912-408-7100 Southern Georgia Oral Surgery

Roger Myers DMD is an oral surgeon in Hinesville GA with offices in Hinesville, Waycross and Statesboro.  Southern Georgia Oral Surgery performs dental IMPLANTS, WISDOM TEETH REMOVAL AND SEDATION.  WWW.SOUTHERNGEORGIAOMS.COM

912-408-7100 Oral surgeon Hinesville GA

Roger Myers DMD oral surgeon in Hinesville provides dental surgery procedures in the realm of wisdom teeth and dental implants.  Oral surgery office location are waycross, Hinesville and statesboro

Hinesville oral surgeon, Roger Myers DMD 912-408-7100

Roger Myers DMD and Southern Georgia Oral Surgery for dental implants, extractions, wisdom teeth and sedation

Waycross oral surgery office 912-285-1437

Oral surgeon in Waycross Roger Myers DMD and Southern Georgia Oral Surgery.  Wisdom teeth, tooth surgery, dental surgery, dental implants and sedation are provided services.  We service douglas, waycross, homesville, Reidsville, Brunswick, folkston, alma, blackshear, baxley, hazelhurst

Oral surgery in Statesboro GA 912-764-7500

Southern Georgia Oral Surgery in Statesboro accepts emergency visits and Walk-ins.  Wisdom teeth, dental sedation, tooth surgery, teeth removal, bone grafting and dental implants is our specialty.  Hinesville, Waycross and Statesboro locations

Oral surgery in Hinesville 912-408-7100

Wisdom Teeth, dental implant and sedation is an integral part of Southern Georgia Oral Surgery in Hinesville GA.  Oral surgery is focused comprehensively in order to provide the best dental treatment possible.  Roger Myers DMD and Nicholas Theodotou DDS.

Roger Myers DMD-oral surgeon and oral surgery in Hinesville

Visit our website to learn more about the services that we provide in the field of oral surgery

Waycross Oral Surgeon 912-285-1437

Waycross oral surgeon Roger Myers DMD provides the best in Oral surgical care.  We remove wisdom teeth and place dental implants with sedation.  www.southerngeorgiaoms.com

Oral surgeon Hinesville GA 912-408-7100

Wisdom teeth and sedation for adults and children.  Sedation affords you the liberty of a great dental experience @ Southern Georgia Oral Surgery

912-408-7100 Oral surgery in Hinesville-Roger Myers DMD

Wisdom teeth, dental implants and sedation for children and adults in our Hinesville and Waycross offices.  Emergency visits and walk-ins are welcomed.  Delta dental, ameritas, united Concordia, metlife, wellcare, amerigroup and medicaid

912-408-7100 Oral surgeon Roger Myers DMD in Hinesville GA

Pediatric and adult oral surgery is performed at our office locations in Waycross, Statesboro and Hinesville.  Southern Georgia Oral Surgery performs dental implants, wisdom teeth and extractions under IV sedation. 

912-408-7100 Wisdom Teeth-Tooth Extraction in Hinesville GA

Southern Georgia Oral Surgery removes wisdom teeth under local and IV sedation methods.  DR. Myers and Dr. Theodotou are trained to provide IV sedation, Monitor and perform all oral surgery procedures in the office setting.  Our oral surgery offices are located in Hinesville, Statesboro and Waycross, Georgia.
www.southerngeorgiaoms.com
  

912-408-7100 Oral surgery-Oral surgeon Hinesville GA

Southern Georgia Oral Surgery in Hinesville removes wisdom teeth and performs dental implants.
Roger Myers DMD has offices in Hinesville, Waycross and Statesboro

912-408-7100 Oral Surgery office in Hinesville GA

Roger Myers DMD is an oral surgeon in Hinesville providing oral surgery procedures for adults and children.  Dental implants, wisdom teeth and extractions under sedation.  Metlife, BCBS, cigna, ameritas, Medicaid, wellcare, amerigroup, guardian, delta dental and united Concordia are accepted.
www.southerngeorgiaoms.com
Southern Georgia Oral Surgery in Hinesville, Statesboro and waycross

Oral surgeon in Waycross 912-285-1437

Oral surgery office bringing care and compassion to the waycross area.  Dr. Roger Myers and Dr. Nicholas Theodotou are oral surgeons dedicated to providing quality care in the realm of dental implants, removal of wisdom teeth and sedation.  Procedures are provided for children and adults.
www.southerngeorgiaoms.com
1302 plant avenue
Waycross, GA 31501

912-408-7100 Dental and oral surgeon in Hinesville GA

Oral surgeon Roger Myers DMD in Hinesville provides treatment for extractions, wisdom teeth, TMJ, bones grafting, dental implants and sedation.  Procedures for dental surgery apply to children and adults.  We accept Delta Dental, Metlife, Tricare, United Concordia, Cigna, Guardian, Ameritas, Wellcare, Medicaid, Amerigroup dental insurance plans.  Offices are located in Hinesville, Waycross and Statesboro
Southern Georgia Oral Surgery in Hinesville GA
Oral surgery office in Hinesville, Dentist in Hinesville, Oral surgeon in Hinesville
912-408-7100, 912-764-7500, 912-285-1437

Waycross Oral Surgeon 912-285-1437 Roger Myers DMD

Southern Georgia Oral Surgery is opening in Waycross, GA;  Roger Myers DMD is and oral surgeon practicing in waycross and performs extractions, wisdom teeth removal, bone grafting and sedation.
Metlife, Cigna, Aetna, United Concordia, Delta Dental, Ameritas, BCBS, Medicaid, Wellcare, and Amerigroup insurance plans will be accepted.  Dr. Myers also has oral surgery offices located in Statesboro and Hinesville.  Oral surgery in Waycross with care and compassion.
www.southerngeorgiaoms.com

912-408-7100 oral surgeon-oral surgery in Hinesville GA

Roger Myers DMD with southern Georgia Oral Surgery in Hinesville performs extractions, removal of wisdom teeth and sedation for adults and children.  Offices located in Hinesville, Statesboro and Waycross

912-408-7100 Oral surgeons in Hinesville and wisdom teeth

Oral surgeon in Hinesville, Dr. Myers and Dr. Theodotou provide specialized care for the extraction of wisdom teeth.  Southern Georgia Oral Surgery has three locations:  Hinesville, Statesboro and Waycross.

Dental surgeon in Hinesville 912-408-7100

Wisdom teeth are problematic and we have the solution.  Southern Georgia Oral Surgery can provide sedation to make your oral surgery experience very pleasant.  www.southerngeorgiaoms.com
Roger Myers DMD practicing oral surgery in Hinesville, Waycross and Statesboro

912-408-7100 Oral surgery office in Hinesville GA

Roger Myers DMD provides sedation for extractions, wisdom teeth and dental implants.  Southern Georgia Oral Surgery has locations in Hinesville, Waycross and Statesboro.  Deltal dental, cigna, ameritas, metlife, guardian, wellcare, amerigroup and Medicaid are accepted.
Hinesville oral surgeon Roger Myers DMD

Oral Surgeon In Hinesville 912-408-7100

Southern Georgia Oral Surgery provides dental surgical procedures for adults and children.  emergency dental-oral surgery is provided and sedation is a great adjunct to our dental care.  Hinesville, Statesboro and Waycross are our office locations.  Wisdom teeth, dental implants, extractions and bone grafting are some of the many services provided.  Oral surgery by oral surgeon that care.

Southern Georgia Oral Surgery in Hinesville

Announcing expansion of our office to Waycross, GA.  Full scope oral surgery will be performed in the realm of dental implants, wisdom teeth and sedation.  Visit our website @ www.southerngeorgiaoms.com
Oral surgery office in Hinesville, Statesboro and Waycross

Hinesville GA Oral Surgeon-Roger Myers DMD: 912-408-7100

For wisdom tooth removal, we attempt to make your visit at Southern Georgia Oral Surgery very comfortable.  Sedation is a must.  Oral surgery is more tolerable under these circumstances and a pleasant experience is more achievable. Visit our website for more info.  www.southerngeorgiaoms.com

oral surgery-oral surgeon in Hinesville 912-408-7100

Roger Myers DMD provides dental surgical services to adults and children.  Extractions, wisdom teeth removal and sedation are some of the procedures that we provide.  Visit www.southerngeorgiaoms.com for more info.  We have offices located in Hinesville, Statesboro and Waycross

Oral surgeon in Hinesville 912-408-7100

Oral surgery office in Hinesville GA providing care for children and adults.  Sedation is provided for all oral surgery procedures.  Wisdom teeth and dental implants in Hinesville.

912-408-7100 Oral surgery and oral surgeon in Hinesville

Oral surgeon with Southern Georgia Oral Surgery performs extractions, removal of wisdom teeth and placement of dental implants.
Medicaid, wellcare and amerigroup accepted
www.southerngeorgiaoms.com

Oral surgery in Hinesville GA-Roger Myers DMD

Roger Myers DMD-Southern Georgia Oral Surgery of Hinesville GA
Tooth infections are very painful and can spread to the soft tissue causing swelling.  The significance of an oral infection due a decayed tooth is very important.  Soft tissue infections spread rapidly and can affect vital structures in their path.  Difficulty breathing, swallowing, and visual disturbances can occur.  Tooth removal or incision and drainage of the affected region may be required.  Followed by pain meds and antibiotics for an extended period time.  The appropriate measure of treatment would require visiting an oral surgeon.

912-408-7100 Oral surgery office in Hinesville GA

Southern Georgia Oral Surgery in Hinesville GA 
Roger Myers DMD is an oral surgeon in Hinesville


Sedation as a method to calm relax a patient prior to surgery

IV sedation is an effective means of relaxing a patient prior to surgery.  However, some form of oral anxiolytic like halcion seems to be a great preface to intravenous medications.  For children and adults alike, our office promotes both forms of sedation.  What do you use in your office ?

Oral Surgery office in Hinesville GA 912-408-7100

Bone grafting after an extraction has many benefits:
1.  Preservation of bone
2.  Increasing the likelihood of quality bone
3   Prevent a noticeable defect in the jaw after an extraction
4.  Helps ensure that the width of the jaw is maintained.

www.southerngeorgiaoms.com
Roger Myers DMD oral surgeon in Hinesville, GA

Hinesville GA Oral Surgeon Roger Myers DMD(Maxillary Tori)

Significant maxillary tori causing difficulty chewing, swallowing and inhibition of speech.  Planned removal of maxillary bony tori in order for the patient to tolerated a denture.  Fabrication of stent after impression is planned.  IV sedation and removal of the tori in sections is the surgical approach.
Will forward post-operative photos later.

Oral surgery-Oral Surgeon in Hinesville GA 912-408-7100

Southern Georgia Oral Surgery in Hinesville GA
Roger Myers DMD

Removal of Pediatric Dentition

Pediatric oral surgery is a facet of the field that requires compassion, patience and overall extreme attentiveness.  Pediatric patients have very short attention spans and bring a level of anxiety in an already tense environment.  The situation of  commencing oral surgery for am pediatric patient is very delicate.  What meds are appropriate for sedation ?, how is this patient going to respond under anesthesia?, and what will be the post-operative outcome?
   Southern Georgia Oral Surgery has implemented an approach to dealing with the anxiety of pediatric patients, by using verbal, oral and IV medications.  The combination of verbal distraction and medications appears to be very effective.  The patients respond to calm and soothing speech, which induces a level of serenity.  The oral sedative assists in helping the patient stay calm and not reactive to an unfamiliar situation.  IV medications allow a level of unconsciousness that promotes amnesia and analgesia.  As a result, the pediatric patients appear to have a more comfortable dental surgery experience. 
For more answers to pediatric oral surgery procedures, please view our website @
www.southerngeorgiaoms.com
Roger Myers DMD-oral surgeon in Hinesville GA

Southern Georgia Oral Surgery of Hinesville; Canine Exposure

 Canine exposure in preparation for orthodontic treatment
www.southerngeorgiaoms.com
Roger Myers DMD oral surgeon in Hinesville GA


Canine exposures are sometimes viewed as very arduous oral surgical procedures.  The orientation of the canine tooth and the proximity to other oral-facial structures is vitally important.  A Panorex or a PA can be taken in order to assess the position of the tooth, but surgical exposure seems to be the most definitive method of identifying tooth position.  In some cases the maxillary sinus, adjacent teeth and the floor of the nasal cavity are major considerations.  Exposure of the area involves a full mucoperiosteal flap in order to visualize the underlying bone/tooth.  A peripheral ostectomy may be required for increased exposure of the canine tooth.  In order to ligate the tooth with a chain and bracket, bleeding in the surgical site must be controlled.  Etchant is placed on the tooth and cleared with copious irrigation of normal saline.  Next the adhesive is placed and light cured.  Finally, composite material in affixed to the bracket and tooth surface.  It is then light cured and the adhesion of the bracket to the tooth is assessed by pulling on the chain lightly.  Silk suture or wire is then used to attach the chain to ortho-wire/tissue.  The patient is then referred to the orthodontist for continued treatment. 
   This dental surgery procedure was performed by Roger Myers DMD at southern Georgia Oral surgery of Hinesville.  The pediatric patient was placed under sedation as the procedure was performed. 

At What Age Should Wisdom Teeth Be Removed

This a difficult and common question.  Age is a criteria of least importance and patients should be evaluated on basis of need.  If a patient is in eminent danger of infection, cyst development, loss of adjacent teeth, TMJ problems or consist pain to the affected region, removal of the wisdom tooth should be considered.  I have encountered 12 yr old patients who exhibit more developed wisdom teeth than a 20 yr old.  Each patient is  to be evaluated on an individual basis and the proper decision is to be made accordingly.  Wisdom teeth are teeth that are typically non-functional and are usually not in occlusion.  There position in the posterior of the jaw inhibits proper hygiene and makes the m more inclined to develop caries.  This information makes it apparent that wisdom teeth erupted or impacted typically serve no function and almost always require removal.

Roger Myers DMD
Southern Georgia Oral Surgery
Hinesville and Statesboro

Wisom Teeth Can Cause Ear Pain

Southern Georgia Oral Surgery
Locations:  Hinesville and Statesboro
Oral surgeon: Roger Myers DMD

In many instances I evaluate patients that complain of a constant ear pain.  Most of the patients determine that the pain derives from an aggravating ear infection.  However, more often than not the pain is coming from an erupted or impacted wisdom tooth.  The etiology of the pain can emanate from an upper or lower wisdom tooth.  Decay and infection can exacerbate the problem and the ear pain feeling usually is identified as referred pain.  The sensory division of the trigeminal nerve, maxillary or mandibular branches can re-direct pain signals to the ear.  This is a result of  the location of the where the nerves originate at the skull base.  As the nerve becomes inflamed from infection or other stimuli, the pain to the side of the head intensifies.  Analgesics, anti-inflammatory meds, antibiotics and warm heat packs are utilized to lessen the degree of pain. 
**Important Note**
Ear pain can be a result of tooth pain

Oral Surgeon Hinesville, Ga.-Southern Georgia Oral Surgery

Southern Georgia Oral Surgery has two locations:
Hinesville, Georgia and Statesboro, Ga.
Owner:  Roger Myers DMD(oral surgeon)

Mission:
Provide quality oral surgical care to all of our patients and implement the most advanced technological techniques to do so.
Vision:  To be the premier oral surgery office in Eastern Georgia, which provides full scope oral surgery with a plethora of  facial esthetics procedures.

