The Christiana Center for Oral & Maxillofacial Sur

Impacted

impacted wisdom teethWhen you hear this word in our office, it is most likely that we are talking about your wisdom teeth. And while we know that it may sound scary to have “impacted wisdom teeth”, we want you to know that, actually, it is very common.

What are impacted wisdom teeth?

Throughout evolutionary history, human mouths (jaws) have become increasingly smaller. While the jaws have gotten smaller, the amount of teeth we have has not. So now we have the same amount of teeth squeezing into a smaller space. Because wisdom teeth are the last to erupt, they often become impacted – that is, blocked by the other teeth around them. Often they are growing in sideways or unable to erupt through the gums at all due to crowding.

Why do wisdom teeth need removal?

The inability to erupt properly means that wisdom teeth can cause a lot of pain and even become infected down the road. This is the main reason that we recommend the removal of all third molars (another name for wisdom teeth). The reason that we remove them during the teen years is that the bone is still soft and recovery from the surgery is taken by the patient much better at this age. If we were to wait, your teeth may become infected, your bite crooked, and it may be too late at some point for us to take them out.

Types of Impaction:

  • Vertical Impaction – In this case, the tooth is unable to break through the gum line. Vertical impaction is very common.
  • Mesioangular Impaction – Angled toward the front of the mouth, the tooth is probably pushing on its neighbor, causing pain and crowding. This type of impaction is also very common.
  • Distoangular Impaction – This tooth is angled toward the rear of the mouth, it is uncommon.
  • Horizontal Impaction – In this case, the tooth is a complete 90 degrees from where it should be, and is likely growing into the roots of its neighboring tooth. This is very rare.

What is the removal procedure like?

You will be completely pain-free during the surgery, which takes just about an hour. You will also be sent home with instructions for pain management, eating and rest orders.

What is recovery like?

You will recover comfortably at home. You can start drinking liquids and soft foods as soon as you feel ready, but should avoid crunchy foods, extra hot or cold items, and straws (NO STRAWS!). You can expect to resume some of your normal activities a few days post-operation.

If you have any questions about wisdom teeth removal or aren’t sure if you even need the procedure, give us a call at Christiana Hospital Location Phone Number 302-292-1600!

Where Do Dental Implants Come From?

kids studyingDental implants have a surprisingly rich and interesting history. Across centuries and throughout cultures around the world there is evidence of attempts at replacing missing teeth with various objects and materials.

The oldest dental implants can be traced back to 2000 BC in China, where missing teeth were substituted with bamboo pegs.

Fast forward a bit to around 1000 BC and you’ll find an ancient Egyptian King whose tomb was recently discovered along with his mummified remains; a copper peg hammered into place where a tooth once lived. This may have been the first time in history that we know of when metal implants were used.

Across the globe some time around 300 BC, an iron tooth was found in a French grave thought to be Celtic in origin. It is possible this implant may have been a post-mortem placement to honor the dead, as an attempt to perform the surgery using a live patient would have been an excruciatingly painful process.

Just 2000 years ago missing teeth were being substituted for animal teeth, and the poor were even selling their teeth to the wealthy, just to make ends meet! The body often rejected these surrogate teeth, causing infection.

More recently in 1931 in Honduras, Dr. Wilson Monroe and his wife found a jawbone amongst other artifacts, with teeth fashioned from shells and attached to the jawbone of an ancient man.

Today we are lucky enough to have dental implants that not only look and feel like real teeth, and anesthesia for the pain is also a plus. Thanks to studies conducted by Per-Ingvar Brånemark of Sweden in the 1950’s, oral surgeons have been able to perfect the process over the years to create today’s implants, which have a 98% success rate! Through a process known as osseointegration, metals and other implant materials are able to be skillfully placed so that your jaw bone actually attaches itself to the implant creating a seamless support system.

Missing a tooth or two? Give us a call at Christiana Hospital Location Phone Number 302-292-1600 to discuss your dental implant options today!

Autograft vs. Allograft

woman smiling about bone graftingSo, you were recently told by your doctor that you need a bone graft, but you aren’t quite sure what that means.

A bone graft is a surgical procedure that is used to fix bones or joints that were damaged by trauma, and it is also used to replace bone that is missing to provide structural stability around the body, including the jawbone. There are many types of bone grafts we can use to grow bone – the two most common are autografts and allografts.

An autograft is a bone or tissue that is transferred from one spot to another on the patient’s body. It is often thought of as the “gold standard” in bone grafting because of its reliability. Its high success rate is due to the fact that it is living tissue and thus its cells are kept intact.

An allograft is a bone or tissue that is transplanted from one person to another. They typically come from a donor, or cadaver bone. The allograft is safe, ready to use and available in large amounts. The main advantage of an allograft is that it requires one less procedure than the autograft, which must first be taken from the patient. Surgical time is minimized and the recovery can be quicker. The allograft comes from a reputable and reliable tissue bank.

Knowing which bone-grafting option you will need can be confusing, but we are here to answer any questions you may have. Please schedule a bone grafting consultation with us by calling Christiana Hospital Location Phone Number 302-292-1600. We will perform a thorough evaluation of your oral health. After our evaluation, we will recommend what bone graft is best for you. We are happy to discuss your options and answer any questions you may have. We want you feeling confident with our choice and worry free.

Preserving your Jaw after Extraction: Socket Preservation

skeleton with jaw bone highlightedIf you come to see us for an extraction, you may hear us talking about “socket preservation” or ”ridge augmentation”, and you might be wondering, what is that?

Socket preservation is a procedure we will sometimes recommend when you are having a tooth extracted. The bones that hold your teeth require frequent use to maintain their size and shape, otherwise they start to recede as they are no longer needed.

When a tooth is extracted, it leaves behind a hole (or “socket”) in the alveolar ridge bone, making it vulnerable to shrinkage. In fact, some studies show that bone loss can be 50% in the first 12 months after extraction.

You may be wondering, “Why does bone loss matter if I don’t have a tooth there anyway?” Unfortunately, without teeth and adequate bone structure, several unwanted oral health problems may occur:

  • Aesthetics: Without adequate bone structure and teeth, your smile starts to cave in in that area, causing undesirable aesthetic consequences. Your skin may begin to look shriveled over time and your smile will be unbalanced and unnatural.
  • Alignment Issues: Your teeth are always moving, particularly into open spaces. A hole on one side of your smile can lead to a severe shift of your teeth over time, affecting your smile and subsequently requiring orthodontic treatment.
  • Implant Complications: The damaged and recessed bone often ensures complications if you plan on getting a dental implant to replace the extracted tooth in the future.

This is where socket preservation comes in. Typically done at the end of your extraction procedure, we place bone-grafting material into the socket and a collagen membrane on top to encourage bone growth in the area. Because the procedure can be done at the same time as your extraction, no additional anesthesia or appointments are necessary.

If you are facing extraction, call us at Christiana Hospital Location Phone Number 302-292-1600 to see if socket preservation is an option for you – it could save your smile!

Immunotherapy and Oral Cancer

woman thinking about oral cancerYou may have heard: Immunotherapy is proving to be very promising in the treatment of a variety of cancers, in particular lung cancer and advanced melanoma. However, immunotherapy has not found its way (yet!) into the treatment regimen for head and neck cancers.

What is immunotherapy?

Immunotherapy is the process of enlisting the patient’s own immune system in the fight against cancer cells. Several drugs have been used successfully to aid in the treatment of advanced lung cancers and melanoma, giving patients a longer prognosis in many cases.

Cancer Cells are Tricky

Cancer cells are notoriously sneaky – their ability to hide from immune cells is one of the reasons that cancer is so hard to treat. This is where “checkpoint inhibitors”, one of the most common classes of immunotherapy drugs in cancer treatment, come in. These drugs help to block the activation of proteins that help cancer cells hide from immune cells.

The Connection with Oral Cancer

Recurring head and neck cancers are very difficult to treat. Often they are resistant to the best chemotherapy drugs, so the hope has always been that immunotherapy drugs may some day step in to assist with the oral pathology fight. A recent trial in the UK has shown that the day may be coming sooner than we thought! The trial proved successful in extending prognosis for many of the patients.

Reduced Side Effects

The research also noted that side effects were reduced to give patients a better quality of life during treatment.

More Testing Needed

While more research is needed before the drugs receive FDA approval for the treatment of oral cancer, the good news is that because these drugs are already approved and on the market for other cancers, the application process for use in oral cancers will be quicker (and smoother) than it would be for a new drug.

At The Christiana Center for Oral & Maxillofacial Surgery P.A., our commitment to your care, comfort, health and safety is evident from the minute you walk through our door. Call us at Christiana Hospital Location Phone Number 302-292-1600 for more information about oral cancer.

Why do we have wisdom teeth, anyway?

woman thinking about wisdom teethWisdom teeth were once an extremely valuable asset to our ancestors. When a typical diet consisted of chewy plants and uncooked meat, third molars (wisdom teeth), which fit easily into our ancestors’ larger jaws, were absolutely necessary. Wisdom teeth were the evolutionary answer to the need for chewing power to combat excessive wear.

