When the extraction of teeth with excessive decay or trauma, soft tissue-hard tissue cysts observed in the jaw region, soft tissue or tooth-related abscesses require surgical intervention, the relevant area is operated by the dentist. The surgery of impacted wisdom teeth and other impacted teeth is also a minor operation performed with local anesthesia in the relevant area.

1. What do we understand by Oral-Dental, Jaw Diseases and Surgery?

Oral-Dental, Jaw Diseases and Surgery; is a branch of dentistry concerned with the diagnosis and treatment of diseases, injuries and disorders related to the mouth, teeth and jaws. 

2. What are these diseases and disorders?

Especially tooth extractions; It covers a very common subject such as surgical extraction of impacted teeth, preparation of the mouth for prosthesis with pre-prosthesis surgery, implant applications, treatment of precancerous structures seen in the soft tissues and gums of the mouth, treatment of abscesses, cysts and tumors in the jaw, treatment of maxillofacial anomalies, treatment of jaw fractures, treatment of jaw joints, treatment of cleft lips and palates.

3. In terms of Jaw Surgery, which cases are most frequently brought to dentistry clinics? How is it treated?

One of the most frequently performed operations in jaw surgery after tooth extraction is impacted teeth. It is most frequently encountered in wisdom teeth and canine teeth (dog teeth). It is operated under local anesthesia.

4. How is wisdom tooth surgery performed? Is it a difficult procedure?

It is not a very difficult procedure. When the anesthesia is fully applied, the patient does not feel pain. First, the soft tissue on the impacted tooth is removed, then the hard tissue. The impacted tooth is removed and the soft tissues are stitched together. The stitches are removed 7 days later.

5. What kind of disorders are seen in the jaw joint? What is the treatment? 

The number of people with pain or joint dysfunction in the jaw joint area is higher than thought. There is a different sound in the joint when opening and closing the mouth, pain while eating, difficulty opening the mouth in the morning, not being able to open it at all, not being able to close the teeth are seen. Treatment varies according to the cause. For example, if the disorder is due to teeth grinding, special plates are made or low-energy laser is applied. Various medications are given.

6. How are jaw and facial bone fractures treated? 

Jaw fractures usually accompany facial injuries. As a result of fractures in the upper jaw, lower jaw, palate, cheekbones and eye socket, breathing, vision, speech and swallowing functions may be disrupted, as well as facial deformities due to trauma. The treatment principles for jaw and facial fractures are the same as those for fractures seen in other parts of the body, such as the arm or leg. The broken bone fragments are restored to their original state and kept immobile until they fuse with each other. Depending on the situation, the open method, namely the surgical approach, or the closed method, namely conservative treatment methods, may be applied in restoring and fixing the broken fragments.

7. What are the common jaw and facial deformities?

The development of the jaws is a complex process that continues until adolescence and is affected by many factors. Negative factors that will arise during this process;
* Jaws developing incompatibly with each other, 
* Teeth crowding, 
* Speech disorders, 
* Chewing, swallowing and biting problems, 
* Breathing problemscan open. 
The incompatible closing of the jaws can also endanger the health of the teeth and gums in the long term. In addition, jaw incompatibility also negatively affects facial aesthetics.

8. How are jaw and facial deformities treated?

 The valid method for the treatment of jaw deformities is to correct the jaws through surgical intervention. Orthodontic treatment is necessary to correct the crookedness in the teeth before the surgical intervention and to prepare the jaws for surgery. During the surgery, one or both jaws are fixed by bringing them to the most appropriate position in terms of aesthetics and functionality. 

9. Can you briefly provide information about cysts in the jaw? Is surgery necessary? 

Cysts can originate from soft tissues in the jaws, either connected to the teeth or independent of the teeth. They must be treated. If left untreated, they can grow and cause aesthetic and functional disorders. They can even cause fractures in the jawbone.  