Procedures provided:
1.  Sedation-  Inhalational/IV/GA
2.  Removal of wisdom teeth/extractions
3.  Facial trauma repair
4.  Dental implants
5.  Surgical pathology
6.  Laser hair removal
7.  Botox
8.  Pediatric oral surgery
9.  Bone grafting

www.southerngeorgiaoms.com

Diabetes and Pre-mature Tooth Loss

Diabetes and Dental Extractions Due to Premature Tooth Loss
Roger Myers DMD-Oral Surgeon Hinesville and Statesboro, Ga.
Southern Georgia Oral Surgery


Diabetes is a disease that can affect the whole body, including your mouth. Dental care is particularly important for people with diabetes because they face a higher than normal risk of oral health problems due to poorly controlled blood sugars. The less well controlled the blood sugar, the more likely oral health problems will arise.  The ramifications caused by uncontrolled sugar level can result in kidney failure, loss of vision and oral/systemic issues.  The patients have a greater susceptibility to infections and delayed healing time recovering from trauma with resultant wounds.  This is because uncontrolled diabetes impairs white blood cells, which are the body's main defense against bacterial infections that can occur in the mouth.

What Dental Problems Are People With Diabetes at Higher Risk For?

People with diabetes face a higher risk of:

• Dry mouth. Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth.  The technical term for dry mouth is xerostomia.   Dry mouth can further lead to soreness, ulcers, infections, and tooth decay.  A decreased salivatory state promotes stagnancy and reduces the bodies natural method of washing away tooth adhered bacteria.  This alone can significantly contribute to premature tooth loss, periodontal issues and fungal infections.
• Gum inflammation (gingivitis and periodontitis). Besides impairing white blood cells, another complication of diabetes is that it causes blood vessels to thicken, which slows the flow of nutrients to and waste products from body tissues, including the mouth.  However, when tissue is inflamed due to infection, the region can exhibit profuse bleeding during surgery. When this combination of events happens, the body's ability to fight infections is reduced. Since periodontal disease is a bacterial infection, diabetics with uncontrolled disease may experience more frequent and more severe gum disease.  Gum disease can lead to periodontal issues which affect the retention of teeth.
• Poor healing of oral tissues. People with uncontrolled diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be impaired.
• Thrush. People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth and tongue. The fungus thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes.
• Burning mouth and/or tongue. This condition is caused by the presence of thrush.  This is also called glossodynia.  This can be of neuropathic etiology or form the presence of candida albicans(fungal).  If the cause derives from a fungal infection, anti-fungal agent can be taken.  But, if the cause is of neural origin the patient must be followed by a neurologist.

People with diabetes who smoke are at even a higher risk -- up to 20 times more likely than nonsmokers -- for the development of thrush and periodontal disease. Smoking also seems to impair blood flow to the gums -- which may affect wound healing in this tissue area.
Since people with diabetes are more prone to conditions that may harm their oral health, it's essential to follow good dental care practices and to pay special attention to any changes in your oral health and to seek a prompt dental consultation if such changes occur. Here are some tips to consider.

• Keep your blood sugar as close to normal as possible( 70-110)
• At each dental care visit, tell your dentist about the status of your diabetes. For instance, he or she may want to know your HgA1C level to determine how well controlled your diabetes is (good control is indicated by a level under 7%). If you've had a hypoglycemic episode in the past (low blood sugar, also called an insulin reaction), you are at increased risk to have another one. Tell your dentist when your last episode was, how frequently such episodes occur, and when you took your last dose of insulin, if you take it.  The A1C is a blood serum blood test.
• See your diabetes doctor before scheduling treatment for periodontal disease. Ask your doctor to talk to your dentist or periodontist about your overall medical condition before any dental treatment is performed. If oral surgery is planned, your doctor or dentist will tell you if you need to take any presurgical antibiotics or need to change your meal schedule or the timing and dosage of your insulin, if you take it. At Southern Georgia Oral Surgery, we premedicate all diabetic patients and ask each patient to take check their level prior to surgery.  If insulin dependent, the patient will take 1/2 their dose prior to surgery or calibrate it accordingly.
• Bring your dentist a list of all the names and dosages of all medications you are taking. Your dentist will need to know this information to prescribe medications least likely to interfere with the medications you are already taking if medications are needed. If a major infection is being treated, your insulin dose -- for those taking insulin -- may need to be adjusted. Check with your doctor.
• Postpone nonemergency dental care procedures if your blood sugar is not in good control.  Lack of sugar control can lead to an inevitable infection and potential prolonged healing after surgery.   However, acute infections, such as abscesses, should be treated right away.
• Keep in mind that healing may take longer in people with diabetes. Follow your dentist's post-treatment instructions closely.

Single Tooth Dental Implants-Oral Surgeon Hinesville, Ga.

Single Tooth Dental Implants


Single toooth dental implants provide replacement of esthetics and fuction for most  patients.  Implants to some patients can be an intimidating endeavor, but with proper illustations and communitation this feeling can be diminished.  Expressing to patients that this is viable option for tooth replacement can be difficult.  However, when they comprehend the overall benefits of the implant over the conventional bridge, the patient is more inclined to select the implant route.

Advantages of implants:
1. Restore form and function
2.  Estheticallly pleasing to the eye once restored
3.  Adheres to the surrounding bone for optimal support
4.  Decay or caries are obsolete
5.  Adjacent teeth are not damaged
6.  Cost comparison to other options is virtually the same
7.  Risk of infection is minimal


Disadvantages of implants:
1.  Possible multiple procedures to accommodate the implant
2.  For multiple implants the cost increases
3.  Healing time for osseointegration
4.  Difficulty of placement
5.  Soft tissue and bone (Quality/Quantity)

 

Roger Myers DMD

Southern Georgia Oral Surgery

TMJ and Upper Wisdom Tooth Position

I have discovered that when female patients are evaluated in my office for wisdom teeth, it is apparent  most of them have TMJ issues.  Issues which get progressively worse as the upper wisdom teeth develop.  These problems manifest into headaches, earaches and constant radiating jaw pain.  Therefore, I have discovered that upper wisdom tooth position may be the etiology of this problem.  The wisdom tooth acts as an obstruction or deflector to the normal arc of jaw opening.  As a result, stress and strain is directed toward the joint region and leads to dysfunction.  The radiograph above illustrates the wisdom tooth in close proximity to the coronoid process or descending ramus.  This is the typical position of wisdom teeth, when patients exclaim to having TMJ issues.
What have you observed in your practice ?  Does this complaint mainly derive from the female population of patients?
Southern Georgia Oral Surgery-  Hinesville and Statesboro, Ga. oral surgeon
Roger Myers DMD

Southern Georgia Oral Surgery-Pediatric Approach To Oral Surgical Care

Pediatric oral surgical care is very important and essential to the full scope approach to oral surgery implemented in our office.  A team approach and plan is critical as the patient is oriented to the service being provide.  I have discovered that establishing a rapport and commonality with young patients is paramount.  I provide sedation for 100% of my pediatric for all procedure types.  I do not use inhalational gases due to their ineffectiveness and time of induction.  Oral sedation is given one hour prior to any procedure in the form of halcion(0.125mg).  This approach seems to be effective and creates a degree of euphoria/anxiolysis.  Thereby allowing myself and my team to be efficient in establishing the IV.  As a result, we can immediately administer all necessary meds and perform our intended procedure.  This process has rendered great results and it appears the patients have great things to say post-operatively.

Roger Myers DMD
www.southerngeorgiaoms.com

3 Reasons to Expose Canine Teeth

Surgical exposure of Imopacted Canine Teeth
Why Expose the Canine Teeth?
The presence of canine teeth act as the cornerstone of oral upper/lower arches and add stability to the entire dentition.  Canine teeth are demensionally the longest teeth and provide greater ability to incise foods.  They help guide our lateral excursive movements and help form the esthetics of our dentition alignment.  Research shows that the cause of canine impactions is mainly hereditary, therefore genetic.  Canine impactions are more frequent among females than males (F : M = 2.3 : 1) or 1.17% of females and 0.51% of males. And, as it was previously mentioned, 85% of impactions are palatal impactions compared to 15% that are vestibular impactions.

