This specialty encompasses the surgical treatment of diseases, injuries and deformities involving the head, face, mouth, teeth, gums, and the jaws. It deals with everything from reconstructing faces injured by trauma to surgically correcting misaligned jaws to implant surgery of the mouth as well as treating a wide spectrum of facial pathology. Both the functional and cosmetic aspects of the hard and soft tissues are dealt with.
Your dentist or GP may have chosen to refer you to Dr. Younessi for one of the following reasons:
Removal of Diseased and Impacted Teeth
Impacted, damaged, and non-restorable teeth are removed in the interest of your overall health. Pain management is a significant aspect of this treatment modality.
Patients with cysts and tumours of the mouth or the facial regions, severe infections of the mouth, salivary glands, jaws, and neck will need care including an admission to a hospital.
Dr. Younessi works closely with your dentist to plan and then place implants to correct for your missing teeth. He may need to graft bone in places with insufficient bone for implant placement. Modification of the gum tissue surrounding implants may also be needed to allow a more natural look.
Management of facial injuries may be by repairing facial lacerations, repairing fractured jaws and facial bones, reconnecting severed nerves and ducts, and treating other injuries. These procedures include care of oral tissues, the jaws, cheek and nasal bones, the forehead, and the eye sockets.
Reconstructive and Cosmetic Surgery
This is typically to correct jaw, facial bone and soft tissue problems left as the result of previous trauma or removal of pathology.
This allows a sufficient measure of relaxation to permit you to cope with minor surgery.
Management of Facial Pain
Diagnosis and treatment of facial pain disorders including those due to jaw joint (TMJ) problems is an important part of our service.
Correction of Bite Deformities
This is surgical reconstruction and realignment of the upper and lower jaws into proper dental and facial relationships to provide improved biting function and facial appearance.
We are committed to reducing your anxiety and making you feel at ease about surgery. Often times it is the fear of the unknown that makes for anxiety. Dr Younessi will make sure you know what to expect. We can discuss if IV sedation or a general anaesthetic is right for you.
You can expect kindness and compassion from us. With a little effort treatment can proceed without it proving a major hurdle.
It is rare for true complications to occur, but we would still like to check on your progress.
We appreciate that in our busy modern lives a follow up appointment may be an annoyance. There could be subtle elements of healing that may need attention. It is not unusual for a simmering problem to be discovered early and dealt with under these circumstances.
Patient related and surgical factors are often different so recovery can be variable but most people are well recovered by seven to ten days.
Depending on the type of surgery at least 24 – 48 hours of rest is essential. It can be more for certain people and for more complicated cases. There is little reason why light duties could not be commenced early but physical activity such as weight lifting should be delayed for about seven days.
Medicines you are given affect your cognition and coordination roughly similarly to being under the influence of alcohol. Driving or operating machinery as well as complex decision making will be impaired. Under these circumstances you can suffer harm or harm others.
These are the only examples in Medicine when a non-biological structure is incorporated as if it was self. Structures like surgical stainless steel are accepted as inert and not rejected but implants are made of a metal that forms a physical bond to bone. These are thus said to have “osteointegrated”. Accordingly they are firm and can be used to replace teeth as artificial roots.
If you have reasonable health, or can be brought into reasonable health, then the answer is usually, yes. The one absolute requirement is that there must be enough bone in the area of the missing teeth to provide adequate anchorage for the implants.
Blood thinners or medicines to lower blood pressure are generally no problems.
Smoking and diabetes are relative contra-indications. This means that whilst these patients are not necessarily ideal candidates, with some further care even these patient populations can have implants.
Dr Younessi considers implants as inappropriate in patients taking a class of medicines known as bisphosphonates. These medicines delay the bone turnover and are used in management of osteoporosis, amongst other conditions.
This depends on the implant type, size, the function, bone quality, and importantly patient’s oral hygiene. They are given at least a 90% success rate in most studies.
A sinus lift, sinus augmentation, or sinus graft surgery involves “lifting” the sinus membrane from within the mouth away from its bony housing so that a bone graft can be placed onto the sinus floor. This way the augmented jaw bone can receive a dental implant without injuring the sinus cavity.
The actual surgical intervention could take about twenty minutes for each tooth but given preparation before and recovery after, generally you should put aside one hour.
We usually give medicines to limit this and swelling is very variable. It depends on your genetic predisposition, surgical complexity of the operation, and anatomical variables.
Swelling can be impressive and peaks on the third post operative day. It soon dissipates.
A true dry socket or localised osteitis is actually quite a lot rarer than is perceived. Any deviation from usual healing can be over-diagnosed as a dry socket in some circles.
After an extraction blood clot fills the tooth socket. The soluble proteins and blood cells deposit to form a meshwork that acts as a lattice for bone cells to grow into it. Eventually the clot becomes new bone. When the clot is lost, a dry socket may occur. Under these circumstances there is often a foul odour about the mouth, significant pain but not necessarily swelling nor fever also occurs. Dry sockets are more common in the lower jaw extraction wounds and when the wounds have not been sutured. Smokers have many fold increased risk for a dry socket.
This is why Dr Younessi generally sutures extraction wounds, asks you to maintain a meticulous mouth hygiene regime and to avoid tobacco.
Oral surgery is, as the name implies, the art and surgical science of treating diseases of the mouth. Maxillofacial surgery is the discipline that deals with surgical treatment of jaws and the face.
You should be able to eat softer foods from the start. Take care not to have anything too hot until the numbness from the anaesthetic has worn off. Hard foods such as apples are not only difficult to eat but could put enough pressure on a bone weakened from surgical trauma to potentially cause a fracture.
No two cases are the same and the internet or advice from friends or neighbours is a poor substitute for professional advice and attention.
At the consultation appointment, Dr Younessi will fully evaluate you and may need to apply particular tools to diagnose your particular condition. Your prior medical history is obtained and this is very relevant to avoid potential harm from interventions or medicines.
You will have the ability to discuss risks, benefits, alternatives and financial matters.
We usually like to consult with you before the surgical appointment but in special circumstances the consultation and surgical appointments can be combined.
This is an acronym for Bisphosphonate Related Osteonecrosis of the Jaw. Bisphosphonates are medications used to treat diseases which result in weakening of the bones, such as osteoporosis. In this country there are many users of these medicines and the medicine is, for the prescribed indication, completely appropriate. They serve to limit bone turn over and thus in turn decrease bone volume loss.
It can be given by mouth. Fosamax (Alendronate) and Actenol (Risendronate) are common oral forms of this drug. Zometa (Zolendronic acid) and Aredia (Pamidronate) are the intravenous forms, most commonly used to treat cancer involving the bones. These later medicines particularly when combined with steroid therapy make for poor bone healing and thus following dental extractions there can be bone “die-back” and complications.
Jaw bone death results in pain, changes in bone, loss of pieces of bone called sequestra that may protrude through the gums or skin, and sometimes drainage of pus.
Management of BRONJ is difficult and prolonged.