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Tooth related (odontogenic) infections are usually mild in the beginning and easily treated with oral antibiotics. Most infections have origins either in the soft tissues (gums) around the teeth, or as cavities of the teeth, both of which may progress to become abscesses. Some infections, if untreated, may become more complex, requiring aggressive treatment such as: IV antibiotics, incision and drainage, and/or hospitalization. Chronic infections that become deeply seeded in the jaws causing destruction of the bone itself is called osteomyelitis. Facial infections sometimes can cause significant destruction of the teeth, soft tissues and jaws without much soreness, but other times may be incredibly painful and swollen. Some maxillofacial infections are associated with trauma such as gunshot wounds or fractures. Some medical diagnoses, anatomic conditions, or previous surgical devices may require the use of antibiotics just prior to certain dental or surgical treatments (antibiotic prophylaxis).
Oral and maxillofacial surgeons are well trained to diagnose and experienced in treating facial infections. Dr. Leighty keeps abreast of current guidelines from the American Dental Association, American Academy of Orthopedic Surgeons, and the American Heart Association regarding the proper use of prophylactic antibiotics.
Some patients with compromised immune systems or other specific health problems may require special treatment to keep the risk of infection to a minimum. Infections involving the salivary glands or sinus have special considerations, as do patients undergoing kidney dialysis or recent cancer treatment (chemotherapy or radiation).
The misuse, overuse, and abuse of antibiotics can result in the development of resistant strains of bacteria. Dr. Leighty believes in evidenced-based medicine and dentistry. This concept rests on the idea that antibiotics are to be prescribed in a logical and consistent manner, in accordance with modern scientific fact.
Proper treatment of infections requires patient compliance. In other words, the patient should take the medicine as per label instructions. In addition, it is important that the patient show up for their followup visit. Occasionally a postoperative infection will interfere with the normal healing of a tooth extraction and can be recognized and treated in a timely fashion.
Thus, the prevention, diagnosis, and treatment of infection are important parts of the oral surgeon’s job. Dr. Leighty will be happy to discuss any specific concerns you have during your pre-operative evaluation.
Bone Injuries of the Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates, screws, or wires at the involved site. This technique of treatment (rigid or semi-rigid fixation) can sometimes allow healing without a long period of having the jaws wired together. When appropriate, this technique allows patients to return to normal function more quickly.
The proper treatment of facial fractures must be accomplished in a thorough and predictable manner. More importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.
Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.
The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient.