Anesthesia Services

A lot of people get nervous to visit the dentist or an oral surgeon. That’s okay! Any doctor’s goal is to make you as comfortable as possible for any procedure you have. For Oral and Maxillofacial Surgeons (OMS), this includes doing procedures under sedation or anesthesia. There are a few different types of anesthesia that can be utilized for different purposes. 

Local anesthesia

Local anesthesia involves numbing a small specific area of the body, typically via a needle. This is used for minor surgical procedures and dental work. OMS use this procedure for biopsies, simple extractions, as well as stitches. The needle injection is applied directly to the target area. There is no loss of consciousness for this procedure, and the patient’s sensory factors to this area are blocked. 

Local anesthesia medications include drugs used to temporarily block nerve impulses to result in a loss of sensation. The most common medications used are Lidocaine, Mepivacaine, Bupivacaine, Articaine, and Procaine. Differences in these medications include onset of action (time taken to affect the area) and duration of affect.

Regional Anesthesia 

Regional Anesthesia involves numbing a specific area of the body, typically an area a lot larger than one numbed with local anesthesia. Typical use of regional anesthesia is for childbirth or to numb extremities in orthopedic surgeries. This anesthesia is an injection into the epidural space, around individual nerves (peripheral nerve blocks), or into the cerebrospinal fluid. Patients can remain awake for some general anesthesia procedures. OMS do not use regional anesthesia, but are trained on how to administer it.

Regional anesthesia medication typically includes a local anesthetic like those listed above, combined with an adjuvant or additive to enhance their effectiveness or prolong the duration of action. These adjuvants or additives can include epinephrine, clonidine, dexamethasone, and opioids. Specific medications are determined depending on factors such as the onset of action of the drugs, type and duration of the procedure, and the patient’s medical history and allergies.

General Anesthesia 

General anesthesia involves loss of both consciousness and sensation throughout the entire body. It can be administered through inhalation (breathing in gasses) or intravenously (through a vein). It is commonly used for major surgeries. OMS use general anesthesia for facial reconstructions, jaw reconstructive (orthognathic) surgery, TMJ procedures, as well as for young children who undergo oral surgery.

The medication involved in general anesthesia includes a combination of drugs to achieve muscle relaxation, unconsciousness, pain relief and amnesia. Intravenous medications can include Propofol, etomidate, and barbiturates; Inhalation medications can include sevoflurane, desflurane, and isoflurane; Other additives for general anesthesia to achieve neuromuscular blocks and pain relief include succinylcholine, non-depolarizing NMBAs, opioids, and benzodiazepines. 

Monitored Sedation 

Sedation is administering medications to induce a state of relaxation and decreased awareness without causing complete loss of consciousness. Often, it’s used in combination with local or regional anesthesia for minor procedures or tests. Sedation can range from minimal (light) to deep sedation depending on the procedure. Deep sedation allows for the patient to be nearly unconscious but still able to respond to stimulation. This is the most common type of anesthesia used in oral surgery.

Depending on the medical procedure and level of sedation will differentiate which drugs are used by your doctor. For minimal sedation, common medications include benzodiazepines and nitrous oxide (“laughing gas”); moderate sedation uses benzodiazepines and opioids; deep sedation uses Propofol, ketamine, and dexmedetomidine. 

Oral Surgery Sedation

Oral Surgeons are qualified to administer anesthesia services due to their 4 year Oral Surgery residency. This education is tailored to the needs of oral and maxillofacial surgery and allows for them to gain both academic education and hands-on experience. At Jackson Oral and Facial Surgery, all of our doctors are certified through the American Board of Oral and Maxillofacial Surgery (ABOMS) and hold licenses for anesthesia procedures through Tennessee Board of Dentistry.  

Every day, our surgeons at Jackson Oral and Facial Surgery use both monitored sedation and local anesthesia. In order to keep our patients as safe as they can be during surgery, not only are our doctors trained in anesthesia, but we use Registered Nurses (RN) to administer it. Having an RN in surgery allows the doctor to focus on the treatment while an RN is closely monitoring the vital signs and respiratory function of the patient. This is imperative to ensure patient safety and optimized treatment. Additionally, we use Certified Registered Nurse Anesthetists (CRNSs) to administer any general anesthesia services for larger surgeries when needed.

Every patient has differences in medical history, age, weight, and procedure complexity. All of these factors and more need to be considered by the healthcare provider administering treatment. We want to ensure that not only the procedure goes well, but also that the patient stays safe during surgery. 

