Quality & Affordable Dentistry in Malaysia

Oral Surgery in Selangor, Malaysia

Posted by dentist3 in Dental Articles | 0 comments

When most people think about going to the oral surgeon, they are visualising wisdom teeth being extracted.
When most people think about going to the oral surgeon, they are visualising wisdom teeth being extracted.

Dental Surgeons in Selangor, Malaysia

Training to be an oral and maxillofacial surgeon in Malaysia is perhaps the most intense and comprehensive of all of dentistry’s specialties. In a sense, this training encompasses two specialties: that of surgeon and also of general anaesthesiologist. Each is a specialty in itself in the medical doctor (MD or MBBS) specialties. And, that is, no doubt, why most Malaysian Dental Council recognised programs are three or four years in length. And today, many oral surgeons attend a full course at medical and dental schools, and then an internship in oral surgery.

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When most people think about going to the oral surgeon, they are visualising wisdom teeth being extracted. It’s true that this activity makes up a large part of their workload, but it is a very small portion of their abilities, knowledge, and procedures. So let’s talk about wisdom teeth. Also known as third molars or 21-year molars, they are the teeth the farthest back in our mouths. Not everyone has them as some people are genetically disposed to never develop them in the first place. Most people have them; but in some, they are impacted and may never erupt. Impaction means that they are under the gum tissue and often imbedded within the bone tissue as well. This latter situation is referred to as a “bony impaction” while the former is known as a “soft tissue impaction.” Other people have one or more of their wisdom teeth come into their mouths in a perfectly good alignment and functioning perfectly with their antagonists in the opposite arch and the second molars just in front of them. But, the more unfortunate patients have them erupt only partially or, in many cases, at an angle or even horizontally rather than vertically. 

When a partially erupted wisdom tooth’s surrounding gum becomes infected, treatment is necessary. There is usually a great deal of pain associated with this condition known as “periocoronitis.” If left untreated, swelling, blood and puss, an elevated body temperature, and an elevated white blood cell count will prevail. Proper treatment involves controlling the infection with antibiotics and the subsequent surgical removal of the offending tooth.

an impacted wisdom tooth MAY cause on and off dull pain if not removed
an impacted wisdom tooth MAY cause on and off dull pain if not removed

If a wisdom tooth is impacted but lying dormant, it is usually good preventive practice to surgically extract it anyway. These types of impactions often tend to push all the teeth in their respective quadrants in a forward direction, thus ultimately causing crowding, overlapping, and rotations of otherwise straight teeth. And, if orthodontics is in the picture for you, the diagnosing orthodontist will probably ask you to go to an oral surgeon for further diagnosis.

When third molars (Wisdom Tooth) are fully erupted and in ideal positions, they are still very difficult to keep clean because of their location so far back in the mouth. So, here again, it is probably a good idea to have them taken out.

In this situation, they will not need to be surgically removed and the procedure is usually relative trouble-free.

All of these procedures will offer you a choice of local or general anaesthetic. Your decision should be based upon the information given to you by each individual surgeon and you should make sure you have a complete discussion and understanding of these two or sometimes more alternatives. When you are satisfied that you have made an informed and intelligent decision on what will be best for you, an informed consent form will be required to be signed by you.

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The number of wisdom teeth to be extracted at each visit will be determined by you and the dentist as well; but in general, if you are going to be put to sleep, it is best to have all four or however many you have remaining removed all at once. This is more efficient and less costly for you and the dental operating team. Also, you will require just one general anaesthetic and your mouth will be sore only once, necessitating a single recovery period.

A local anaesthesia procedure may dictate that you do only two wisdom teeth at a time, the upper and lower ones on the same side of your mouth. The advantage of this method allows you to function on one side of your mouth while the other is healing. Also, you are less likely to bite your lips and cheeks and tongue while the anaesthesia is wearing off, as one side remains normal throughout.