10. Is every swelling or color change in the tongue, cheek, under the tongue, and palate a sign of a dangerous disease?  

No. However, the mouth is still one of the first places where the initial symptoms of many illnesses in the body are seen. Therefore, such formations should be monitored and if they show signs of serious illness, treatment should be started without delay.  

11. Is it necessary to make a surgical preparation in the mouth before the prosthesis is made?  

Although not in every patient, it may be necessary to perform a surgical intervention before the prosthesis in some patients. Especially in patients who have lost their teeth a long time ago or are older, there may not be a bone area in the mouth for the prosthesis to sit. Sometimes, the old prosthesis used may have caused bumps and some tissue irregularities in the mouth. Therefore, it will not be possible to take a healthy measurement and make a suitable prosthesis without correcting these.

12. What is the most important mistake made in the treatment of tooth-related abscesses (infections)? 

Tooth-related abscesses appear as swellings filled with pus inside or outside the mouth. These pus-filled swellings must be surgically opened immediately and the pus inside must be drained. Patients often try to treat themselves by taking only antibiotics, which makes treatment difficult because the abscess is not drained.

3. BRUXISM TREATMENT

Tooth contacts other than chewing and swallowing are considered parafunctions (unwanted functional movements). Bruxism (teeth clenching, teeth grinding) is the teeth-clenching behavior that occurs during the day or night, other than chewing and swallowing. This disorder, which is also frequently seen in our society, is often unaware of the patient himself.

How is it applied?
Negativities Caused by Bruxism...
There are two main reasons for the habit of clenching teeth. The first is stress, and the second is malocclusion. As a result of the habit of clenching teeth; abrasion and pain occur in the teeth. In addition, cracks, fractures and displacement may be seen in the teeth. White lines form on the inner surface of the cheek and traces of the teeth are visible around the tongue. Pain occurs in the head, neck and facial muscles. The lower face height decreases, the tip of the chin and the tip of the nose approach each other and an older appearance occurs. The lower jaw moves forward over time and a concave (concave) profile image is formed. The face appears angular and square.
10 Methods Used in Bruxism Treatment
1) Night plate
2) Renewal of incorrectly made dental fillings and coatings
3) Botox treatment
4) Herbal treatment method for teeth grinding
5) Stress therapy
6) Surgical operation
7) Muscle relaxant drug application
8) Electroshock treatment method
9) Prosthesis applications for replacing missing teeth
10) Measures to ensure comfortable sleep

4.20-YEAR-OLD TOOTH EXTRACTION

Wisdom teeth are usually impacted due to their location in the jawbone and being covered with gums or bone.
The tooth In cases where a part of it is covered by gums, infection and swelling of the face and decreased jaw opening often occur. As a result of repeated infections, the bone around the wisdom teeth begins to melt and inflammatory tissue forms in its place.
In addition, due to its location in the jaw bone, it can sometimes apply pressure to the molars in front of it, which causes pain and crowding in the front teeth.

How is Wisdom Tooth Extraction Performed?
The extraction of wisdom teeth is usually done surgically and swelling and pain may occur in this area after extraction. This condition occurs when there is bone tissue around the wisdom tooth. In order to remove the bone around the toothWhen hard tissue laser (ER-YAG) is used instead of traditional methods, swelling and pain are reduced by 80 percent and tissue healing is accelerated. In addition, with low-level laser application (LLLT) after extraction, the recovery period after wisdom tooth extraction and the jaw locking due to muscle spasm after extraction are shorter.

What is the Recovery Process After Impacted Wisdom Tooth Extraction? If stitches were placed, which is the case in most cases, the stitches are removed after 1 week and our patient has no problems. There may be pain and swelling in the first 1-2 days after the impacted tooth is removed. It is especially important not to have the stitches removed. In order for the stitches not to come out, the mouth should not be opened too much and soft and liquid foods should be consumed. In the care process after the stitches are removed, the following should be taken into consideration: the tooth gap there does not close immediately. First of all, the gums close and then over time, when the bone fills from below, that space closes. Naturally, the food that will enter that tooth space should not be infected and we should not constantly play with that area with our tongue.

