Braces treatment (Orthodontic treatment) is used to correct the teeth alignment prior to jaw surgery (Orthognathic surgery) for patients with discrepancy in his jaw relationship. This procedure requires close collaboration between orthodontist (dentist who does braces treatment) and maxillofacial surgeon (dentist who does jaw surgery). The objective of braces treatment before jaw surgery is to prepare the patient for surgery by placing the teeth in correct position in relative to their respective jaw bone without concern for the bite and aesthetic of patient. During this phase, patient might have compromised aesthetic and bitting ability until the jaw surgery is done. After jaw surgery, short duration of braces treatment is required to refine the final occlusion.
Oral cysts and tumors may develop in the jawbone or soft tissues in the mouth and face.
Oral cyst is an abnormal cavity within bone or soft tissues which may contain fluid. There are many different types of cysts in the mouth.
Reason to remove oral cyst:
Oral tumor is a solid or semi-solid mass in the bone or soft tissue that is made of unusual cells. Oral tumor can be benign tumor (not cancerous) or malignant tumor (cancerous). This can be confirmed by using biopsy test (a surgery that removes part of your tumor to examine it under a microscope). Biopsy is needed to diagnose the tumor before starting any treatment.
When should I suspect that I have an oral cyst or tumor?
Most of the oral lesions do not have any symptoms. Oral cyst may cause swelling, bone expansion, displacement or loosening teeth and pain (if infected). Oral tumor may present as a non-painful bump, lump, or ulcer. After your oral and maxillofacial surgeon examines the cyst or tumor, he will often recommend an X-ray to determine what kind of treatment you need.
Type of common treatments for oral tumors and cysts – Treatment options depends on the location and the type of lesion and your symptoms.
The post was prepared by Dr. Jean
Multiple dental extraction is defined as removal of more than one tooth in a single dental visit. This procedue usually will be done under general anaesthesia (GA) in the hospital setup. Dental extraction under GA also can be performed on children who is anxious, uncooperative or having medical condition such as cerebral palsy or hyperactive child. In some cases, dental extraction under GA is done on children with badly decay teeth which needed multiple dental visit for extraction. It is therefore, better to have it done under general anaesthesia.
The indications of dental extractions under general anesthesia are:
Dental extraction under GA di performed in the hospital setup as day-care (no hospitalization). The patient (or the child) is usually health (ASA I) and fasting since midnight. The anesthesiologist will assess the child and written consent is taken before the procedure started.
In the operating room, the anesthesiologist will put a tube in patient’s throat to administer ‘sleeping’ gas allowing patient to ‘sleep’ during the whole procedure. The oral surgeon will come in to perform the dental extraction. After the procedure, the tube with be removed from the patient’s throat, and he will placed in the recovery room. He will be allowed to discharge from the hospital when fully conscious and ambulated.
Upon the procedure, a minor bleeding in extraction site, swollen tongue/lip/chin/cheek, temporary mouth opening limitation are the sequelae or conditions to be expected.
Advantage of extraction under GA
Disadvantage of extraction under GA
In intravenous sedation, a cannula is placed into a vein and a drug is administered directly into the patient’s blood stream with the patient in supine position.
A cannula (thin plastic tube) will be put into a vein in the back of one of your hands.
The primary goal of IV sedation is to reduce your anxiety, make you feel relaxed and less aware of the dental procedure.
The use of intravenous sedation is indicated in the management of patients with high level of dental anxiety or patients that unable to tolerate stress (epileptic, stroke patient).
During the procedure, adequately sedated patient is demonstrated by expressionless face, drowsiness, and slow speech but they will still be able to understand and respond to verbal contact. However, this patient may not be able to recall events that occurred during the procedure after the treatment.
The major side effect with midazolam sedation is respiratory depression. Thus, the use of a pulse oximeter (device attached to your finger to measure oxygen level and heart rate) is mandatory to monitor patient from this potentially dangerous side effect during the procedure.
Patient who is allergy to benzodiazepines is an absolute contraindication but is extremely rare. IV sedation should be aware in pregnant patient, patient with kidney, liver and heart disease, elderly patient, and children.
Before intravenous sedation
After intravenous sedation
When compared to general anaesthesia, intravenous sedation is simpler, easier to administer, faster onset with fewer complications and contraindications, patient remains conscious and can breathe on their own throughout procedure.
In general anesthesia (GA), drugs are administered by intravenous or inhalation routes which makes the person to be unconscious and do not feel or remember anything during the surgery. This patient is not wakened even by painful stimulation. General anaesthesia currently can only be performed in the operating room under the hospital setup where the sleep doctor (anaesthesiologist) will be the one to make the patient sleep.
GA is recommended for:
The uses for general anesthesia in dentistry have decreased over the years as other less invasive sedation techniques have evolved. Nevertheless, there are still many situations that require the use of GA.
Minor oral surgery is a field in dentistry that involves surgical treatment that performed within the mouth. This surgery can be done under local anaesthesia with or without sedation. In most situations, it requires only a relatively short recovery period. Types of Minor Oral Surgery
A procedure to correct the gum shape and contour thus improve the smile line. Gingivoplasty surgery is usually done on the upper front teeth (can be up to the premolar region) where the gums here can be seen when smiling.
Most of these gum defects are usually caused by gum diseases (eg. periodontitis). However, in certain cases, the gum recedes due to over brushing or probably just because the gum itself is thin (thin biotype).
In gingivoplasty, a gum graft can be done where the tissue is taken from the roof of the mouth (this is called a graft) and then stitched into place on either side of the tooth that is recessed.
Here, is a case of a young male presented with receded gum due to over brushing…
He didn’t like his teeth and gum for a few aesthetic
We found out that he was a right-handed person, using his toothbrush to brush his left teeth too hard!! That causing the gum to shrink upwards.
Secondly, his gums were thin biotype and the previous dentist had over-filled his abrasion cavity with composite preventing the gum from ‘coming down’
Correct his over-brushing technique
BDS (AIMST), MFDS.RCS( Edinburgh,UK), DClintDent (Ortho)(UKM)
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Dr Joann Yong received her dental degree in 2011 and obtained her Membership of Faculty of Dental Surgery from the Royal College of Surgeons of Edinburgh, UK in 2014. She then undertook specialty training in orthodontics at the National University of Malaysia and was awarded Doctor of Clinical Dentistry with Distinction in 2020. Dr Joann had served under the Ministry of Health with working experiences at various specialty clinics and hospitals. She is also actively involved in research and has several publications to her name.
Aligning teeth with confidence, bringing a tidy and beautiful smile to her patients is Dr. Joann’s biggest passion.
DDS (USM) MFDS.RCS (Edinburgh)
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Dr Eddy Loo is a dental surgeon who has special interest in Endodontics, Orthodontics and Dental Implantology. He obtained his Doctor of Dental Surgery (DDS) from Universiti Sains Malaysia (USM). He completed his compulsory government service and was previously attached to the Oral Maxillofacial Surgery (OMFS) and Pediatric Dentistry department in Hospital Raja Permaisuri Bainun (HRPB) in Ipoh. As an avid learner, he often attends courses and conferences locally and internationally.
He is currently pursuing a 3 years Orthodontic Programme by Dr Derek Mahony which will qualify for a Postgraduate Diploma in Orthodontics from the University of City London Dental School.
With good knowledge and advance technology, Dr. Eddy believes he can provide the best dental treatment for his patient.
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