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Facial Neuropathology

The dentist is frequently called upon to determine the etiology of pain in the oral-maxillofacial region. Although oral pain is most frequently of odontogenic origin, many facial pains arise from other sources. The diversity of structures in the head and neck region (e.g., eyes, ears, salivary glands, muscle, joints, sinus membranes, intracranial blood vessels) can make arriving at an accurate diagnosis challenging. Even typical toothache symptoms…

Surgical Reconstruction of Defects of the Jaws

Defects of the facial bones, especially the jaws, have a variety of causes, such as eradication of pathologic conditions, trauma, infections, and congenital deformities. The size of the defects that are commonly reconstructed in the oral-maxillofacial region varies considerably, from small alveolar clefts to mandibulectomy defects. Each defect poses a unique set of problems that reconstructive surgical intervention must address. In each of these instances, restoration…

Management of Patients With Orofacial Clefts

A cleft is a congenital abnormal space or gap in the upper lip, alveolus, or palate. The colloquial term for this condition is harelip . The use of this term should be discouraged because it carries demeaning connotations. The more appropriate terms are cleft lip, cleft palate, or cleft lip and palate. Clefts of the lip and palate are the most common serious congenital anomalies to…

Facial Cosmetic Surgery

Introduction and Historical Perspective From a historical perspective, cosmetic surgery in the United States has been primarily performed by plastic surgeons, including both facial and body cosmetic surgery. As time went on, with the introduction of competing specialties, such as otolaryngology, a shift in this practice occurred. Otolaryngologists, with their expertise in nasal surgery, began to expand the field and slowly entered the arena of facial…

Correction of Dentofacial Deformities

Prevalence of Dentofacial Deformities Epidemiologic surveys demonstrate that a large percentage of the U.S. population has a significant malocclusion. Very little data describe the exact prevalence of significant skeletal facial deformity. This information can be extrapolated from studies that have evaluated the prevalence of severe malocclusion. The National Health and Nutrition Examination Survey III, conducted from 1989 to 1994, obtained a sample of 14,000 individuals ages…

Management of Facial Fractures

Trauma to the facial region frequently results in injuries to soft tissue, teeth, and major skeletal components of the face, including the mandible, maxilla, zygoma, naso-orbital-ethmoid (NOE) complex, and supraorbital structures. In addition, these injuries frequently occur in combination with injuries to other areas of the body. Participation in the treatment and rehabilitation of the patient with facial trauma involves a thorough understanding of the types…

Soft Tissue and Dentoalveolar Injuries

Soft Tissue Injuries The types of soft tissue injuries the dentist may see in practice vary considerably. However, it is fair to assume that given the current availability of other health care providers, the dentist will probably not be involved in the management of severe soft tissue injuries around the face. Those injuries seen with some frequency are the ones associated with concomitant dentoalveolar trauma or…

Surgical Management of Oral Pathologic Lesions

The specific surgical techniques for the treatment of oral pathologic lesions can be as varied as those for the surgical management of any other entity. Each clinician surgically treats patients using techniques that are based on previous training, biases, experience, personal skill, intuition, and ingenuity. The purpose of this chapter is not to describe the specifics of surgical techniques for the management of individual oral pathologic…

Principles of Differential Diagnosis and Biopsy

Examination and Diagnostic Methods Lesions of the oral cavity and perioral areas must be identified and accurately diagnosed so that appropriate therapy can eliminate them. When abnormal tissue growth is discovered, several important and orderly steps should be undertaken to identify and characterize it ( Fig. 22.1 ). These steps include a comprehensive health history, history of the identified lesion(s), clinical and radiographic examinations, and relevant…

Diagnosis and Management of Salivary Gland Disorders

As experts in the oral and maxillofacial region, the practicing dentist and dental specialist may be required to perform the necessary assessment, diagnosis, and management of a variety of salivary gland disorders ranging from minor, self-limiting disease processes to more significant disorders of the major and minor salivary glands; thus a thorough practical knowledge of the incidence, demographics, embryology, anatomy, and pathophysiology is necessary to manage…