Reasons Why Canines should be exposed
 1.  Arch Stabilty
      The canines are one the widest and longest tooth type in the dentistion and its presence gives the arch great stability.  The canine has a greater propensity of preventing migration of the adjacent teeth.
In the absence of canines, the arch is less stable and dentition aligment becomes increasingly weaker.
2.  Cyst Potential
     Cysts can develop in the presence of any impacted tooth and the canines are no exception.  Dentigerous cysts and ameloblastomas are the most prevalent of this type. 
3.  Damage To Adjacent Teeth
     Many times impacted canines are positions in a manner which compromises adjacent teeth.  In many instances the canines cause resorption of adjacent teeth and possibly delayed eruption of teeth in their proximity.

Southern Georgia Oral Surgery
Roger Myers DMD
912-408-7100

5 Reasons to Remove Labial or Lingual Frenums(Frenectomy)

  5 Reasons why pediatric patients require ligual/labial frenectomy removal:
1. Speech deficiency
2. Phonation impairment
3. Delayed learning and comprehension ability
4. Loss of soft tissue and bony attachment around affected teeth
5. Malposition of teeth/crowding

Southern Georgia Oral Surgery-Roger Myers DMD

Palatal tori

Roger L. Myers DMD
Southern Georgia Oral Surgery
Hinesville, Ga. and Statesboro, Ga. Offices
www.southerngeorgiaoms.com

Torus palatinus (tori palatinus) is a bony protrusion on the palate. Palatal tori are usually present on the midline of the hard palate.  However, can be diffuse in size and shape which can encompass the palate unilaterally or bilaterally.   Most palatal tori are less than 2 cm in diameter, but their size can change throughout life.  As one ages the palatal tori can enlarge in size and cause associated issues.  Such as speech, swallowing and chewing problems of the oral cavity.
Prevalence of palatal tori ranges from 9% - 60% and are more common than bony growths occurring on the mandible, known as torus mandibularis. Palatal tori are more common in Asian, Native American and Inuit populations, and twice more common in females. In the United States, the prevalence is 20% - 35% of the population with similar findings between blacks and whites.  In my practice, I  have noticed that more African Americans exhibit palatal tori over mandibular tori.  In addition, seems the most prodominate race with this condition.
Although some research suggest palatal tori to be an autosomal dominant trait, it is generally believed that palatal tori are caused by several factors.  They are more common in early adult life and can increase in size. In some older people, the size of the tori may decrease due to bone resorption. It is believed that tori of the lower jaw are the result of local stresses and not solely on genetic influences.
Sometimes, the tori are categorized by their appearance.  Arising as a broad base and a smooth surface, flat tori are located on the midline of the palate and extend symmetrically to either side. Spindle tori have a ridge located at their midline. Nodular tori have multiple bony growths that each have their own base. Lobular tori have multiple bony growths with a common base.
Palatal tori are usually a clinical finding with no treatment necessary.  It is possible for ulcers to form on the area of the tori due to repeated trauma(As seen in the Photo).   Also, the tori may complicate the fabrication of dentures. If removal of the tori is needed, surgery can be done to reduce the amount of bone present.  If surgical intervention is warranted for placement of a denture, one has to be cognizant of the thin nature of the coving tissue.  The palatal tissue covering the tori in very thin and dehiscence after surgery is very common.  Periodic examination and will allow visualization of the tissue granulating in order to establish closure of the wound.  There is no specific time to predict the healing time, but serial evaluations are suggested as the area heals.  Upon completion of wound healing, the area should be inspected for any bony projections or prominences.  These factors alone can inhibit the placement of a denture post-operatively.

CASE STUDY:

Chief Complaint:  "I can't chew without teeth and I need a denture"
PMH:  Heart Murmur, Diabetes Type 2, Kidney Disease, HTN
Meds:  Diovan, Metoprolol, Plavix, Actos
PSHx:  None
ALL:  NKDA

Findings:  Massive palatal tori obstucting patients ability to chew, spaeak and breath.  Bilateral growth with central prominence.
Plan:
1.  Surgically remove palatal tori
2.  IV sedation/LA
3.  losure with 3.0 Vicryl suture
Result:
The procedure was performed under IV sedarion in which multiple incisions for tissue reflection and acess were made.  The palatal tori was removed and primary closure was achieved.  The patient will be seen one week post-operatively and followed until healing is complete.

www.southerngeorgiaoms.com

Supranumerary Teeth-Mesiodens

Southern georgia Oral Surgery-Statesbor, Ga. and Hinesville, Ga.
Oral Surgeon-Roger Myers DMD

What are Supernumerary Teeth ?

By definition, supernumerary teeth are extra teeth, whish are typically malformed and diminutive compared to normal dentition. It is more common in the midline region of the upper or lower jaw;  Most frequently found in the region of the upper central incisors; Therefore, the occurrence rate in the mandible region is quite infrequent. The most common type of supernumerary tooth as indicated is mesiodens. Mesiodens may occur as single, multiple, unilateral or bilateral. In some syndromes, mesiodens may present as a part of the symptoms; however, this condition might be seen in normal individuals. It seems that positive family history is one of the predisposing factors .
Extra teeth have a lot of names! They are classified based upon where they are located and what they look like.
If an extra tooth is shaped like another "normal" tooth, it is called a supplemental tooth. If it is not shaped like a normal tooth, then it is known as a rudimentary tooth. Rudimental teeth are then classified based on what they look like:

• Conical Rudimentary Teeth look small or peg-shaped.
• Tuberculate Rudimentary Teeth appear to be barrel-shaped and have more than one cusp.
• Molariform Rudimentary Teeth look similar to premolar or molar teeth, but not enough to be called a supplemental tooth.

Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. Given this high frequency, the general dentist should be knowledgeable about the signs and symptoms of mesiodentes and appropriate treatment. The cause of mesiodentes is not fully understood, although proliferation of the dental lamina and genetic factors have been implicated. Mesiodentes can cause delayed or ectopic eruption of the permanent incisors, which can further alter occlusion and appearance. It is therefore important for the clinician to diagnose a mesiodens early in development to allow for optimal yet minimal treatment.

Treatment options may include surgical extraction of the mesiodens. If the permanent teeth do not erupt in a reasonable period after the extraction, surgical exposure and orthodontic treatment may be required to ensure eruption and proper alignment of the teeth. In some instances, fixed orthodontic therapy is also required to create sufficient arch space before eruption and alignment of the incisor(s). Early diagnosis allows the most appropriate treatment, often reducing the extent of surgery, orthodontic treatment and possible complications. This paper outlines the causes and modes of presentation of mesiodentes, and presents guidelines for diagnosis and management of nonsyndromic mesiodentes.

 

 

 

 

Two Most common Cysts Associated With Impacted Wisdom Teeth

Dentigerous Cyst
A dentigerous cyst or follicular cyst is an odontogenic cyst- thought to be of developmental origin - associated with the crown of an unerupted (or partially erupted) tooth.  Meaning that the cyst-like tissue may cover a portion or the entire crown of the tooth. The cyst cavity is lined by epithelial cells derived from the reduced enamel epithelium of the tooth forming organ. Regarding its pathogenesis, it has been suggested that the pressure exerted by an erupting tooth on the follicle may obstruct venous flow inducing accumulation of exudate between the reduced enamel epithelium and the tooth crown.  This can account for the fluid material in the cyst cavity.
Histologically a normal dental follicle is lined by enamel epithelium, whereas a dentigerous cyst is lined by non-keratinized stratified squamous epithelium. Since the dentigerous cyst develops from follicular epithelium it has more potential for growth, differentiation and degeneration than a radicular cyst. Occasionally the wall of a dentigerous cyst may give rise to a more ominous mucoepidermoid carcinoma. Due to the tendency for dentigerous cysts to expand rapidly, they may cause dehiscence or pathologic fracture of jaw bone.
The usual radiographic appearance is that of a well-demarcated radiolucent lesion attached at an acute angle to the cervical area of an unerupted tooth. The border of the lesion may be radiopaque. The radiographic differentiation between a dentigerous cyst and a normal dental follicle is based merely on size. Radiographically, a dentigerous cyst should always be differentiated from a normal dental follicle. Dentigerous cysts are the most common cysts with this radiographic appearance.  However, histological analysis is a more definitive method of identification. Radiographically the cyst appears unilocular with well defined margins and often sclerotic boarders. Infected cysts show ill-defined margins.
The most common location of dentigerous cysts are the Mandibular 3rd Molars and the Maxillary Canines, and they rarely involve deciduous teeth and are occasionally associated with odontomas.


