Our Oral Surgery Services

Extraction of Wisdom Teeth

Wisdom teeth or third molar teeth are the last teeth to erupt in to the mouth. There are normally four wisdom teeth, one at the back of each of the four corners of the mouth, behind the last adult tooth. Some people can develop less than four wisdom teeth and occasionally others can develop more than four. These would normally erupt between the ages of 8-24.

There needs to be enough space for the wisdom teeth to erupt or get in to the mouth. A wisdom tooth can fail to erupt properly in. to mouthing become stuck, either under the gum or as it pushes through the gum – this is referred to as an impacted wisdom tooth. Sometimes the wisdom tooth will not become impacted and and will erupt and function normally, if there is enough space in the mouth. Both impacted and non-impacted wisdom teeth can cause problems for people, such as pain and swelling, however other wisdom teeth may have no symptoms all but will still cause problems in the mouth. People often develop problems soon after their wisdom teeth erupt bu others may not cause problems until later on in life.

Wisdom teeth are a the back of the mouth and can be difficult to clean. This can lead to a number of problems the most common of which are:

Infection of the gum around the wisdom tooth (pericoronitis). This occurs in 50-60% of patients that we see and is the most common reason why wisdom teeth are removed. This type of infection can be severe and cause pain and swelling, however sometimes symptoms are mild.

Tooth decay (dental caries) can occur in the wisdom tooth or the tooth in front. We see this in 25-30% of patients. This may not cause immediate problems un til the tooth decay affects the nerve of the tooth, then an abscess can form. Toothache will be a feature of this.

Wisdom teeth can be affected by gum disease (periodontal disease) or contribute to gum disease on the tooth in front (5-10% off patients we see). Patients may not get any symptoms but it can still cause problems.

Cyst formation around the wisdom tooth. All teeth form within a sac called a follicle and occasionally this can expand like a balloon. This is called a cyst and over time it can become larger and cause problems. We see this in less than 1% of patients.

These are the most common reason why wisdom teeth may bereaved. There are other reasons and your surgeon will discuss these with you if required.

Dental Implants

Dental implants are metal anchors put inside the jawbone underneath the gumline. Small posts are attached to the implants, and artificial teeth or dentures are fastened to the posts.  Most patients need two surgical procedures to install the implants. The first procedure involves drilling small holes into the jawbone and placing the anchors. A temporary denture may be worn for a few months while the anchors bond with the jawbone and the gums and bone heal.

The second procedure will uncover the implants to allow for attachment of the posts. After the posts are in place, the replacement teeth, in the form of a fixed or removable bridgework or denture, are fastened to the posts. Depending upon the condition of the mouth, bone grafting or guided tissue regeneration may also be necessary to install the anchors and posts. The potential benefits of this procedure include the replacement of missing natural teeth or supporting dentures. For more information on Dental Implants click here.

Apicectomy

When a tooth is badly decayed, has a large filling or receives a blow, for example, in an accident, the soft tissues within it (the pulp) may die. This dead tissue must be removed to prevent infection and this is undertaken by a procedure called root canal treatment. Sometimes, this treatment is unsuccessful or not possible and the infection persists at the tip of the root. This may sometimes cause pain and may also result in discharge of pus from the gum above the tooth which is sometimes called a gumboil.

An apicectomy is the operation designed to remove this infected part of the root tip. It gives an alternative to having the tooth extracted or where it will prove difficult to try and redo the root filling. It is a minor surgical procedure to remove the top of the root of a dead tooth and then seal the end with a filling.

Sinus Lift

A sinus lift is surgery that adds bone to your upper jaw in the area of your molars and premolars. It’s sometimes called a sinus augmentation. The bone is added between your jaw and the maxillary sinuses, which are on either side of your nose. To make room for the bone, the sinus membrane has to be moved upward, or “lifted.” A sinus lift is done when there is not enough bone height in the upper jaw, or the sinuses are too close to the jaw, for dental implants to be placed.

Jaw Joint Problems

The temporomandibular joint (jaw joint) is located infant of the ear where the skull and the bottom jaw meet. It allows the lower jaw to function. The joint itself is made up of two bones that are separated by a disc of cartilage. Ligaments and muscles surround the joint. Problems with the jaw joint are very common but typically only last a few months before getting better.In some cases only the muscles are affected (myofacial pain dysfunction) whereas in others the cartilages and ligaments may also be at fault (internal derangement). The most common symptoms are :

• Joint noises – such as clicking, cracking, crunching, popping, grating
• Pain – usually a dull ache in and around the ear, which may radiate along the cheekbone or downwards in to the neck
• Headache
• Limited mouth opening

Most jaw joint problems are made worse by chewing and are aggravated at times of stress.

