Hunterdon Oral & Maxillofacial Surgical Specialist

Facial lacerations can be a scary situation for anyone. That is why it’s best to visit experts, like us, who have expereience in treating and repairing facial injuries and trauma. However, we know that your recovery doesn’t end the moment you leave our doors. We want you to have the best outcome following surgery which is why we’re writing this to answer some of your most common questions and to give you our best tips for treating your wound as it heals.

• Know the general time table of healing. Within 2 days the cut should seal, and by 5 to 10 days it should be strong. In the first 3 months you may notice the skin around the scar may thicken and have a red or purple tint. By 4 to 6 months this process should reverse and the scar will flatten and the discoloration will fade. Usually by 6 months the scar will be completely healed, but there can be continued improvement for up to a year.
• There are many factors that impact your healing. How deep your cut is, its location, your age, and the way your skin heals all determine how visible a final scar will be. Younger skin actually produces thicker scarring.
• Apply ointment frequently to keep the wound moist. This can increase the speed of healing considerably and reduce scabbing, which actually increases the build up of scar tissue.
• Apply antibiotic ointment to prevent infection. An infected wound will make a bigger scar. Be sure to continue to apply antibiotic ointment or cream as directed by our team to keep the wound moist and fight off any infection.
• Make sure you know the signs of infection. Antibiotics will often be prescribed to prevent infection, especially if the wound is a result of injury. Contact us immediately if you see any signs of an infection including:
  • A large amount of pus coming from the wound
  • Increased redness or swelling
  • Fever
• Massage the wound gently to increase blood flow. Sutures are usually removed between 5 and 8 days. Massage the wound after sutures have been removed using a moisturizing lotion with Vitamin E or Aloe. Gently massage the skin around the wound twice daily for the first two weeks, and then once a day for a month. This will increase the blood flow in the area and prevent scar tissue build up.
• Be gentle and avoid scrubbing your wound. It is usually okay to allow clean shower water to wash over the wound as long as you don’t scrub it. If crusts of blood accumulate, lightly dabbing with clean gauze moistened with hydrogen peroxide is best.
• Avoid sun exposure. It is extremely important that you do your best to avoid sun exposure. The scar may tan a much darker color than the skin around it, and this may become permanent. Cover the area as much as possible or use sun block of SPF#50 or greater.

Whether you have had elective surgery or surgery to repair a facial injury we hope that these tips help answer your questions. If you or your loved one ever requires a trip to the emergency room involving a facial injury or laceration, be sure to seek our consultation as soon as possible and please contact us with any additional questions that you may have.

Sometimes jaw problems may require more than orthodontic treatment. Jaw surgery, also known as orthognathic (or-thog-NATH-ik) surgery, can be a great choice for moderate to severe jaw issues.   Oral and Maxillofacial Surgeons (OMS) are specially trained in orthognathic surgery that can dramatically improve chewing, speaking, breathing, and in the process enhance a patient’s appearance. If you are considering orthognathic surgery, here are some important things to know.

Why You May Need It. Most conditions that require corrective surgery are the result of abnormal growth of the jaws as they develop. These conditions are often inherited. Other less common causes are facial injury or arthritis of the jaw joints.

Orthognathis surgery may be indicated for the following conditions:

-Difficulty biting, chewing or swallowing food

-Excessive wear or breakdown of teeth

-Chronic jaw or jaw joint pain caused by TMJ (temporomandbular joint disorder) or other jaw problems

-Improve “gummy” smiles, where the lips don’t fully close and show large areas of the gums or “toothess” smiles, where the lips cover all of the teeth

-Facial imbalance, including underbites, overbites, crossbites, and deficient chins

-sleep apnea

Treatment Team. While we will plan and perform the actual surgery, we will also be working with your dentist and orthodontist for the full course of treatment. Most treatment includes braces for 9 to 18 months before surgery to level and align your teeth. After your jaw heals from surgery, which typically takes about 6 weeks, your orthodontist will finish your alignment and remove the braces. Depending on the severity of your jaw problem, the entire treatment process can take from 12 to 24 months. We know that this is a long-term commitment and we will do our best to minimize the length of treatment and provide you with the best estimates of what will be required.

What to Expect. Jaw surgery can be performed on the upper jaw, lower jaw or both. It is best to perform the surgery after growth stops, usually ages 13 to 15 for females and 16 to 18 for males. Jaw surgery usually can be performed entirely inside your mouth, so no facial scars show. Once your jaws are properly aligned, screws and bone plates secure the bones into their new position. In some cases, extra bone may be added to the jaw. In this case, we transfer the bone from your hip, leg or rib and secure it with temporary wires.

Surgery can take place in an in-patient or out-patient setting, depending on the procedure required. Facial swelling, while variable, is common and increases for a couple of days following surgery before it subsides. More subtle changes in your appearance will continue for up to a year. For this reason, our students generally choose to have the surgery during school vacations. For adults, one to three weeks is usually required before returning to work.