5. IMPRINTED TOOTH SURGERY

What is Impacted Tooth Surgery?
Contrary to what our patients know, impacted teeth may not only be located in the upper or lower jaw (anatomical location). There are cases of impacted teeth that have been observed to emerge in various parts of the body (paranasal sinuses, other skull bones, ovarian cysts or tumoral formations such as dermoid cysts) (ectopically impacted teeth). Therefore, the interpretation and examination of a plastic surgeon is particularly important in determining the appropriate approach to these.

How is it applied?

The impacted teeth located in the lower jaw usually show themselves in the 20s and are called with terms such as wisdom teeth or wisdom teeth. Wisdom teeth do not always remain embedded. The ones that emerge properly can rarely adapt to the normal alignment adjacent to the 2nd molar. However, they often tend to lean inward, outward, forward and backward. It may be necessary to remove the tilted teeth by opening a window in the bone, especially if they are buried under the bone. It may be necessary to make some incisions in the oral cavity during the extraction of the impacted lower jaw teeth. Impacted teeth usually remain silent unless they show themselves with pain in the jaw. The cause of pain in the jaw is basically the impacted tooth pushing the others. In some patients, due to being diagnosed at a later stage, tooth axis distortions that can be described as the view of a tree blowing in the wind may occur. Therefore, such tooth alignment disorders also constitute a necessity for the extraction of the impacted tooth.
Embedded teeth, especially when located in the upper jaw, can cause pre-auricular pain originating from the jaw joint. In this case, extracting these teeth can be beneficial in terms of providing biomechanical balance of the jaw joint.
If the impacted tooth is in the lower jaw, it is located in the corner of the jaw and forms the weak point of the bone tissue here. Therefore, it prepares the ground for the lower jaw bone to break with small impacts. In these patients, if the tooth prevents the bone from fitting on top of each other and there is a possibility of infection in the tooth socket, the tooth may need to be extracted.

6. JAW CYST SURGERY

JAW CYSTS ARE SLOWLY DEVELOPING AND UNNOTICED FOR A LONG TIME. THEY NEED TO BE REMOVED WITH SURGICAL INTERVENTION. JAW CYST ARE CYSTS THAT CAN FORM IN THE JAW BONE OR SOFT TISSUE.
They usually tend to grow without giving any symptoms for a long time. Jaw cysts are detected on panoramic x-rays after a palpable mass or a dental examination and need to be removed with surgical intervention. Those with jaw cysts experience loosening of the teeth above the cyst, spontaneous tooth removal with its root, ear and headache, pain in the jaw, pain and numbness in the lip as a result of pressure on the nerve of the tooth and lip. Those with enlarged cysts encounter a palpable structure in their jaws.

How is it applied?
JAW CYSTS THAT ARE NOT REMOVED BY SURGICAL METHOD MAY GROW, MAY CAUSE JAW BONE DAMAGE, INFECTION, TOOTH LOSS, AND MAY TRANSFORM INTO BENEFICIAL OR MALIGNANT TUMOR.
Jaw cyst surgery is performed with two methods. The first of these is the Enucleation method applied for small cysts. The enucleation method is performed by numbing the area where the cyst is located or by completely anesthetizing the patient. The anesthesia method is administered by the anesthesia doctor and dentist together. After the anesthesia method is applied, the gum in the cyst area is cut to reach the cyst and it is removed with the cyst capsule. The area where the cyst is removed is cleaned, stitched and closed.
The second method is Marsupialization. In the method applied to large jaw cysts, the cystDue to its size and the pressure it naturally exerts on the sac, a small incision is first made on the cyst to drain some of the pus inside, and then a larger incision is made to remove it from the cyst area and stitch it. The reason why the cyst is not removed directly is that it may burst during the procedure due to the pressure caused by the cyst's size and tension, and the pus may spread to the mouth and pharynx, causing infection. After the procedure, for those who have had dental work done, root canal treatment is performed after the wound heals, and for those who have had a tooth extraction, an implant (tooth is attached to the jawbone by screwing it in) is performed, allowing the patient to return to their old life.

