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