demonstrate.

Shift away from dentures

McNally thinks consistent dental care is important given the prevalence of dental diseases such as cavities among people with dementia in long-term care, as well as the decreasing incidence of dentures among seniors generally.

"The aging population is actually aging with more of their natural teeth. So now folks are going into residential care. Even a generation ago, they mostly had dentures. Well, now we know that they mostly have natural teeth. So that has a huge impact on the care system because the care system and care providers are having to adjust to this whole level of managing an aspect of health that they didn't have to manage before."

McNally says it's clear this is becoming an issue of wider concern. Her research and training document and videos are available online and gets hits from Europe, Australia, India and South America as well as Canada and the U.S.

Gail MacDougall understands the challenges of getting a frail senior with dementia to receive dental care. Her 95-year-old mother has dementia but MacDougall says it was never a question as to whether her mother would go for regular dental visits, not only for her health but also her looks.

"My mother loves her clothes. She likes to look well. I think appearance is part of it, as well as nutrition and overall health. You don't want unnecessary infections in a body that's already compromised."

Back at the dental clinic at Northwood, Dr. Kirby finishes the procedure on LeVernois. It's not clear LeVernois has any clue what has just happened to him.

Kirby says a little compassion goes a long way.

"Many of us will be in the same situation so I think it's important that you just keep calm and do what you can."

Dr. Domenick Coletti practices the full scope of oral and maxillofacial surgery. To learn more about his expertise, click here.