Jaw surgery can enhance your comfort, appearance, and improve your overall health. We are here to answer any questions you have. Please make an appointment for a consultation so we can review the potential of this life changing treatment with you!

Your son is playing a championship game against the team he’s waited all season to play. The score is tied, and as the minutes wind down, the players have gotten more forceful in their actions. You blink, and all of a sudden your son is holding his mouth and a time-out has been called. You run down to him, and your mind is racing, “What happened? How hurt is he?” As you approach him, you see that in his hand he is holding an adult tooth that has been dislodged from the socket. As the sideline paramedics assess for signs of a concussion or hemorrhage you think, “Now what?”

The injury, and circumstances surrounding the injury may cloud your ability to choose your next action. You can rest assured knowing that when you mix today’s technology and the expertise you can expect from a coordinated team approach, the tooth’s fate is looking brighter already!

In the case of avulsion (when a tooth is out of the socket), the approach will most likely be a team effort. Your first course of action following the injury is to rinse off the tooth and try to place it back in the socket. If this is not possible, place the tooth in milk. If you’re expecting an injury like this (as a coach or school teacher etc. might), have Hank’s Balanced Salt Solution on hand to place the tooth in. Water should never be used to place the tooth in. Why milk? Milk maintains the correct fluid balance in the root of the dislodged tooth, which in turn increases the tooth’s chance of survival. Water causes the cells in the tooth to swell and die. If there is no option to place the tooth in any of the approved solutions, place the tooth in between the injured person’s cheek and gum to keep it moist.

After you have arrived at our office, it’s time for us to take over. The investigation phase begins. If a concussion or hemorrhage has not been ruled out, now is the time. When the coast is clear, it is time to move onto a gathering of both radiographic evidence of the injury and clinical documentation about the patient and the incident. From that extracted information, we can make a diagnosis and a subsequent treatment plan. As we mentioned before, depending on the type and severity of the injury, the process may involve a dental professional team.

The aim of treating a tooth trauma case is always to maintain or regain pulpal vitality in the affected tooth/teeth.

In the next few months we will cover other types of tooth injuries and treatments. Stay tuned!

It’s estimated that 125 million Americans are missing at least one tooth. If you are one of them, you may be considering dental implants for tooth replacement. We think it’s important for you to know what factors make a person a good candidate for such a procedure. Here are a few things to consider.

Most People Are Good Candidates. Dental implants can replace one, several, or all of your teeth. They can be used in place of bridges or dentures. Good candidates have healthy gums and are old enough so that their jawbone has stopped growing. You should also have enough bone to support and anchor the implants. Even if you have lost bone in your jaw, however, you may still be a good candidate for implants. In fact, dental implants may be recommended to prevent further bone loss. In these situations, bone can actually be rebuilt with grafting procedures as part of the implant process.

Evaluation. Successful implantation starts with a thorough evaluation of your jaw, teeth, mouth and overall health. You will receive a mouth X-ray and possibly a Computed Tomography (CT) scan. This will help us identify areas of bone loss and carefully see the shape of your sinuses and nerve location to make accurate assessments for your treatment. We will also do a thorough medical evaluation, as your overall health and history plays a big role in how well your implant will heal and fuse to the bone.

People At Risk of Poor Outcomes. Uncontrolled diabetes, cancer, radiation to the jaws, smoking, alcoholism, or uncontrolled gum disease are all risk factors that can adversely affect your outcome. You may still be a good candidate with one of these diseases, but we’ll want to thoroughly assess your situation and work with you and your doctor to increase your overall health and functioning. People who take certain medications, such as steroids or drugs that suppress the immune system may not be suitable candidates, either. And people with certain habits, such as people who severely grind or clench their teeth may put too much pressure on the implants, causing long term damage.

Overall, dental implants have a very high rate of success and patients tell us how happy they are with the outcome. If you are considering implants, we can complete a careful examination to determine what options are best suited for you. Call us today to make that appointment!

It seems like something out of a science fiction movie, but with our help, you can easily re-grow bone to treat many common disorders in the mouth and make it dental-implant ready! Bone grafting is a common procedure done right in our office. Here is a simple explanation of this effective treatment option.

Reasons for Bone Grafting. There are many different reasons that a person loses bone support in the jaw. Sometimes it is due to injury, sometimes it because of missing teeth, and other times it is a due to a developmental defect or periodontitis. Bone graft surgery, also called regenerative surgery, is used to replace bone and soft tissue by actually stimulating the body’s natural ability to re-grow the lost tissue.   If your jawbone is inadequate to support dental implants, bone grafting can be used to build a sturdy foundation for implant-supported teeth.