7. PREPROSTHETIC SURGERY

These are surgical procedures performed to improve the soft and hard tissues before the prosthesis is made.

These are;
* Correction of indentations and protrusions on the jawbone (These cause constant impact wounds during the use of removable prostheses)
* Removal of toruses (developmental bone growths, i.e. lobular bone protrusions)
* Frenectomy (removal of tongue and lip ties)
* Removal of formations that develop due to the irritation of the mucosa by the prosthesis edges (prosthesis edge tumor, irritation fibroma)
* Removal of the same It involves the removal of mobile tissues (arrangement of mobile crests) that occur on the jawbone along with bone resorption as a result of the unbalanced transmission of chewing pressures to the bone in patients using dentures.

How is it applied?
Some people may have bone protrusions in the middle of their upper palate or on the jawbone on the tongue-facing surfaces of the lower premolars. These protrusions are congenital. In other words, they do not form later. They are specific to the individual. They may cause denture impacts in those using removable partial or complete dentures, as well as frequent breakage of the used denture. If present, these protrusions called “Torus” should be corrected before starting the denture.
In people with old dentures that have been used for a long time and have lost their harmony with the oral tissues, there may be growths in the gums and loose soft tissues due to the old denture. These tissues will weaken the retention of the new denture and cause denture impacts. In addition, they should be removed as they can cause serious conditions that can lead to oral cancer as a result of long-term prosthesis irritation.
Especially in patients who have been using Removable Prosthesis since a young age, the jaw bones that hold the prosthesis have melted and become blurred. In order to ensure that the newly made prosthesis holds, a procedure called “Vestibuloplasty” can be performed by Jaw Surgeons to make the bone that will support the prosthesis a little more apparent.

8.APICAL RESECTION

It is the process of removing the cyst or infection at the tip of the tooth root together with the lower 1/3 of the tooth root.
In the presence of an abscess in the tooth roots, extraction is not the only option. Root canal treatment is performed first. If it is not enough, there is a chance for resection.
Apical resection is the treatment of stubborn root abscesses by direct intervention from the outside to the tooth root. A small window is opened on the jaw bone in the area where the root of the tooth and the abscess are located, and the abscess is cleaned. The tooth is left to heal.
Apical resection may be decided in cases where root canal treatment is insufficient, in cases where root canal treatment cannot be performed with traditional methods, or for biopsy purposes.
There are certain conditions for apical resection to be performed. For example, if the inflammation in the root of the tooth is caused by a root fracture, resection will not be of any benefit. If the root of the tooth is close to anatomical formations, apical resection will be problematic.

How is it applied?
It is beneficial for the patient to rinse their mouth with an antiseptic mouthwash before the operation. It will be beneficial for the patient to start using a mouthwash containing chlorhexidine 1 day before the operation to accelerate wound healing. Using a painkiller before the operation will reduce post-operative pain.
The tooth to be subjected to apical resection is numbed with local anesthesia. The tooth will be numbed in the same way as a classic dental filling and tooth extraction.
Depending on the size of the lesion in the root and the degree of damage to the root of the tooth, only the bone surface is opened from the root tip area or the border where the tooth and gum begin, and the inflammatory tissue at the root tip is cleaned. Here, a section of the tooth root will be cut to completely eliminate the bacteria.
The lesion at the root tip will also affect the neighboring teeth.In cases where it is found, root canal treatment should be performed on these teeth and apical resection should be performed in the area that will also cover the neighboring teeth.
After the infected area is completely cleaned and the root tip is filled, the lifted gum is stitched in place. If the stitches are made with non-resorbable threads, they will be removed after 7 days.