Odontogenic Diseases of the Maxillary Sinus

Embryology and Anatomy The maxillary sinuses are air-containing spaces that occupy maxillary bone bilaterally. They are the first of the paranasal sinuses (e.g., maxillary, ethmoid, frontal, and sphenoid) to develop embryonically and begin in the third month of fetal development as mucosal invaginations or pouching of the ethmoid infundibula. The initial maxillary sinus development, also termed primary pneumatization , progresses as the invagination expands into the…

Management of the Patient Undergoing Radiotherapy or Chemotherapy

Dental Management of Patients Undergoing Radiotherapy to the Head and Neck Radiotherapy (i.e., radiation therapy and x-ray treatment) is a common modality for treating malignancies of the head and neck. Approximately 30,000 cases of head and neck cancer occur each year in the United States. The use of therapeutic irradiation to treat this cancer is ideally predicated on the ability of radiation to destroy neoplastic cells…

Principles of Endodontic Surgery

Endodontic surgery is the management of periradicular disease by a surgical approach. In general, this includes abscess drainage, periapical surgery, corrective surgery, intentional replantation, and root removal ( Box 18.1 ). Box 18.1 From Thomas P, Lieblich SE, Ward Booth P. Controversies in office-base surgery. In: Ward-Booth P, Schendel S, Hausamen J-E, eds. Maxillofacial Surgery . 2nd ed. London: Churchill Livingstone; 2007. Factors Associated With Success…

Complex Odontogenic Infections

Introduction Orofacial infections are the most common reason that patients present to the dentist or dental specialist; the infections are primarily due to dental caries, with inflammatory periapical pathology manifesting clinically as pain and swelling. However, periapical lesions involving the root apex may extend to, and beyond, the bone of the maxilla or mandible, then spreading to the adjacent and distant soft tissues. In general, odontogenic…

Principles of Management and Prevention of Odontogenic Infections

Odontogenic infections are commonly encountered clinical problems that may have serious consequences if not managed promptly and properly. Although a wide range of clinical practitioners, including emergency medicine and primary care physicians and nurse practitioners, encounter odontogenic infections, the role of the dentist is crucial and indispensable. It is imperative to thoroughly understand the pathogenesis and natural progression of infections in the head and neck region…

Implant Treatment: Advanced Concepts and Complex Cases

Chapter 14 focuses primarily on the clinical evaluation and surgical, as well as prosthetic, considerations for basic implant treatment. The techniques described in that chapter primarily focus on clinical situations where adequate bone and soft tissue exist and implants can be placed into a well-healed area of bone without jeopardizing anatomic structures such as the maxillary sinus or the inferior alveolar nerve. There are situations where…

Implant Treatment: Basic Concepts and Techniques

The dental profession has experienced tremendous advancements in dental restoration therapies that are effective, efficient, and predictable. Techniques, materials, instrumentation, and science have evolved to afford the dental patient every opportunity to enjoy a healthy and functional dental life. In spite of all the advancements and opportunities, there still exists a significant population of patients who are either partially or totally edentulous. Dental implants have given…

Preprosthetic Surgery

After the loss of natural teeth, bony changes in the jaws begin to take place immediately. Because the alveolar bone no longer responds to stresses placed in this area by teeth and the periodontal ligament, bone begins to resorb. The specific pattern of resorption is unpredictable in a given patient because great variation exists among individuals. In many patients, this resorption process tends to stabilize after…

Medicolegal Considerations

Dentistry is a discipline in which most practitioners regularly perform invasive procedures. Thus, similar to physicians, particularly those who commonly do procedures, dentists are subject to claims of dental malpractice. Some of the most common lawsuits against dentists relate to the extraction of the wrong tooth, failure to diagnose a problem, and lack of proper informed consent, which are all problems that may occur when a…

Postextraction Patient Management

Many patients have more preoperative concerns about the sequelae of surgery—such as pain, swelling, and complications—than about the procedure itself. This is particularly true if they have confidence in the surgeon and planned anesthesia. The surgeon can do many things to mitigate the common problems patients face after surgery. This chapter discusses those strategies. This chapter also discusses the most common complications, some minor and some…