Ameloblastoma

Ameloblastoma is a rare, benign tumor of odontogenic epithelium (ameloblasts, or outside portion, of the teeth during development) much more commonly appearing in the lower jaw than the upper jaw.  The lesion usually is associated in the lower posterior mandible and can be affiliated with any molar tooth in this region.
While these tumors are rarely malignant or metastatic (that is, they rarely spread to other parts of the body), and progress slowly, the resulting lesions can cause severe abnormalities of the face and jaw. Additionally, because abnormal cell growth easily infiltrates and destroys surrounding bony tissues, wide surgical excision is required to treat this disorder.
Ameloblastomas are often associated with the presence of unerupted teeth. Symptoms include painless swelling, facial deformity if severe enough, pain if the swelling impinges on other structures, loose teeth, ulcers, and periodontal (gum) disease. Lesions will occur in the mandible and maxilla,although 75% occur in the ascending ramus area and will result in extensive and grotesque deformitites of the mandible and maxilla. In the maxilla it can extend into the maxillary sinus and floor of the nose. The lesion has a tendency to expand the bony cortices because slow growth rate of the lesion allows time for periosteum to develop thin shell of bone ahead of the expanding lesion. This shell of bone cracks when palpated and this phenomenon is referred to as "Egg Shell Cracking" or crepitus, an important diagnostic feature. Ameloblastoma is tentatively diagnosed through radiographic examination and must be confirmed by histological examination (e.g., biopsy). Radiographically, it appears as a lucency in the bone of varying size and features—sometimes it is a single, well-demarcated lesion whereas it often demonstrates as a multiloculated "soap bubble" appearance. Resorption of roots of involved teeth can be seen in some cases, but is not unique to ameloblastoma. The disease is most often found in the posterior body and angle of the mandible, but can occur anywhere in either the maxilla or mandible.
Ameloblastoma is often associated with bony-impacted wisdom teeth—one of the many reasons some dentists recommend having them extracted

7 Complications Associated with Wisdom Tooth Removal

 7 Complications Associated With Wisdom Tooth Removal

Southern Georgia Oral Surgery
WWW.SouthernGeorgiaOMS.com
Roger Myers DMD

Requiring removal of wisdom teeth can be an anxious moment. In most cases, we seek treatment because of pain, swelling and other related issues.
Before one makes the decision to have wisdom teeth removed, the risks and complications of the procedure should be identified.

1) Bleeding- Bleeding is inherent to most surgical procedures and can be dealt with accordingly. Lower wisdom teeth are sometimes difficult to remove and bleeding will occur post-operatively. After an extraction, the patient should bite on guaze for intervals of 10 minutes until the bleeding stops. If after and hour, I usually instruct my patients to bite on a wet tea bag. The tea bag has tannins which facilitate a clot(this method has also worked on patients taking anticoagulants).
2) Nerve Numbness- There are three different degrees of nerve injury
a) Neuropraxia- Crushed or piched, transient loss of sensation 1-3
months
b) Axonotemesis- Partial nerve tear, regian feeling 3-6 months
c) Neurotemesis- Complete tear of nerce bundle, repair required with
no definte nerve recuperation
3) Swelling- The presence of swelling can result in limited opening and increased post-operative pain. A hot water bottle is the method of reducing the swelling expediantly, because the warmth diffuses the fluid collection that causes swelling.
4) Damage to adjacent teeth- Having any tooth removed can result in damage of an adjacent tooth. Whether the damage is a fracture or luxation of the adjacent tooth, it can and does happen.
5) Jaw Fractue- Whether the tooth is an upper or lower wisdom tooth, the bone can be fractured during the extraction process.
6) Tooth Fragments- Attempting to remove a tooth can cause afracture of the root. If the root fragment is less than 1mm, it can remain without incident. But, if the fragment is significant the remaining tooth portion must be removed. By remaining the tooth fragment acts as a nidus for infection and thereby icrease the risk of infection for the patient.
7) Infection- Any surgery that results in bleeding and exposure of the patient to the external environment can result in an infection. The oral cavity have a plethora of bacterial typoes and antibiotics chould be given after any extraction is complete.

4 Major Reasons Why Dental Implants Fail

Southern Georgia Oral Surgery-Hinesville, GA.
Roger Myers DMD

The reasons why dental implants fail is a multi-factorial and very consistent.  The placement of a foreign body or material intended to be accepted by the human body has considerable unpredictability.  Provided the right conditions are met, the dental implant has a high degree of success and acceptance.  A plethora of considerations should be made prior to placement of an implant, which will be discussed later.  However, the following are some valid reasons for dental implants failing

1)  Suitable Host
     ASA classification is a very important factor, when considering the type of patient for implant  
      placement
     ASA Physical Status 1 - A normal healthy patient
     ASA Physical Status 2 - A patient with mild systemic disease
     ASA Physical Status 3 - A patient with severe systemic disease
     ASA Physical Status 4 - A patient with severe systemic disease that is a constant threat to life
     ASA Physical Status 5 - A moribund patient who is not expected to survive without the operation
     ASA Physical Status 6 - A declared brain-dead patient whose organs are being removed for   
     donor purposes
     The healthier the patient, the less risk of implant failure.  As a patients health status diminishes,
      the risk of of implant failure increases.

  2)  Quantity and Quality of Bone
       Height and width of  the bone is very important in order to assess when assessing or evaluating
       the patient.  Cancellous and cortical bone of sufficient amount is the real mitigating factor
       determining placement.   As the degree of cancellous bone diminishes, the patient is relegated to
        lesser quality of bone.  The cortical bone of lesser quality because of its decreased vascularity.
        A balance between the two is more optimal and usually correlates to better success.
   3)  Negligence by Dentist:
        One of the major causes of dental implant failure is the negligence of the dentist. A dentist is 
        supposed to follow the protocol of osseointegration appropriately(typically four month of  
        healing time for the implant). A dentist is should study the patients medical history very well
        and include it in their decision making process to advance with implant placement. 
        The following are requirements for a proper dental implant procedure.
        1)   Placement of implant at the site in jaw with the appropriate size
        2)   Proper preparation of the location
        3)   Suitable bone graft
        4)   Proper angulation of placement
        5)  Proper torque for placement @ 35-40 ncm-Excessive Torque
        6)  Do not use excessive drilling
        7) 
         It is also observed that many dentists take a shortcut for diagnosis. They follow the results of a 
         two dimensional panographic x-ray. The information shown by the two dimensional
         panographic x-ray is adequate for most of the dental surgery cases, however it is not sufficient 
         for all. This kind of x-ray cannot provide information about the amount and quality of bone 
         present to hold the implant and the accurate location of nerves and blood vessels running 
         through the bone.  This would require computerized tomography(CT) 3-Dimensional
    4)  Infection:

         Infection: Another common cause of dental implant failure is infection. It occurs mainly

         because of two reasons. The dentist does not follow proper techniques for implant integration or

         uses unsterilized instruments for fitting the dental fixtures. Secondly, you do not care much for

         dental health. Poor dental hygiene is sure to invite pathogens to infect your mouth and 

         eventually, leads to failure of dental implant

Southern Georgia Oral Surgery(Hinesville, Ga.)-Full Scope Oral Surgery

What is full scope oral surgery?
  Full scope oral surgery is the practice of implementing and incorporating all facets of the field of oral surgery in one's repetoire.  The field of oral surgery is a collage of dentistry, plastic surgery and ENT.  Oral surgery directly relates to reparing, altering and correcting problems of the craniofacial region.  The field provides care to the adult and pediatric patient with cosiderable emphasis on maintaining or re-establishing facial form/function.  In our office(Southern Georgia Oral Surgery), we provide a plethora of procedures and adjunct services, which enables our office to be considered a full scope oral surgery practice.
  1)  Dental Implants
  2)  Wisdom Tooth Removal
  3)  Botox and Facial Rejuvenation
  4)  Facial Trauma Repair
  5)  IV and Oral Sedation
  6)  TMJ Treatment (Surgical and Non-Surgical)
  7)  Routine and Surgical Removal of Teeth
  8)  Facial Trauma
  9)  Bone Grafting
10)  Oral Pathology and Recostruction
11)  Pre-Prosthetic Surgery
12)  Distraction Osteogenesis
13)  Sleep Apnea
14)  Cleft Lip Repair

We have oral surgery offices located in:
Hinesville, Ga. and Statesboro, Ga.
Roger Myers DMD

Most Common Causes of TMJ Pain

Southern Georgia Oral Surgery Roger Myers DMD Statistics indicate that the vast majority of TMJ problems are caused by traumatic occureneces. By trauma, we mean an injury as obvious as a blow to the jaw with a fist or something as subtle as a whiplash injury from a car accident that causes direct trauma to the head or jaw.  Violent insults to the head and neck region can result in longterm injury and in some cases the injuries can be irreparable.  The jaw joint specifically is an area that articulates the lower jaw bone to the base of the skull.  It is a hinge joint and functions similarly to the the knee joint and is very sensitive to any abnormal stimuli causes change to the joint space.                    The most common forms of trauma that cause TMD are: Whiplash (cervical acceleration/deceleration) Air bag deployment Opening the jaw too wide Bruxism Bad bite (malocclusion) Orthodontics Ligament laxity Stress Systemic diseases Whiplash (Cervical Acceleration/Deceleration) Whiplash injuries often damage the soft tissue in the neck, back and TMJs. Usually these injuries happen when a car is hit in the rear. The violent motion of the head being thrown from a still state backwards and then forwards again often causes the mouth to be forced open. This produces stretching and/or tearing of the ligaments and connective tissues in one or both TMJs, and possibly bleeding and displacement of the disc in the TMJ. Common complaints after a whiplash injury include neck pain, neck stiffness or difficulty in turning the head, headaches (especially where the neck attaches to the head), TMJ pain, limited ability to open the mouth, TMJ noises, face and/or ear pain, change in bite, dizziness, visual changes (such as light sensitivity or blurry vision) and swallowing difficulties or hoarseness. Air Bag Deployment While air bags have undoubtedly saved lives, they have also been implicated in causing TMJ problems. Patients who have been injured with air bags often experience one or more of the following symptoms: burned or abraded skin on the chin, face or nose; almost immediate TMJ pain; swelling of the TMJs; limited mouth opening; neck pain; and change in the dental occlusion (bite). Opening the Jaw Too Wide All joints have limitations to movement, and the TMJ is no exception. If you open wide for a long time or if your mouth is forced wide open, ligaments may be torn, swelling and bruising develop and disc dislocation may occur. Bruxism Bruxism is the abnormal grinding of the teeth. Bruxism usually occurs during sleep, which is why many people don’t realize they are doing it. But when grinding continues, TMJ problems may develop. An indication that a person is grinding their teeth in their sleep is sore jaw muscles when waking. Minimally, bruxism may produce muscle pain, tooth sensitivity or worn teeth. In some cases, the pressure to the TMJ from constant grinding of teeth leads to ligament injuries, which might cause the disc to dislocate. Bad Bite (Malocclusion) A bad bite, or malocclusion, may be produced by poor development of the jaws, removal of teeth without replacement, a high dental restoration, a poor fitting denture or partial denture, or a displaced TMJ disc. Orthodontics Some dentists feel that orthodontic treatment, or braces, might be a cause of TMJ. By moving teeth with orthodontic appliances, malocclusion is produced during treatment. That’s probably why many people undergoing orthodontics report sensitive teeth, pain in the jaw muscles or even bruxism. However, there is no scientific proof that orthodontic treatment produces TMJ problems, particularly once the treatment has been completed. Ligament Laxity People who appear to be double-jointed suffer from a problem termed aligament laxity. When this occurs, a joint appears to be double – or loose. This does happen to the TMJ. Ligament laxity is a fairly common problem in active young women who suffer with TMJ problems and, often, injuries to other joints. Stress Stress has many effects on our bodies: some good and some bad. Physiological changes can produce muscle tightness and pain. When a person is subjected to chronic stress, these physical changes may produce harmful effects. When it comes to TMJ problems, stress is like throwing gasoline on a fire. The gasoline doesn’t produce the fire, but it does make it worse. Similarly stress intensifies TMJ problems. Muscles tighten, teeth clench, abnormal pressure is forced against the TMJ disc, and if the ligaments are weak or if the patient is one that has ligament laxity, the disc may dislocate. There are a number of other pain disorders that are often confused with TMJ because they involve pain in the jaw. Most common among these are: Temporal Tendinitis Ernest Syndrome Occipital Neuralgia Trigeminal Neuralgia Atypical Trigeminal Neuralgia Atypical Face Pain Neuralgia Inducing Cavitational Osteonecrosis (NICO) Temporal Tendinitis – The “Migraine Mimic” Temporal tendinitis has been called “the migraine mimic” because so many of its symptoms are similar to migraine headache pain. It is characterized by TMJ pain, ear pain and pressure, temporal headaches, cheek pain, tooth sensitivity and neck and shoulder pain. Treatment consists of injecting local anesthetics and other medications, a soft diet, applying moist heat, using muscle relaxants and anti-inflammatory medications, and physiotherapy. In very rare cases (less than 4%), surgery may be needed. Ernest Syndrome This TMJ-like problem involves a tiny ligament structure that connects the base of the skull with the mandibular or lower jaw. If injured, the structure can produce pain in the face, head, neck, temple, ear, cheek eye, throat and/or TMJ. Treatment of Ernest Syndrome, which is successful about 80% of the time, consists of injections of local anesthetic and medication (like cortisone or Sarapin), physiotherapy and, at times, the use of an intraoral splint. Occipital Neuralgia This disorder is characterized by pain radiating to one or both sides of the head, temples, cheek and forehead and particularly pain above and behind the eye.  This is attributed to the sensory nerve supply to the globe of the eye socket. Trigeminal Neuralgia Also known as tic douloureux, this is a disorder of the trigeminal, or fifth cranial nerve. It is characterized by sharp electrical pain, which lasts for seconds. The pain is triggered by touching a specific area of the skin, as when washing, shaving, applying makeup, brushing the teeth, kissing or even from exposure to cold air. The pain is often very severe. Atypical Trigeminal Neuralgia In contrast to the typical type, atypical trigeminal neuralgia produces constant pain that increases or decreases in intensity. There are trigger zones, but there is also an area of dull aching. A common cause of this disorder is trauma, especially after a surgical incision or blow to the face. (June: how is it treated? does it go away or is it chronic? what do you do for it?) Atypical Face Pain While the same trigeminal nerve is involved in atypical face pain, in this case the facial pain seems to affect people who are under a tremendous amount of stress or have a history of psychiatric problems. Neuralgia Inducing Cavitational Osteonecrosis (NICO) Also known as osteocavitational lesions or Ratner’s bone cavities, this disorder produces pain similar to that of typical and atypical trigeminal neuralgia as well as referred pain patterns. There are trigger areas for the pain, which, in this case, develop directly over areas of dead bone. Generally, the lower jaw is affected more often than the upper jaw

5 Best Ways To Stop Wisdom Tooth Pain

Ways To Stop Wisdom Tooth Pain

1.  Partial bony impacted wisdom teeth typically are associated with inflammed tissue on the back portion of the tooth(distal portion).  This tissue gets intermittently edematous and is an area of a focal infection.  It acts as a food trap and hard to reach area, which can cause an infection(pericornitis).  This focal infection can be sporadic and unpredictable, which in extreme cases can require antibiotics.  A severely decayed tooth can also cause an infection in the form of an abcess.  An abcess usually forms at the base of a tooth root and purulence(pus) develops in a focal region.  The pus is encapsulated in a wall of epithelium and penetrate bone/sot tissue, which results in soft tissue swelling.  Antibiotics is the therapeutic choice to resolve an infection.