Treatments vary depending on whether you are suffering from myofacial pain dysfunction, internal derangement or a combination of both. On the whole treatment is aimed at trying to reduce the workload of the muscles so allowing the disc of cartilage to return to a normal position in the joint.

• A soft dit that requires little chewing  – allows the overworked muscles to rest
• Painkillers – anti-inflammatory medication (eg Nurofen) is good and can be taken either as tablets or applied as a gel on the outside of the joint
• Heat – eg warm water in a hot water bottle wrapped in a towel applied to the outside of the face
• Identifying and stopping habits, which may be subconscious, such as clenching or grinding
• Relaxation therapy and learning techniques to control tension and stress
• Jaw relaxation exercises which will be discussed by the doctor treating you
• Resting the joint as much as possible such as stifled yawns and supporting the jaw when laughing
• Wearing a clear plastic splint that fits over the teeth and is worn mainly at night. This helps support the joint and the surrounding muscles
• Physiotherapy
• Replacing missing teeth to balance the bite

Surgery is only carried out in a small number of cases. This can involve manipulation of the joint whilst you are asleep, wash out of the affected joint (arthrocentesis), using a mini telescope (arthroscopy). In extreme cases it may be necessary to open the joint  and operate on the bones, cartilages and ligaments.

It is important to realise that jaw joint problems, although a nuisance , are not sinister and usually respond to relatively simple measures over a period of time. Patients themselves can manage most of these treatments. Occasionally jaw joint problems can return after several years. It is very rare for jaw joint problems to progress to arthritis.

Mouth Cancer

Mouth cancer can develop in most parts of the mouth, including the lips, gum, tongue, floor of mouth, roof of mouth and occasionally the throat. It is the sixth most common cancer in the world but it’s much less common in the UK. Around 6800 people are diagnosed with mouth cancer each year in the UK, which is about 2% of all cancers diagnosed. Most mouth cancers occur in order adults aged 50-74. Only 1 in 8 (12.5%) cases affect people younger than 50. The most common causes are smoking  or drinking excess alcohol (more than 14 units per week). Smoking and drinking is a particularly lethal combination and multiplies the risk of developing mouth cancer. Mouth cancer can occur in younger adults. HPV infection is thought to be associated with the majority of cases that occur in younger people. Cancer of the mouth is also more common in men than in women. this may be because eon average men tend to drink more alcohol than women.

The most common symptoms are:

• sore mouth ulcers that don’t heal within several weeks
• unexplained persistent lumps in the mouth that won’t go away
• unexplained persistent lumps in the lymph glands in the neck that won’t go away

Other symptoms may include:

• pain or difficulty when swallowing (dysphagia)
• changes in your voice or speech problems
• unexplained weight loss
• bleeding or numbness in the mouth
• a tooth to teeth that become loose for no obvious reason, or a tooth socket that doesn’t heal
• red or white patches on the lining of the mouth – these are common and are very rarely cancerous, but they can sometimes turn in to mouth cancer, so it’s worth seeing a specialist if you have them

Many of the above symptoms can be caused by less serious conditions, such as minor infections. However, it is strongly recommended that you see the GP or dentist if any of the above symptoms have lasted longer than 3 weeks. It is particularly important to seek medical advice if you drink or smoke regularly.

Neck Lumps

Most neck lumps are enlarged lymph nodes. Sometimes the lump is a congenital cyst, an enlarged salivary gland, or an enraged thyroid gland.

The most common causes of enlarged lymph nodes include the following:

• reaction to nearby infection (such as a cold, sore throat or dental infection)
• direct bacterial infection of a lymph node
• certain bodywide (systemic) infections

One or more neck lymph nodes often enlarge in response to an upper airways respiratory infection, throat infection or dental infection. These nodes are soft, contender, and typically return to normal shortly after the infection goes away.

Sometimes, bacteria can directly affect a lymph node which is called lymphadenitis. Such infected lymph nodes are quite tender to touch.

Certain systemic infections typically cause multiple lymph nodes to enlarge, including some in the neck.

A much less common bur more serious cause is cancer.

If you are concerned that you have a lump in the neck for more than 3 weeks you should be assessed by our specialist oral and maxillofacial surgeon or see your GP who will refer your appropriately.

Skin Cancer

The commonest skin cancer is basal cell carcinoma (BCC). It accounts for more than 80% of all skin cancer in the UK. It is sometimes called a ‘rodent ulcer’. The commonest cause is too much exposure to ultraviolet (UV) light from the sun or from sun beds. BCCs can occur anywhere on your body, but are most common on areas that are exposed to the sun, such asa your face, head, neck and ears. It is also possible for BCCs to develop where burns, scars or ulcers have damaged the skin. BCCs are not infections.