Today, our diets are not as rough as those of our ancestors. With modern marvels like forks, spoons, and knives, as well as softer food, the need for wisdom teeth is virtually nonexistent. And yet, on average, about 65% of the human population is born with wisdom teeth which usually erupt between the ages 17 and 25.

Although wisdom teeth were incredibly advantageous for our ancestors, they pose a bit of a problem for the modern mouth. Humans have evolved to have smaller jaws, and so wisdom teeth are often either too big for the jaw or the jaws themselves are just too small. Either way, third molars crowd the mouth. Because of this lack of space, molars often grow sideways, only partially emerging from the gums, or actually get trapped inside the gums and jawbone.

These impacted wisdom teeth can be chronically contaminated with bacteria associated with infection, tooth decay, inflammation, and gum disease. And because they’re so far back in the mouth or trapped underneath gums, it’s difficult and sometimes impossible to keep them clean. Even when wisdom teeth come in fully, they are so far back in the mouth that it’s just too easy for food to get trapped, leading to plaque, cavities, and gum disease.

Although wisdom teeth were very important to our ancestors, nowadays, they pose a serious problem to oral health. Call The Christiana Center for Oral & Maxillofacial Surgery P.A. to find out if your wisdom teeth are ready to come out!

How Are Wisdom Teeth Removed

impacted wisdom teeth diagram

Don’t be worried about your wisdom tooth extraction, let us outline the whole process for you:

Treatment Development

During late adolescence, wisdom teeth start to appear and occasionally are accompanied by oral pain, as well as an increased risk of dental issues such as pericoronitis, gum disease, and tooth decay. Through evaluation, your oral surgeon will determine the number of wisdom teeth present, as well as how they are developing in relation to the rest of your teeth. Using advanced imaging technology, an oral surgeon will discover if the teeth are partially or fully impacted, and then will create a strategic treatment plan in order to remove the teeth and ensure successful recovery.

Preparation

Although sedation is not always necessary, many patients have found anesthesia to be helpful in relaxation and reducing pain during the procedure. If sedation is chosen, there are certain preparations that must be made: patients must enlist the help of family or friends to bring them back home after their surgery.

The Procedure

Local anesthesia is applied to the area. Then, a surgical tool is used to reveal the bone and tooth. After the tooth is clearly visible, it is removed. Once the tooth is extracted, the gums and bone are left to heal.

Healing

Following the procedure, there may be some swelling in the tissue and cheeks near the treatment site. To promote a successful recovery, patients should avoid strenuous activity, smoking, and eating hard foods. Patients should not touch the treatment area with their tongue, or use straws, as this could potentially dislodge the developing blood clots and expose the area to food and bacteria.

Wisdom tooth extraction can be an uncomplicated procedure that ultimately will protect your long-term oral health. For more information about wisdom tooth extraction, schedule your consultation at The Christiana Center for Oral & Maxillofacial Surgery P.A. today!

Little Medium Big Bone Grafts

'bone graft' 'bone tissue'

Bone grafting is a straightforward procedure that is immensely beneficial for numerous reasons. In the instance of a missing tooth (or teeth), the jaw bone can begin to slowly degrade. The jaw bone is holds teeth in place, and once a tooth is no longer present, the bone doesn’t have anything to support. There are different types of bone grafts, and depending on your situation. Outlined below are several different types of bone grafts:

Little Bone Graft

In the case of a simple, single lost tooth, the ideal course of action is to not lose excess bone. In this process, sterile, demineralized human bone granules are packed into the tooth socket immediately after tooth extraction. This procedure is very simple, and does not add anything to your recovery time. Over the next several weeks, your own bone will fill the tooth socket and preserve the bone height enough for you to have the area restored.

Medium Bone Grafts

If a tooth was removed a long time ago, there is likely to already be some bone loss impeding the restoration of the area. In this case, the area of the missing tooth is opened with a small incision, the bone surface is prepared, and demineralized bone graft granules are used to build up the area. Many surgeons prefer to use a little bit of the patient’s own bone in this procedure in order to ensure the best results possible. If your own bone is used, your surgeon will take it from another area of the jaw bone, usually near the wisdom tooth area, shaving off tiny granules and combining them with the demineralized bone. The bone graft will heal and integrate with the surrounding bone tissue. This type of graft can be used for one or multiple areas of missing teeth.