There are other dangers of leaving third molars impacted. Occasionally, a cyst or other pre-cancerous lesion can form around them, thus endangering you to the prospect of needing much more extensive treatment when discovered. Most oral surgeons recommend removal if the patient is under 35 years old and leaving them if over 40. I have never heard them say what to do if one is between 35 and 40, but I should suspect that this becomes a judgment call to be worked out among the patient, general dentist, and oral surgeon.

Other specialties of the oral surgeon are implants, removal of other diseased and condemned teeth, eradication through surgery of abscesses, cysts, failed root canal infections (apioectomy), bone and tooth transplantation, artificial and real bone augmentation, and the very complicated and skilled discipline of maxillofacial surgery.

oral surgeons are exemplary trained in their knowledge of anatomical landmarks which are significant in the placement of dental implants
oral surgeons are exemplary trained in their knowledge of anatomical landmarks which are significant in the placement of dental implants

We will discuss each briefly, starting with implants. These are artificial metal, sometimes covered with hydroxyapatite (HP). They are strategically and surgically placed into the dental arches where teeth are missing and it has been diagnosed to have a favourable prognosis. Oral surgeons are uniquely qualified for this procedure because of their general anaesthetic abilities as many patients request this type of anaesthesia for implant surgery. In addition, oral surgeons are exemplary trained in their knowledge of anatomical landmarks which are significant in the placement of dental implants. And finally, if a particular case requires bone augmentation prior to the placement of the implant, they are familiar and experienced with this procedure as well.

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Teeth other than third molars are often times decayed beyond repair or too periodontally involved to be salvaged. Also, sometimes teeth are fractured beyond repair. In these cases, the oral surgeon again feels right at home and is highly qualified to handle any situation or complication that may result. In the cases of bone infections, broken and retained roots, abscesses, cysts, and fistulas, he or she is very experienced to perform the proper surgery.

Apicoectomies (the entry through the gums and bone into the root area of a tooth treated or being treated by root canal therapy) has long been one of the mainstays of endodontics. But in more recent years, the oral surgeon is increasingly performing this procedure as well.

Tooth transplantation especially autogenous (from one location to another within the same individual) can be successfully accomplished by the oral surgeon. This might be effective in the case of the loss of a first or second molar where a third molar is present and healthy within the same quadrant. The surgeon would remove the condemned tooth, then the wisdom tooth, place it into the freshly vacated socket, and hold it in place with any number of available dental splints. He may also place back an evulsed tooth (a tooth that has been forcibly removed from its socket either by an accident or a fight) if it has not been significantly damaged and proper precautions for saving it were taken. (See Chapter 3.)

Bone augmentation (GBR) – Guided Bone Regeneration (the artificial building up of bony areas deprived of a healthy supply of bone) can also be accomplished with either artificial bone or bone taken from other areas of a patient’s mouth or even his hip. This is performed to help make stronger foundations for implants or teeth that have lost valuable bone and which must be stabilised either just for their own benefit or, in some cases, so they can serve as  prosthodontics abutments (anchor teeth). 

Maxillofacial surgery involves a whole myriad of surgical procedures, including the ones just discussed. I want to relate an experience of an oral surgeon that I have worked with from time to time. 

Accidents from cars and other causes often require the treatment of oral surgeons to place the lower jaw bone into its maxillary (or upper part of the skull) socket. Many other stabilisation and surgeries are provided by oral surgeons. Now, I think you will agree with me that oral surgeons are highly trained and skilled members of the dental and medical team.

Horizontally impacted wisdom teeth on each side of lower arch. Impacted wisdom tooth. The last tooth in each quadrant is an impacted wisdom tooth. (Note the underdeveloped wisdom tooth in upper left of photo.)
Horizontally impacted wisdom teeth on each side of lower arch. Impacted wisdom tooth. The last tooth in each quadrant is an impacted wisdom tooth. (Note the underdeveloped wisdom tooth in upper left of photo.)
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