Torus Mandibularis (mandibular or dental tori) are bone growths that develop on the roof or floor of your mouth, under your tongue . Tori growths are not dangerous, and do not cause pain. They vary in size and shape among individuals, and can be uncomfortable and inconvenient. Some people are born with them, and others develop it later in life. 

Typically benign and non-cancerous, Tori are usually asymptomatic and often discovered during dental examinations or imaging studies. Treatment of Tori isn’t necessary unless it interferes with your ability to eat or speak. 

Dental Tori can either be one growth or several, and vary in both number and size. It’s common to have growths on both sides of your mouth. Having Mandibular Tori is relatively uncommon, prevalent in about 27 out of every 1,000 adults in the US. 

Causes and Symptoms

The largest cause of Mandibular Tori comes from genetic and environmental factors. There is a genetic predisposition to developing tori, indicating that it is hereditary. Additionally, factors such as dietary habits, nutritional deficiencies, age and gender play a role. Although none of these factors have been firmly established as causes, they all play a role. 

Although a majority of Tori cases are discovered during a dental exam, you can still notice changes in your mouth when doing at home dental checks. 

Typical symptoms include:

• Noticing the growths themselves
• Difficulty chewing or swallowing
• Difficulty getting dental appliances to fit correctly (retainers, mouth guards, ot dentures)
• Food particles getting stuck in or around the growths
• Speech difficulty
• Inflammation of gums
• Loose teeth

Treatment 

The presence of tori alone does not necessarily indicate a need for treatment, but surgery by an Oral and Maxillofacial Surgeon (OMS) is recommended when tori growths start interfering with speech or life quality. Tori removal itself is simpler than other surgical procedures. Although complications are rare, infection and excessive bleeding can occur following the procedure.

Surgical treatment includes:

• Using IV sedation or a local anesthetic to keep the patient comfortable
• Making an incision using a scalpel through your gums overlying the tori to get access to it
• Remove the extra bone tissue and sand the area down with the help of dental instruments such as drills. 
• Rinse the area with a saline solution and disinfectant
• Use stitches to close the incision 

Recovery

It can take between 6-8 weeks to fully heal after tori removal. Many patients will experience some discomfort and swelling following their surgery, which can be treated with pain medication and ice packs. Other experiences include dry/chapped lips, and slight bleeding following the surgery. Post operative instructions include avoiding strenuous exercise, hard and crunchy foods, and using medications and a mouth rinse daily. As the weeks progress, your ability to eat and do more physical activity will increase. 

There is no way to prevent mandibular tori, so let your dentist know if you have suspicious of Mandibular tori and with early detection they can keep an eye on the growth to make sure they don’t cause any issues. Unfortunately even after surgical treatment, tori can grow back in some cases. Living with tori is possible as long as it doesn’t interfere with your function or quality of life.

To schedule a consultation with our doctors please Contact Us

When visiting a dentist or doing an oral examination, the discovery of a cyst or sore can be upsetting. If this happens to you, make an appointment with an Oral and Maxillofacial surgeon. Not all oral pathologies are cancerous, but a surgeon will be able to walk you through your next steps. If left untreated, some noncancerous pathologies can become cancerous down the road, or cause other oral health issues. 

Oral Pathology 

A pathology itself is the study of diseases and their causes. Oral Pathology is the branch of dentistry that deals with the study, diagnosis and management of diseases and conditions affecting the mouth and surrounding oral structures. This can include a wide range of conditions, including oral cancers, infectious diseases, autoimmune disorders, developmental abnormalities, and other conditions that might affect the oral cavity, jaws, salivary glands, or other related structures. 

Oral pathology diagnoses and plans treatment for these conditions using different techniques such as biopsies, imaging studies, and laboratory tests. 

Pathologies can also be discovered by doing a self-exam and looking for symptoms of oral cancer. Visit  Here to see possible symptoms of oral cancer.

While many pathologies can be benign, they can still increase the risk of cancer when going untreated. 

Oral Cancer

While certain oral pathologies can be precursors to cancer, you cannot rely on a diagnosis without a biopsy of the tissue. When discovering an abnormality or symptom of pathology, this is always your first step. Steps for a biopsy include numbing the area, removing a small piece of tissue and sending it to a lab to be tested. A specialist will use a microscope to examine the tissue for any signs of cancer cells.

There are 5 main types of oral cancers. These can all develop in various forms, affecting different parts of the mouth and oral cavity (inside the mouth or cancers of the lips). Each type of cancer is also named for the location it gets found in.