It’s A Natural Process. With bone grafting surgery, a piece of bone is removed from another area of your jaw or your body, often the hip, and is transplanted into your jawbone. Sometimes we may use donor or synthetic graft material. Your body uses the implanted bone graft material as a frame on which it can grow new bone. Over time and with your body’s own healing mechanisms, the grafted bone fuses and becomes an integrated part of your existing bone. Bone grafting is a safe and very successful procedure that can be done in the office under local anesthesia. After the procedure, you will be given antibiotics and pain medication if needed. Swelling can be treated with ice packs applied to your face. Most patients proceed with their normal life the next day. Be sure to follow medication instructions and keep your mouth as clean as possible while you heal.

Healing Times. Healing time following bone grafting depends on the amount of bone loss and the location of the graft area. Maintaining a healthy amount of bone tissue around your teeth is crucial to keeping up your oral health. We are more than happy to explain different materials and techniques that can be used for an optimal outcome.

Bone grafting allows your body to rebuild itself. It can be a great way to restore your natural jaw line and smile. Let us help you decide if bone grafting is the right procedure for you!

When compared to the costs of other tooth replacement options, boy do dental implants seem expensive! Yet you may be surprised to learn that, in the long run, dental implants can be more affordable than their traditional counterparts. Understanding this procedure and the factors that determine the costs can help you decide if dental implants are a good investment for you!

What is a Dental Implant? A dental implant is a permanent replacement for lost teeth. It is made of an artificial tooth firmly held in place by a tooth root made of titanium (which is biocompatible) that is surgically placed into your jaw. Dental implants help stabilize the jaw and the bone around it to avoid future bone loss and maintain the shape of your jaw. They never have to be removed and feel more natural and comfortable than dentures. And unlike bridges or crowns, which are cemented in, the chances of slippage or shifting are eliminated. With implants, talking and eating become worry free.

Steps In a Dental Implant Procedure. We will first use extensive imaging to determine bone health, height, and thickness to assess your bone and teeth structure carefully. The surgery itself is done in our office in separate stages. First, the implant is surgically placed into your jawbone, completely hidden within your gum tissue. Once the implant has integrated into your bone, a healing process of about 4 to 6 months, the next stage is the placement of the abutment, or the post that penetrates the gum and will connect the replacement tooth to the implant. The final stage involves attaching your artificial tooth (made from impressions of your natural tooth) to the abutment. If more than one tooth is being replaced, a removable bridge is used, as it is more affordable than implanting each tooth separately. For a bridge, it takes only one implant on either side to span an area holding several teeth. The bridge snaps into place for a more permanent and natural fit than dentures.

Factors That Affect the Cost. While dental implant surgery is a safe and routine option, it is a complex procedure that takes time and expertise to be done effectively. There are many factors that will influence the final costs including what X-ray and CT scans are necessary to evaluate and assess the implant area and the brand and material of the post, abutment and artificial teeth. However, the biggest cost factor is the complexity of the surgery itself. For example, how many teeth are we replacing and what is the location? Will additional procedures, such as bone grafting or sinus elevation be required? We do our best to make sure that your estimate includes all of the possible costs of each of the steps of your procedure.

While dental implants may seem expensive, they are often more affordable in the long run than traditional restoration methods such as crowns and bridges, which are more vulnerable to damage and usually require repairs or replacement every few years.

Dental implants are known to have a 95% success rate when completed by professionals with the right experience and training, such as us! Because dental implants offer a permanent solution, are natural and comfortable, and require little maintenance, they are a cost effective choice for most of our patients.

Injuries to the face and mouth are emotionally upsetting as well as physically damaging. It’s extremely important to have medical and dental care by experts who know how to address the psychological, medical, and aesthetic elements of recovery. This blog will cover the most common causes of facial trauma and the types of injures that may occur. As with most injuries, prevention is the best medicine, so we will cover tips in avoiding facial trauma all together!

Most Common Causes of Facial Trauma: There are many ways in which the face can be damaged. Accidents, falls, automobile crashes, work related injuries, and interpersonal violence are among the most common causes for adults. For children, sports related injuries are the leading cause. Children who participate in contact sports, cheerleading, and gymnastics are especially at risk, especially for dental trauma. Dental trauma accounts for 17% of injuries to the body for children, according to the American Dental Association, compared to 5% across all ages. It is most frequently observed in males compared to females, and usually involves the front teeth.

Types of Injuries: Every year about 3 million people are treated for facial trauma according to the American Association of Oral and Maxillofacial Surgeons. Soft tissue trauma includes any cuts to the face or gums. Avulsed, or knocked out teeth are another type of injury, and must be dealt with immediately to increase the chances for reimplantation. Bone injuries, such as fractured jaws, cheekbones, and noses can also occur as well as damage to the nerves in the eyes, face and salivary glands. It is extremely important to have facial trauma assessed and treated by an expert in facial trauma. Besides the aesthetic reasons, serious health complications can occur, even from a small amount of damage. Depending on the location of the injury, speech, swallowing, and breathing can be affected. For dental injury, teeth that are loose in their sockets can make eating difficult and cause speech impediments. Chipped, broken, or misaligned teeth can cause TMJ and other functional problems, in addition to the loss of confidence in your appearance.