Big Bone Graft

Patients who have many missing teeth and who have been missing many teeth for many years, have often experienced advanced bone loss. In those who wear dentures, the lower jaw bone often recedes so severely that they can no longer wear them. Extensive bone grafting is necessary in order to consider restorative methods. A combination of demineralized, sterile human bone and the patient’s own bone is used to restore the jaw bone, creating enough width and height to consider dental implants. The patient’s bone is supplied by another part of the jaw, hip, or tibia. Bone granules are also used to enhance and strengthen the graft.

Bone grafting is a surgical procedure that takes time. However, it plays an essential role in making new teeth possible, and will ultimately be a positive process! For more information, call 302-292-1600 today for a consultation with The Christiana Center for Oral & Maxillofacial Surgery P.A.

Dental Implant Recovery

dental implants

Dental implants, titanium posts that are placed within your jawbone, are an excellent option for restoring missing teeth. The process of getting dental implants typically takes a few appointments over the span of several months, and since the strength of dental implants comes from their fusion with the jawbone, proper healing from this surgery is absolutely essential. Here are some tips for a speedy and well-healed recovery!

Prepare

One of the best ways to promote a speedy recovery is to properly prepare for dental implant placement. Get ready for your procedure by:

  • Getting plenty of sleep
  • Avoiding smoking or drinking excessively
  • Maintain your oral health! Brush twice a day and floss once a day!
  • Arrange for someone to drive you to and from your procedure
  • Plan to take some time off work so you can really focus on resting and recovering
  • Pick up post-surgical prescriptions, gauze, cold compresses, and any other supplies
  • Ask for a recovery timeline
  • Getting ready before your dental implant surgery can make a huge difference in the recovery afterwards!

Recovery Time Factors

Recovery time for the dental implants procedure depends on several factors. While each patient’s case is slightly different, these following factors are the main contributors to healing time:

  • The number of implants: Having a single implant may take less recovery time than multiple implant placement.
  • Whether or not you require preparatory procedures such as bone grafting
  • Your oral and overall health: the healthier you are, the easier it will be for you to heal quickly.
  • Your oral surgeon will explain your unique estimated recovery time based on these and other factors at your initial consultation.

After Your Surgery

After the procedure, the healing process can be sped up through:

  • Biting down on gauze to staunch the bleeding
  • Avoiding any activity that could put pressure on your mouth
  • Taking proper prescribed medication
  • Eating soft foods and avoiding chewing near the treatment area
  • Rinsing your mouth with warm saltwater between meals
  • Using a cold compress to reduce swelling
  • Gently retaining oral health routines like brushing and flossing
  • Following these guidelines, you will be able to heal comfortably and successfully!

To learn more about this treatment, or schedule a consultation, call 302-292-1600 and come see us at The Christiana Center for Oral & Maxillofacial Surgery P.A. today!

Learning the Lingo – Dental Implants

Dental implants are a safe and effective replacement for a missing tooth or teeth. The implant is placed in your jawbone and integrates with your natural bone. This implant then forms a stable, sturdy base for your new teeth. dental implant

What They Are

Implant: The implant itself is a rod that is screwed into the jawbone.

Abutment: This is the connection between the implant and the crown.

Crown: A tooth shaped cap that is attached to the abutment. It is the part of the tooth that is visible above the gum line.

What They’re Made Of

Titanium: Most implants are typically made of titanium, a biocompatible metal.

Zirconia: Often used for crowns and bridges and can be used as a metal-free option. Zirconia is biocompatible just like titanium.

Where They Go

Endosteal Implants: Placed in the jawbone. These implants are typically shaped like small screws, cylinders or plates, and they are the most commonly used.

Subperiosteal Implants: Placed under the gum, but on or above the jawbone. These implants are mostly for people with smaller jaws or shallow jawbones.

What Happens To Them

Osseointegration: Creates strength and durability by fusing directly to the bone and is bio-compatible. Bone cells attach themselves directly to the titanium/zirconium surface, essentially locking the implant into the jaw bone. Osseointegrated implants can then be used to support prosthetic tooth replacements of various designs and functionality. Anything from a single tooth, to all teeth in the upper and lower jaws. The teeth/crowns are usually made to match the enamel color of the existing teeth to create a natural appearance.

Bone augmentation: Some people do not have enough healthy bone to support dental implants, so bone must be built. Procedures can include bone-grafting which means adding bone to the jaw.

Talk to us today at The Christiana Center for Oral & Maxillofacial Surgery P.A. to discuss your options with an implant specialist!