• Oral and oropharyngeal cancer
• Laryngeal and hypopharyngeal cancer
• Nasal cavity and paranasal sinus cancer
• Nasopharyngeal cancer
• Salivary gland cancer

To prevent issues with oral pathology or cancer, please keep an eye out for any symptoms you may develop. If you have any suspicious, please see an OMS as soon as you can. Get regular dental cleaning so your Dentist is able to keep an eye out for you as well. 

To make a pathology appointment please visit our Contact Us page.

Knowing when to visit a dentist is easy, but Oral Surgeons have a large range of specialty within the teeth world. Some dentists and oral surgeons offer similar services, but the trick to picking between them is choosing the provider who is most skilled and prepared to help you with your needs. Oral Surgeons are dental specialists that have the ability diagnose and surgically treat concerns related to your mouth, jaw and other oral structures. 

Let’s talk about the different training, education, and services between dentists and oral surgeons. 

Training

Both a general dentist and oral and maxillofacial surgeons attend dental school, but oral and maxillofacial surgeons have 4-6 years of additional specialty training beyond dental school. Some oral surgeons attend an integrated MD program where they obtain their MD (Medical Doctorate) in addition to their dental degree. Medical school is not required, but a four year hospital based residency training program is. 

This education teaches Oral Surgeons to treat both dental and medical issues. They are surgeons of the head, face, and neck, and are not limited to only treating dental procedures like other specialties. Additionally, surgeons who hold a Doctor of Medicine degree are able to diagnose and provide medical clearance for some health risk patients without the need of collaborating with other doctors. 

An Oral and Maxillofacial Surgeon (OMS) performs surgeries on the mouth, jaw and face. They are trained to diagnose issues and perform invasive procedures for possible treatment solutions.

Specific trainings include:

• Anesthesia training
• General surgery
• Plastic surgery
• Internal medicine
• Critical care medicine
• Pathology

Hands-on training include:

• Hospital settings
• Outpatient surgery centers
• Ambulatory surgery facilities
• Private offices

Education and Certifications

To recap, both Dentists and Oral Surgeons attend either a DDS or DMD program for dental school. DDS stands for Doctor of Dental Surgery; DMD can stand for Doctor of Medicine in Dentistry or Doctor of Dental Medicine. The Commision on Dental Accreditation (CODA) sets standards that are followed throughout the United States in both academic and clinical training of students. All DDS and DMD dental graduates must pass the same National Dental Board exams. 

OMS then have the option to go into Medical school, then the 4 year residency training, or just the residency training. After this training, Surgeons have the option to become board-certified by The American Board of Oral and Maxillofacial Surgery (ABOMS). This is a rigorous certification process that includes a maintenance program. 

For more information regarding this process, visit this site from the American Board of Oral and Maxillofacial Surgery:

https://www.aboms.org/who-we-are/patient-information

Services

Visiting your dentist twice a year ensures optimal health of both your teeth and gums. X-rays and exams with your dentist can provide insight into any issues you may be having that you can’t feel or see. Specific procedures dentists usually offer include:

• General Dentistry
  • Preventative cleanings
  • Exams looking for decay or gum disease
  • Flouride Treatments
  • Extractions
  • Fillings
• Cosmetic Dentistry
  • Teeth Whitening
  • Crowns
  • Dentures
  • Implants
  • Tooth Shaping
  • Veneers

Additionally, other specialties of Dentistry offer additional procedures described below: 

Orthodontists are trained to diagnose, prevent, intercept, guide and correct your bite. They study for 2-3 years after dental school to focus on ensuring that your teeth are straight and properly meet when you close your jaw. This can be done through braces, aligners, and even jaw corrective surgery done by an oral surgeon. 

Endodontists focus on the tissues and dental pulp (connective tissue) surrounding the roots of your teeth. Often referred to as a root canal treatment, an endodontist specializes in saving your teeth. In two years of education past dental school, Endodontists study root canal treatment, endodontic surgery, and special procedures to save teeth after traumatic dental injuries. If an Endodontist is unable to save a tooth, they will have an Oral Surgeon remove it instead.

Periodontistry is the exclusive focus of the inflammatory disease that destroys the gums and other supporting structures around the teeth. This requires an additional 3 years of training after dental school to study prevention, diagnosis, and treatment of periodontal diseases. 

Oral surgery refers to more advanced concerns within your teeth, gums, jaws, and other oral structures. 

At Jackson Oral and Facial Surgery, we offer:

• Extractions/Wisdom Teeth
• Dentoalveolar Surgery
• Anesthesia Services
• Implant/Bone Grafting 
• TMJ Services
• Pathology/Reconstruction of the Head and Neck
• Facial Trauma
• Jaw Corrective Surgery (Orthognathic Surgery)
• Non-Surgical Cosmetic Procedures