Wisdom teeth are the last teeth in the mouth to develop. Approximately 15% of people have enough room in the jaws and mouth for the wisdom teeth to grow in properly. The remaining 85% of people generally do not have enough space for the teeth to grow in and become fully functional. Due to the possibility of problems arising from the inability of these teeth to grow in to a functional and hygienic position, many people require the removal of these teeth. These teeth have a tendency to become impacted (stuck either partially under the gum tissue or completely covered), and are a risk factor for infections, decay resulting in damage to the wisdom tooth or the adjacent tooth, pain and possibly pathology (cysts and rarely tumours).
The recommendation as to whether or not to remove or monitor them is based upon both radiographic (x-ray) and clinical evaluations. The age and health of the individual is also a factor. Your Oral and Maxillofacial Surgeon will assess your situation and advise you as to the benefits of removal or retention of your wisdom teeth.
Should you need to have the tooth/teeth removed, your surgeon will review the options available to you regarding anesthesia. These recommendations will be based upon many factors including your health, degree of difficulty of the procedure and likelihood of being able to achieve adequate local anaesthesia (sometimes difficult in the presence of an active infection).
There are generally four types of anesthesia contemplated, local anesthesia – commonly used in a dental office to “freeze” the tooth, sedation and local anesthesia – with nitrous oxide or sedative pills, or intravenous sedation or general anaesthesia. With intravenous sedation a combination of medications are used to relax a patient during the procedure. This combination of medications frequently includes a valium like medication in combination with a narcotic or codeine like medication on occasion supplemented with nitrous oxide (laughing gas). General anesthesia is used to put patients “to sleep” during the procedure. The choice of anesthetic technique will be discussed with you during your consultation with your surgeon.
Dental Implant surgery has become a routine procedure since it was introduced in North America in 1979. For the majority of patients, this procedure has become the welcomed and long awaited “3rd Set of Teeth”
In preparation for implant treatment, patients generally require a separate consultation appointment prior to the surgical procedure. This appointment gives us the opportunity to evaluate the sites contemplated and to co-ordinate your care with your dentist.
There are generally 2 aspects to dental implant restorations; surgical and prosthetic. The surgical aspect is where we come in to the picture. Our role is to provide the dentist with a base upon which to secure a prosthesis, either fixed (not removable) or removable. Our role is in the planning and placement of the implant fixture and healing abutment. Your dentist will, once the implant is solid, place a crown, bridge or denture over the implant/s. We will work with your dentist to develop a proposed course of treatment prior to the placement of an implant. Depending upon the complexity of the individual’s problem, the “work-up” phase may be very quick, (1 pre-operative appointment) or may require additional study and preparation. Some patients do not have adequate bone to support an implant. These patients may require some form of bone grafting either prior to or at the same time as the placement of the implant. If you are one of these people, you will be advised at the initial appointment of this concern. The types of grafts are quite varied and include bone from various sources. They are known as autogenous bone (your own bone), cadaveric or allogenic bone (from another person) or bovine (cow sourced) bone. Other materials such as “synthetic bone” or absorbable membranes are sometimes used. If necessary, these treatments will be reviewed in detail with you directly.
There are also many different options with regard to implant type, placement and prosthesis design. These will be reviewed with you at your consultation. For more detailed information regarding implants in general, please use the links below.
Orthognathic (Jaw) Surgery
Corrective jaw, or Orthognathic Surgery is the group of surgeries used to correct minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. Most of these surgeries are performed in a hospital setting and require an overnight stay. This type of surgery is usually done in conjunction with an Orthodontist and may require braces or Invisalign ® trays.
These surgeries are designed to improve function, chewing, speaking and breathing. The patient’s appearance may be enhanced as a result of this type of surgery, however, orthognathic surgery is performed primarily to correct functional problems.
– Difficulty chewing, or biting food
– Difficulty swallowing
– Excessive wear of the teeth
– Open bite (space between the upper and lower teeth when the mouth is closed)
– Unbalanced facial appearance from the front, or side
– Facial injury
– Birth defects
– Receding lower jaw and chin
– Protruding jaw
– Inability to make the lips meet without straining
– Chronic mouth breathing
– Sleep apnea (breathing problems when sleeping, including snoring)
Your dentist, orthodontist and Surgeon will work together to determine whether you are a candidate for corrective jaw, or orthognathic surgery
The orthodontist and the Oral Surgeon generally determine which corrective jaw surgical procedure is appropriate. It is important to understand that your treatment, which will probably include orthodontics before and after surgery, may take several years to complete. This is a long-term commitment for you and for many of our patients, their families. We strive to provide our patients with realistic goals and timelines. Treatment of this type by nature is dynamic and on occasion requires reassessment during treatment to assess an individual’s response to care.