2.  Tooth pain can be very excruciating and could require potent pain meds.  Analgesics(Narcotics) are stronger meds that can alleviate painful toothaches.  These meds are required to be prescibed by a licensed dentist or physician.

3.  NSAIDS are non-steroidal anti-inflammatory drugs.  Motin and alleve are two excellent examples, which can reduce the inflammatory process associated with a painful tooth.

4.  Warm salt water rinses is a method of washing debris in the area of an infected tooth.  For example, removing debris form under the tissue of a partially impacted wisdom tooth can reduce the probability of pain and infection.

5.  Warm heat is a great adjunct to assist in reducing swelling and drawing the abcess to a halt.  Heat assists in localizationof the abcess to help identification and drainage.

www.southerngeorgiaoms.com
Roger Myers DMD

Southern Georgia Oral surgeon Hinesville Ga. and Oral Surgeon Statesboro Ga.: Top 10 Reasons to have wisdom teeth removed

Southern Georgia Oral surgeon Hinesville Ga. and Oral Surgeon Statesboro Ga.: Top 10 Reasons to have wisdom teeth removed

Top 10 Reasons to have wisdom teeth removed

Wisdom Teeth- Southern Georgia Oral Surgery
Why We Should Remove Wisdom Teeth
Roger Myers DMD

Why do they cause so many issues for us?
The more patient evaluations for wisdom teeth that I perform, the more I ponder on their lack of necessity.  When a wisdom tooth is erupting, I call it the adult teething stage and the symptoms for a tooth erupting for a child appear to the same.  The infection, erythemas, swelling and pain appear and removal of the tooth is warranted.  Called "wisdom teeth" because they emerge later in life, the upper and lower third molars generally cause problems because there is not enough room in the mouth for them to erupt, or break through the gum, into a normal position. As a result, these molars are often left impacted in the gum or jawbone. Impacted teeth can lead to a variety of problems including pain, infection, crowding, or damage to adjacent teeth, and can contribute to more significant inflammation that can spread to other teeth, which can compromise the integrity of adjacent teeth.
2. Oral inflammation associated with wisdom teeth may contribute to preterm or low birth weight infants.  Extremely important to pregnant patients.
3. Fully erupted wisdom teeth rarely provide meaningful use and are difficult to keep clean.  Their incidence of developing caries is very high.
1. Limited space for wisdom teeth to erupt can lead to infection and by, the risk of caries is always present.
4. Impacted wisdom teeth may develop associated cysts and/or tumors that could require extensive procedures to remove & repair jaw function and appearance.
5. Chance of complications related to the removal of wisdom teeth increases with age.  The tooth position and roots may compromise the nerves and blood vessels.
6. Gum disease and inflammation associated with wisdom teeth may lead to receding gum tissues, deterioration of the jawbone and tooth loss.
7. Full eruption of wisdom teeth may lead to crowding of nearby teeth.  Normally the lower anterior mandible is affected with the canine to canine area being most compromised.
8. Even wisdom teeth that seem to be problem-free remain a breeding ground for oral infection & inflammation. This inflammation can enter the bloodstream and contribute to the development or progression of diabetes, heart disease, and stroke.
9. Wisdom teeth removed at an early age allows for easier and faster recovery. TRUE
10.  They serve absolutely no function at all.

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Pediatric Oral Surgery-Removal Of A Compound Odontoma.

Southern Georgia Oral Surgery

What is a compound Odontoma?
A compound odontoma has the three separate dental tissues (enamel, dentin and cementum), but may present  as a lobulated appearance where there is no definitive demarcation of separate tissues between the individual "toothlets".  Several small abnormal teeth surrounded by a fibrous sac tumor of enamel and dentin arranged in the form of anomalous miniature teeth.  The associated tissue usually appears as characteristic dentigrous cyst type.  It usually appears in the anterior maxilla and in some instances a compound odontoma can be positioned in a manner that compromises the adjacent teeth.  It is usually asymmtomatic and in most cases only be discernable with utilization of a radiograph.  However, cases have been reported to exhibit focal swelling of the affected site.  This appearance would and could be the impetus for the patient to be evaluated by a dentist.

Differential Diagnosis

Compound odontomas can be detected easily due to their tooth-like appearance. Complex odontomas can be differentiated from cemento-ossifying fibromas due to their propensity to be associated with crown of unerupted molar and they are more radiopaque than cement-ossifying fibromas. They can also develop at much younger age than cemento-ossifying fibromas. A dense bony island can be included in the differential. However, the presence of a soft tissue capsule is very useful in differentiation. Periapical cemental dysplasia may resemble complex odontomas but usually they are multiple, surrounded by sclerotic borders and centered around apices of teeth, whereas odontomas are commonly found occlusal or overlapping the involved teeth

Radiographic Features

The borders are well-defined, often with a cortex surrounding a soft tissue capsule. The internal structure is largely radiopaque. They often interfere with normal eruption of teeth. They can be associated with impacted, malposition, malformation, and displacement of adjacent teeth.

Treatment

Compound and complex odontomas are easily removed by simple excision. They do not recur and are not invasive.

Case Study
The patient presented as an 8yr old male, No Meds, NKDA
The patient was referred from their general dentist in order to be evaluated for a radiopaque mass in right maxillary region.  The patients clinical evaluation revealed a prominence of the buccal aspect of the right maxilla, that was non-tender or fluctuant.  Primary teeth "B" and "C" were present, but were mobile, decayed and required extraction.  Radiographically, there was a radiopaque mass positioned above teeth "B" and "C".  The mass was approximately 1cm x 1cm and inhibited the eruption of  the permanant premolar.  The plan was to remove the affected primary teeth and remove the mass/associated tissue for biopsy.  The procedure was performed under IV sedation successfully.
It was our intention not to place bone graft material in the bony defect after the surgery.  The goal was to allow full maturation of the remaining premolar, which should spontaneously assume its position in the dentition.  The patient will receive follow up every 6 months for a clinical evaluation and serial radiographs.

Path Report

Decalcified sections show multiple "toothlets" which show abnormal morphologic pattern.  Fragments of bone and connective tissue also appear.  Remnants of what appears to represent a dentigerous cyst associated with the lesionis also noted. 

Post op Visit
The patient returned one week later to examine the surgical site post-operatively.  Minimal swelling was evident and the patient exhibited no complaint of discomfort.  A bone graft to obliterate the bony defect was not suggested as to not inhibit the eruption of the permanant tooth.  The patient will be place on a 6 month recall for further observation and evaluation of the region.
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10 Signs Of A Canine Space Infection

Many patients come into my office to be evaluated for varying reasons, but some of the most dramatic and life-threatening cases are infections.  Overtime I have assessed that one of the most serious facial infections is the canine space infection.  This infection is typically associated with a severely decayed maxillary canine and deisplays the following signs/symptoms:

1.  Periorbital cellulitis(Swelling)
2.  Periorbital Erythema(redness)
3.  Blurry vision-due to closure of the upper/lower palpebral space and associated edema
4.  Exquisite pain to palpation-due to the presence of the infraorbital nerve which is approximately
     one inch below the infraorbital rim
5.  Cheek and upper lip swelling-cellulitis is the tissue spread of the infection which results
     in inflammation, swelling and puffy tissue.
6.  Focal abcess-this is a centralized and indurated area walled off with epithelium.  This can
     be fluctuant or hard and can enlarge as the infection progresses.
7.  Limited opening due to perceived pain
8.  Parathesia of the accessory sensory nerves due to swelling
9.  Headaches, earaches and affected side generalized facial pain
10.  Risk of cavernous sinus thrombosis