What You Can Do to Prevent Injuries: Using a mouthguard during sports or other high-risk activities is the most effective way to prevent injury. Studies in high-risk populations for facial trauma show relatively low compliance in using mouthguards. We can also recommend helmets, face shields, and protective eyewear that can further reduce your risks. The spring season seems to bring an increase of children to the emergency room as kids are eager to get on their bicycles, skateboards, and swing sets. As a parent, educate your child in safety measures and supervise their activity.

People often wonder, “How does a tooth get to the point of infection?”

It’s a common misconception that teeth are not alive. That belief leads to confusion about how teeth become infected. Because you can’t “feel” the part that you can see (the crown), many people think that their teeth are not alive. Yet, the opposite is true. Most of the material that makes up your teeth is, in fact, made of living cells. Since the material is alive, it makes a great hosting site for bacterial infections!

Similar to hair and fingernails, there is a part of your teeth that is not alive – it is the outermost part, called “enamel”. This is the hard, white part that you can see. It is made of calcium phosphate, a very hard mineral that is perfect for breaking down food when you eat. Underneath that enamel, however, is where all of the live action happens!

Starting on the outside and working our way in, we find dentin (alive), and then the pulp cavity and root canal, through which nerves and blood vessels flow.

Generally speaking, if the enamel is intact, bacteria cannot get through to the pulp to cause problems. However, if there is a crack in the outer part of the tooth due to injury or decay, this creates a pathway for bacteria to enter into the innermost part of the tooth (the pulp cavity and canal) causing infection of the living tissue.

That is when endodontic treatment becomes essential! The only way to remove the infected material is manually, by accessing the canal itself, irrigating and then filling, or closing off access, to the inside of the tooth again.

The practice of bone grafting is nothing new. In fact, it goes back hundred of years to a time when a Dutch doctor implanted a dog’s bone into an injured soldier’s skull. The soldier later wanted it removed but it could not be removed, as it had bonded so closely to the bone. This brings up a very common question that we hear in our practice: What is a bone graft made of?

What the Dutch doctor didn’t know was that the implanted bone was likely resorbed by the patient’s body and replaced with his natural bone. This natural process is called “guided bone regeneration”, and it is one of the reasons that bone grafting has worked so well over time!

Naturally, patients are concerned about where their bone grafting material has come from. But in all cases, we stress that the material that we implant is not the final material that you will have in there. Bone grafting material is really just a place-holder, it encourages (and fools) your body into producing more bone in that site, and in the process resorbs the material that we have implanted.

Here are some common sources for bone grafts:

• The skull, hip, and lower leg bones are very effective and common donor sites.
• Tissue banks may be used when more bone is needed.
• Shavings: If we drill into your jaw, naturally there will be shavings that are produced during the procedure, and often they make ideal bone grafting material!
• Synthetic bone grafting materials.

It is natural to be concerned about what type of tissue we are implanting into your body! Please don’t hesitate to ask us questions about this or your other upcoming procedures.

Regular oral pathology exams are extremely important when it comes to preventing head and neck cancer. When you visit us make sure to ask about the exam if you haven’t had one before or have noticed anything strange on the inside of your mouth. It’s also good to perform an oral pathology check on yourself from time to time. Let’s go over how to do an at-home check and what you should be looking out for.

Step 1: Know what you’re looking for. Oral cancer signs include:

• A difference in color in one particular area
• A change in texture
• Lumps of any kind (especially if it’s something you haven’t noticed before)
• Lesions

Step 2: Take a bright light such as a flashlight and while looking in a mirror, check the following:

• Lips
• Tongue
• Cheek walls
• Top and bottom of mouth
• Back of throat

If you notice any of the above signs, give us a call immediately to schedule an appointment. It’s also beneficial to perform an extra-oral screening. When performing an extra-oral exam on yourself, you want to feel for any lumps or bumps. Here are the steps for doing this exam at home:

Step 1: Place your hands on the back of each side of your jaw under your ears. Open and close your jaw while feeling for any bumps.

Step 2: With your hands in the same position work your way down your neck.

Step 3: Turn your head to the right and feel your left side-neck muscles. Turn your head left and feel your right side neck muscles.

Step 4: Grab your gullet and swallow.

Step 5: Put your chin down and with your palms facing away from you feel the underside of your jaw with your fingers.

We hope we don’t have to see you in the office if you’ve discovered something wrong but we are here to help. We can catch the early signs of oral cancer! If you feel anything strange, call us to schedule an appointment.