Oral surgery

What is oral surgery?

Oral surgery is the branch of odontology that encompasses all surgical procedures carried out in the oral cavity performed by an oral surgeon.

It is necessary to differentiate between oral surgeons and maxillo-facial surgeons. The latter, aside from performing all surgery required within the oral cavity, procedures conducted by the oral surgeon, also carries out all possible surgery required on the face and neck. Of note within this type of surgery is the surgical repositioning of the jaw or the removal of tumours.

Oral surgery focuses on the specific pathology of the teeth and the surrounding tissue, with teeth extraction being the most usual procedure. The fitting of dental implants is also a highly common procedure within the specialism of oral surgery, and both maxillo-facial surgeons and dental surgeons are trained to fit them.

Oral surgery types and techniques

Below is a detail of oral surgery procedures and techniques.

Teeth removal

The most common procedures and types of oral surgery are teeth extractions, both simple and surgical, and wisdom and cordal tooth extractions.

• Simple extractions: Extraction is the simple action of removing a tooth that can be seen within the mouth. In the event of a simple extraction, the odontologist or oral surgeon uses an instrument known as a dental puller to dislocate the tooth. After that, the tooth is extracted using forceps.
• Surgical extractions: these are much more complex than simple extractions. Oral surgeons and maxillo-facial surgeons are those that normally carry out this type of procedure. However, general odontologists can also carry them out. It is necessary to make a small incision in the gum to surgically extract the cordal or wisdom tooth or broken tooth. Sometimes, it may be necessary to extract the bone around the tooth or to cut it in half to be able to remove it.
• Cordal tooth removals: wisdom teeth, third molars or cordals are permanent teeth located in the furthest part of the mouth, both above and below. They usually emerge between the ages of 17 and 25. When wisdom teeth have no space to grow, they can have an impact and cause pain, oral infections or other dental problems. Odontologists often suggest that they be removed.

Apicoectomy

Among other types of oral surgery, the apicoectomy refers to oral surgery to eliminate an infection affecting the root of a tooth or the tissue of the adjoining area. It is an alternative solution to the removal of the tooth, although it is not indicated for any type of infection and the specialist will determine when this option is recommended.

This oral surgery consists of opening the gum, withdrawing the affected part of the root (tip), sealing the root duct with different materials and stitching it up. The operation is easy and the post-operation does not require great care, except to maximise the hygiene measures and to adapt the patient’s diet for a few days. The total regeneration of the area involved is achieved in 2-3 months.

Gingivectomy

Gingivectomy is a type of oral surgery related to the appearance of different illnesses affecting the gums, such as gingivitis, pulpitis or periodontitis. Consists of the removal of part of the tissue and the subsequent reconstruction of the area. It is most frequently used to remove periodontal pockets, but on occasions a gingivectomy is also used for purely aesthetic reasons, generally in patients that need to have the size of the gums surrounding their teeth reduced.

Other surgical procedures performed by oral surgeons are phrenectomies and fenestrations.

• Oral phrenectomy: refers to the procedure in which the tissue attached to the body is cut or modified, such as labial or lingual frenula. In the mouth, the frenulum refers to a piece of soft tissue that connects the lips to the gum or the bottom of the mouth with the tongue. The labial frenulum connects the top lip with the area of the gums just above the front teeth. If this frenelum is shorter than normal, it may cause speaking difficulties. This condition is a type of labial adherence. Lip adherence can also cause a problem with teeth development and make it difficult to fully clean gums and front teeth. This increases the risk of gum disease and other dental complications. The maxillary frenectomy may provide greater mobility to the top lip.  The lingual frenulum links the bottom of the mouth to the base of the tongue. If this frenelum is too short, it limits the movement of the tongue, and may interfere in breast feeding, swallowing or speech development as the child grows. The lingual frenectomy is a quick procedure that grants the tongue a wider range of movement.
• Dental fenestration: fenestration is the surgical exposure of the affected tooth, which is indicated when the tooth does not erupt spontaneously after creating sufficient space in the arch.

Mostly the procedures encompassed within oral surgery are outpatient procedures and normal activity can generally be recommenced immediately. It is the case of the fitting of implants and post-operation.

Benefits of oral surgery

Oral surgery is the most effective alternative to resolve problems and dysfunctions of the oral cavity when other treatments (orthodontics, root canal work or odontology) are not applicable or have not provided the expected outcome. These are simple operations performed with local anaesthetic, most of which are of an outpatient nature and involve a rapid recovery with minimum discomfort, whose effects provide a response to the expectations sought almost immediately. They also solve functional and aesthetic matters at the same time. It can be concluded that they provide a notable improvement in quality of life without having to suffer risks or significant discomfort.

It is an especially effective treatment to extract defective teeth and substitute them by implants or micro-implants, to eliminate pain or mouth infections, to improve the fitting of a prosthesis, among other situations. Following oral surgery, essential functions such as chewing, talking or breathing are improved, which have an effect of improved general well-being. And, on many occasions, they involve an increased self-esteem, especially when they resolve problems of an aesthetic nature or prevent the leading of a normal life. Without forgetting that most oral surgery is definitive, that is, it permanently resolves a problem.