Methods of how to resolve this condition will be discussed on my next entry

Oral surgeon Statesboro, Ga. and Oral Surgeon Hinesville,Ga.Southern Georgia oral Surgery- Facebook page

7 Reasons To Get Dental Implants

Reasons to consider dental implants to replace teeth
1.  Form and maintenance of facial profile
2.  Ability to chew foods adequately
3.  Esthetics and creation of a beautifule smile
4.  Preservation of bone
5.  Prevention of teeth from shifting
6.  Abilty to have pemanant dentition
7.  Securing attachments for removable prosthesis(i.e. partial, denture)

Southern Georgia Oral Surger
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Upper wisdom teeth and females

Southern Georgia Oral and Maxillofacial Surgery
Dentist in Hinesville and Statesboro Ga.
www.SouthernGeorgiaOMS.com

In my office we remove wisdom teeth on a regular basis.  Therefore, overtime I have discovered that female patients have a high prevalence of TMJ symptoms.  These TMJ symptoms are always accompanied with the presence of wisdom teeth(impacted or erupted) and an audible click is always present.  I always tell my patients that there is a space descrepancy and there is not enough room for the wisdom teeth.  As a result, complications manifest which present accordingly:
1.  Deviation upon opening
2.  Headaches
3.  Earaches
4.  Radiating pain to the head, jaw and neck region
5.  Pronounced pressure
6.  Mucosal inflammation
7.  Blurry vision or eye pain
8.  Locked jaw(open or closed)
9.  Limited opening.

I have discovered that this desciption is applicable to patients in the following age range: 14-22
Typically, once the teeth are removed, the pain and complaints diminish.

Have you noticed this incidence in your practice and how do you manage the symptoms and/or treat the condition?

IV sedation for pediatric patients(Oral surgeon-Hinesville, GA and Statesboro, GA)

www.SouthernGeorgiaOMS
Statesboro and Hinesville oral surgeon

IV sedation for pediatric patients in the oral surgery Setting

Providing the service of IV sedation in the oral surgery setting is a tediuos and anxious process.  It is even more unsettling when pediatric patients are the recipents of this modality of treatment.  I employ the following measures to ensure a safe and comfortable IV sedation experience for my patients.

1)  At the initial consultation build a rapport with the child.  This envokes and establishes a level of trust between you and the patient.  Communication is ultimately the key to success and it starts with formulating commonality with the patient.  I have patients that come to my office and say "your the only doctor that has spoken to me like a human being".  I emphasize in my office communication, compassion and politeness.
2)  Minimize the risk of aspiration by informing the patient not to eat or drink 8 hours prior to the procedure.
Inform the patient that this is a significant action to perform prior to surgery.
3)  To reduce the patients level of anxiety, I have them take a tablet of halcion 1 hour prior to the procedure.  This relaxes the patient and really promotes a better experience.
4)  Having the parent in the room prior to and during the placement of the IV.  This presents a factor of reassurance and less alienation for the patient.  Once again, I gently talk the patient through the process and I have never not been successful placing an IV involving a pediatric patient.

What modality or approach do you use in your office?

Four important tips after a tooth extraction

Southern Georgia Oral Surgery
Hinesville and Statesboro locations
WWW.SouthernGeorgiaOMS.com
Roger L. Myers DMD

Tooth extraction post-op management

1)  Prolonged bleeding
     Once a tooth has been extracted it is important to control post operative bleeding.  I always compare an extraction to a laceration on the skin.  Direct pressure will tamponade the bleeding and therefore create a clot.  Biting on guaze simulates this comparison and is effetive in most cases.  However, there are some instances where bleeding is prolonged.  In this case I always encourage patients to bite on a wet tea bag and the tannins(component of tea leaves) in most cases will stop the hemorrhaging.  This scenario has even been effective for patients on anticoagulants( i.e. coumadin, aspirin).

2)  Pain Control
      NSAIDS such as motrin are very efficacious in cotrolling pain and inflammation post extraction.  Of course time, level of difficulty and trauma incurred during and after the extraction influence how your body is going to respond.  It is also recommended to take antibiotics and stronger analgesics when warranted.  Thereby reducing the incident of pain and subsequent infection.

3)  Swelling
     The most profound swelling for any surgical procedure occurs 72 hours post-op.  The critical time to reduce the level and progression of swelling is 24 hours after the procedure.  Ice should be applied for the first 24 hours and then warm heat for a least three more days post-op.  This should in effect reduce the level of swelling evident after a toothe extraction.  I find that there is a considerably high correlation between the amount of swelling and level of pain one experiences.

4)  Dry Socket
      Dry socket is a circumstance that occurs after an extraction has been performed and a blood clot has not formed.  This results in bone exposure and leads to susequent radiating pain to the jaw.  There appears to be no effective remedy with the exception of strong analgesics.  Otherwise a visit to your dentist is warrantedto adress the issue of pain.  Dry socket paste(Eugenol) based paste is applied to the extraction site and acts as a medicament that coats the area and helps alleviate pain.

Top 7 reasons for removing wisdom teeth

Southern Georgia Oral Surgery - Hinesville Georgia
WWW.SouthernGeorgiaOMS.com

1)  Limited opening
     Commonly known as trismus.  This symptom usually appears when an infection is present with concomitant swelling(abcess or cellulitis).  This condition often occurs when a third molar is partially
erupted and has a food trap resulting in inflammation/erythema.
2)  Ear pain
     Some misinterpret this as an ear infection, but the nerves that give sensation to the tooth is the actual culptrit.  This is called referred pain and the origin of the nerve is in the area of the ear canal.
Many of my patients have been evaluated by their ENT because they think that an ear infection is present.  But to their surprise, there is no ear infection and the pain is comming from an infected wisdom tooth.
3)  Headaches
     The trigeminal nerve has many branches which provides sensation to one half of the face.  This nerve is bilateral and is stimulated only on the affected side.  Typically the headaches resolve once the wisdom teeth are removed.
4)  Loss of adjacent teeth
     If wisdom teeth are impacted(partial or complete bony) there is a possibilty of losing adjacent teeth.  Meaning that wisdom can exert pressure on an adjacent tooth which may result in decay and subsequent loss of a tooth.
5)  Crowding of Teeth
     Wisdom teeth apply pressure to adjacent teeth and eventually in most cases the lower front anterior teeth become crowded.  As a result, the crowding may require the removal of wisdom teeth and eventual orthodontic(braces) treatment.
6)  TMJ(Temporomandibular Joint Disorder)
     Wisodom teeth in the upper jaw can create a problem called TMJ.  In most cases our jaw structure is too small to accomodate all the teeth we have in the upper jaw.  In this case, the wisdom teeth are usually impinged between the adjacent tooth and the coronoid process of the lower jaw.  This arrangement creates limited opening, deviation of the jaw upon opening, locking and clicking, and specific pain to the ear.
7)  Cyst development
      When wisdom teeth do not erupt through the bone and tissue a cyst can develop.  Cysts associated with wisdom teeth are usually benign(dentigerous cyst), but some can become malignant(ameloblastoma).  Numbness, swelling and pain are variant indicators of a cyst.  However, symptoms some times do not appear at all clinically and require a radiograph for diagnosis.  If this occurs, the site will require treatment and continued follow-up over a number of years.

Roger Myers DMD oral surgeon@ Southern Georgia Oral Surgery

     

Southern Georgia Oral Surgery
Full scope oral and maxillofacial surgery office with two locations:  Hinesville and Statesboro, Georgia.
Dr. Roger Myers is the owner and operator of these locations and practices full scope oral surgery.  Procedures include the placement dental implants, removal of wisdom teeth and sedation for children/adults.  Our website is www.SouthernGeorgiaOMS.com which provides answers to all your questions convening the field of oral surgery.
Our mission is to educate the public in reference to oral surgical issues and provide guidance on how to address these issues should they arise.

  Roger