BCCs mainly affect fair-skinned adults ands are more common in men than women. Those with the highest risk of developing BCCs are :

• people with freckles or with pale skin and blond or red hair
• those who have had a lot of exposure to the sun, such as people with outdoor hobbies or those who work out doors, people who have lived in sunny climates
• people who use stun beds
• people who have previously had a BCC

Apart from a rare familial condition called Gorlin’s syndrome, BCCs are not hereditary. However some of the things that increase the risk of getting one (eg fear skin, a tendency to burn rather than tan, and freckling) do run in families.

Most BCCs are painless. People often first become aware of them as a scab that bleeds occasionally and does not heal completely. Some BCCs are very superficial and look like  a scaly red flat mark; other have a pearl-like rim surrounding a central crater. If left for years the latter type can eventually erode the skin causing an ulcer, hence the name “rodent ulcer”. Other BCCs are quite lumpy, with one or more shiny nodules crossed by small bur easily seen blood vessels.

Sometimes the diagnosis s clear from the appearance. Sometimes a small area of the abnormal skin (an incision biopsy) our all of the lesion (an excision biopsy) may be cut out under local anaesthetic and examined under the microscope.

BCCs can be cured in almost every case, although treatment becomes complicated if they have been neglected for a very long time, or if they are in an awkward place – such as near the eye, nose or ear. Seldom, if ever doe they spread to other parts of the body.

Other less common skin cancers are squamous cell carcinomas and melanomas.

If you suspect that you have a skin cancer on your head and neck, the OMF surgeon will be pleased to assess and advise you.

Trigeminal Neuralgia

Trigeminal neuralgia (TN) is an extremely severe facial pain that tends to come and unpredictably in sudden shock-like attacks. The pain is normally triggered, for example by light touch, and is described as stabbing, shooting, excruciating or burning. It usually lasts for a few seconds but there can be many bursts of pain in quick succession.

The trigeminal nerve is the fifth cranial nerve and its function is to send pin messages to the brain. When the nerve malfunctions pain messages are sent at inappropriate times and the pain can be of great severity.In fact TN is regarded as the most painful condition that is known in the medical world.

The pains are variously described as a strong electric shock shooting through the face, or very intense sensations of stabbing and burning. TN affects more women than men and the pains are normally felt on one side of the face only, generally the right hand side.The majority of people affected are over 50 years of age, although young adults, and very rarely children can also be affected.

The trigeminal nerve has three branches (or divisions) on each side of the face:

• Ophthalmic branch which runs above the eye, forehead and front of the head
• Maxillary branch which runs through he cheek, upper jaw, teeth and gums, and to the side of the nose
• Mandibular branch which runs through the lower jaw, teeth and gums.
• The pain can result from one or more branches but the middle and lower branches are most frequently affected.

More research still needs to be undertaken in to TN but the transmission of abnormal messages of pain often appears to result from damage to the protective coating  (myelin sheath) around the trigeminal nerve. There are several possible causes of damage, including pressure from blood vessels or arteries, and very rarely, tumours or multiple sclerosis.

There is no diagnostic test for TN, so the patient’s description of the pattern and nature of the pains is vitally important when it comes to getting an accurate diagnosis. An MRI scan may show a compression of the trigeminal nerve by a blood vessel but even if no compression is visible, the cause of the pain may still be TN.

Anticonvulsant drugs are normally prescribed for people with TN and there are also a number off operations which can offer relief. However, unless the diagnosis is classic TN, surgical procedures may make the pain far worse

Burning Mouth Syndrome

Burning mouth syndrome (BMS) is the name given to discomfort or pain in the mouth. It often affects the tongue, lips and cheeks but the parts of the lining of the mouth can also feel uncomfortable. Most people with the condition complain of a burning or scalded feeling.

BMS is a common condition. It often affects women, particularly after the menopause, but men can sometimes get it too. Up to one in three older women report noticing a burning sensation in their mouth.

The sensation of burning in the mouth can occasionally be the result of medical or dental problems. These include thrush infection and blood or vitamin deficiencies.

The hormonal changes around the menopause can be related to BMS. it can also occur or get worse when somebody is stressed, anxious or depressed, or going through a difficult time of life. Not knowing why your mouth is burning can also make you vey anxious.

If you describe a burning sensation in your mouth you will be examined thoroughly to make sure another medical or dental cause is not responsible and some blood tests may be arranged.

Sometimes people get worried that they might have mouth cancer. This is quite a common anxiety of people with BMS. Carrying out a thorough examination and any necessary tests will enable the specialist to reassure you that all is normal with no sign of cancer.

Hormone replacement therapy has not been shown to improve the symptoms, and neither have vitamins, if your blood tests are normal. Symptoms often improve following reassurance that there is no serious disease present in the mouth. The burning feeling can sometimes be worse at times of stress and go away when life is running more smoothly.

In the sea way that low doses of antidepressants can help patients with neuralgia even if they are not depressed, sometimes low doses of antidepressants can relieve the symptoms of BMS.

We know that we can’t always make you better. Trying not to focus on the feeling, learning to live with the sensation and remembering that no serious disease has been found can sometimes be the best way of managing this common problem.

Lichen Planus

Lichen planus is an inflammatory condition that can affect the lining of the mouth as well as skin. The cause is not fully understood. It is common and affects top to 2% of the population. It is most frequent in middle age and women are affected slightly more frequently than men. Although there is no known cure treatment can be given to make the symptoms better.

In the mouth lichen planus is usually found on the inside of the cheeks and fin the side of the tongue although It can also affect the gums and roof of mouth. Usually lichen planus has a lace-like pattern of streaky white patches that occasionally can be thickened. Often the patches are symmetrical, ie affect the same site on different sides of the mouth. Sometimes lichen planus can be associated with red patches or sores.

• It is not cancer.
• It is not inherited, ie passed on from your parents.
• It is not contagious, ie you cannot “catch it” from someone who has it or give to someone else.
• It is not related to nutrition although some foods you eat can Mae he patches of lichen planus sore.

The appearance of lichen planus is usually typical and can be diagnosed by an experienced doctor just looking inside your mouth. The diagnosis can sometimes require conformation with a biopsy (ie removal of a small amount of tissue which can then be examined under a microscope).

If lichen planus is not causing you any problems it does not require treatment although you may be kept a close eye on. If lichen planus is causing you problems such as soreness treatment can be given to lessen the symptoms. Usually these are given directly (topically) to the affected areas rather than having to take tablets to swallow.

• You may find it helpful to keep a diary and look for trigger events if you have a flare-up of symptoms. These flare-ups may be related to particular foods, stress or local trauma.
• You may find it useful to change to a milder form of toothpaste. It is important to maintain good hygiene in the mouth.
• Some lichen planus can be related to amalgam (metal fillings). If this is the case it may be suggested that a filling is replaced.
• Some people suffer for only a few months before their symptoms settle down. Others may suffer for several years. Once the symptoms disappear they may or may not return at a later date.

Recurrent Oral Ulceration

Recurrent oral ulceration (ROU) is a term used to describe small mouth ulcers which typically last a few days but come back every few weeks or months. Typically they affect the tongue, lips and cheeks, but any part of the mouth can get ulcers. They are very common, often starting in childhood. About two in every three people will have been affected with ROU at some time in their lives.

Although the cause of the most common type of ROU is unknown there are lots of reasons why people can get other types of ulcers in their mouths. Some ulcers can be relayed to low levels of iron or vitamins in the blood. Rarely, ulcers can be associated with skin or stomach problems.

the specialist will ask you about your general health and ask you questions about whether you have noticed any problems with your skin or stomach. You will also be asked if you have noticed ulcers anywhere else on your body.

If you have ulcers, blood tests are usually taken to check if they are the result of another medical condition. However the majority of people with mouth ulcers have completely normal blood tests.

Because mouth ulcers are so common their treatment has been studied by lots of scientists. there are a wide variety of treatments available all of which probably make the ulcers goo away more quickly and feel less painful but do not prevent the next crop of ulcers from occurring. Mouthwashes (such as Corsodyl, Difflam) can be used. Similarly weak steroids in the form of pastes, dissolving tablets or mouthwashes can sometimes help.

They are not infectious and cannot be passed on to others.

ROU often gets better with age. We are not sure why but people often grow out of their mouth ulcers by their 30s for 40s. However they can disappear sooner or carry on later in some people.

Dry Mouth

It’s normal to occasionally have a dry mouth if you are feeling dehydrated or feeling nervous, but persistently dry mouth can be a sign of an underlying problem. Thou should see your dentist or GP if you have an unusually dry mouth (known as xerostomia) so they can try to determine the cause.

A dry mouth can issue when the salivary glands in your mouth and neck don’t produce enough saliva.

This is often the result of dehydration, which means you don ‘t have enough fluid in your body to produce the saliva you need. It’s also common for your mouth to become dry if you’re feeling anxious or nervous.

A dry mouth can sometimes be caused by an underlying problem or medical condition, such as:

• medication – many different drugs can cause a dry mouth, including antidepressants, antihistamines and diuretics
• a blocked nose – breathing through your mouth while you sleep can cause it to dry out
• diabetes – in this condition a person’s blood sugar level becomes too high
• radiotherapy to the head and neck – this damages the salivary glands so that they don’t produce sufficient saliva
• Sjogren’s syndrome – a condition where the immune system attacks and damages the salivary glands

If you see your dentist or GP, let them know about any other symptoms that you are experiencing and any treatments you are having, as this will help the to work out why your mouth is dry.