Oral Medicine and Pathology
Oral Medicine and Oral Pathology is the branch and specialty of dentistry concerned with the diagnosis, nature and management of oral, maxillofacial, and temporomandibular diseases and disorders, including dental management of patients with medical complications.We treat most benign lesions in our practice however, oral cancers and large or aggressive benign tumors will be referred to a teaching hospital for management.
If you suspect you have an oral lesion requiring assessment or your dentist has found a lesion, it is important to have it assessed. You can call our office directly to arrange an examination and consultation appointment. We will frequently consider a biopsy on the consultation date if it is convenient for the patient or urgent from our perspective. Most of the time the procedure can be done under a local anesthetic in our offices.
Our goal is to provide all our patients with a safe and comfortable experience. All of the surgeons are registered with the RCDS(O) and trained to provide general anesthesia in an office setting. As such, our offices are registered with the Royal College of Dental Surgeons of Ontario to provide general anesthesia services to those patients who are candidates for outpatient office anesthesia. Patients who are not candidates for office anesthesia can consider the option of hospital care with us. We employ the full scope of anesthesia services from local anesthesia, local with sedation – and intravenous, and general anesthesia.
We understand that the thought of surgery can prove to be frightening. We believe that our nurses are a very important part of your experience and they are proud of their skills, accomplishments but most importantly, their commitment to your comfort and well-being. They bring experience from operating rooms, intensive care units, emergency rooms, surgical floors and community care and are all very experienced in our type of care. We are trained in Advanced Cardiac Life Support (ACLS). There is always a dedicated recovery room nurse to look after our patients after sedations or anesthesia.
For information regarding preparation and instructions regarding anesthesia, please see the section “Office Forms and Instructions” – “Preparation for Anesthesia”.
Temporary Anchorage Devices for Orthodontics
TAD’s or Temporary Anchorage Devices are a group of devices that are either screws or screws and plates that are placed into the jaws to provide extra anchor points for orthodontist to use in order to move teeth. As the name implies they are temporary and are removed after the orthodontist is finished using them, or at times, when they loosen.
These devices can commonly be placed in the office setting with a local anesthetic only as it is usually a minor procedure to place them.
The most common use for these devices is to assist the orthodontist in closing a space between teeth or correcting the position of a tooth that is far out of position. One area of active interest is in the use of these devices to close a gap between front teeth, known as an ANTERIOR OPEN BITE DEFORMITY. The use of this device in these cases is still an area of active research and shows promise. If successful in closing an open bite, patients may be able to avoid major corrective jaw surgery.
Our Oral and Maxillofacial Surgeons are experienced with this type of treatment and work with your orthodontist to determine whether you are a candidate for this type of treatment.
IF YOUR TOOTH HAS BEEN KNOCKED OUT and IF YOU CAN FIND THE TOOTH – CLEAN IT OFF and REPLACE IT IN THE SOCKET within 30-60 minutes if possible.
FOR MORE INFORMATION: please see guidelines from Sick Kids Hospital below:
All of our surgeons have had extensive training in Facial Trauma Management and cover “on-call” responsibilities at our affiliated hospitals on a rotation basis. Treatment for traumatic injuries may either be scheduled in our out patient facilities or a hospital settings as may be required. Follow up is typically through our offices.
PLEASE NOTE: If you are seriously injured, GO TO your NEAREST HOSPITAL for care.
Extraction of Teeth and Preprosthetic Surgery
Although most patients who see us for the removal of teeth or preprosthetic surgery have been referred for treatment, we are available to see patients without a referral.
During the consultation phase of your care, you will be examined and any necessary radiographs will be taken or arranged. The details of your procedure will be outlined for you as well as your options and alternatives including anesthetic choices. Depending upon the procedure, patients will be advised regarding the average length of time required to recuperated and anticipated time off work or school activities.
In general, most minor procedures can be completed in our office setting but more advanced or complicated procedures may need to be booked in hospital. We will review those options with you and if necessary, co-ordinate your care with both the hospitals and your dentist.
Our offices are equipped with the capability to take routine dental radiographs, Panoramic views, and Cephalograms in Toronto and Oshawa.
All Our CBCT scans are read reviewed in the office and then reported on by a Dental Radiologist.