"My relative is injecting Prolia (a kind of Denosumab injection) regularly but is having toothache and has been examined to find tooth abscess. The previous dentist recommends tooth removal but we afraid that avascular necrosis would happen and will affect the jawbone. I would like to ask what specialist of dentist should we find if we want to do the extraction safely?"
Someone once asked me the above question. Sometimes, a general dentist will refer the patient to a specialist after diagnosis. This is an example. Prolia injection is a drug for the treatment of osteoporosis. The most worrying thing is the problem of avascular necrosis after tooth extraction, that is, the bone cannot heal by itself and cause jaw bone infection and collapse. This type of tooth extraction involves a high risk and needs to be evaluated in many ways. Generally, it is referred to a dental specialist in Oral and Maxillofacial Surgery (OMFS).
Oral and Maxillofacial Surgery (OMFS) is a specialty of dentistry. As of April 2020, there are 62 specialists of OMFS in Hong Kong. You may not know much about oral and maxillofacial surgery, we will now give a detailed introduction of the scope of services in this department.
Oral and Maxillofacial Surgeons are mainly responsible for dealing with injuries and diseases related to soft or hard tissues of the oral cavity, teeth, jawbone and face, and are treated with drugs and surgery. These include complex tooth removal, surgical removal of wisdom teeth and impacted teeth, dental implants and related bone grafts, sinus lift surgery, temporo-mandibular joint (TMJ) treatment, cleft lip palate, facial trauma or fracture, and orthopedic surgery of the jaw bone. In addition, they will also do biopsy and removal for jaw bone cysts, oral tumors, and tissue hyperplasia. They have more comprehensive knowledge and research in these areas.
Dentists can perform most dental and oral surgeries. So, when do I need a specialist in oral and maxillofacial surgery?
In the case of wisdom tooth extraction surgery, the patient will be advised to seek help from a specialist when a general dentist found that the wisdom tooth is close to the Trigeminal nerve or the case is very complicated after examination by x-ray and 3D scan. It needs to avoid touching the nerve during the tooth removal, otherwise may have sequelae if not handling it very carefully.
Based on the above example, if osteoporosis patients that are injecting Denosumab, they get a higher chance of suffering from avascular necrosis after tooth removal, the timing of tooth removal should be decided carefully. In the process of tooth removal, it may also be necessary to consider sutures for the wound and grinding of bones. Specialist in OMFS have rich surgical experience, which can minimize the risk for patients.
There are some people who have pain in temporo-mandibular joint (TMJ) or the movement of the TMJ is not smooth, but may think that it is not a problem caused by teeth. They may be confused with finding a dentist or what kinds of doctor. Oral and maxillofacial surgeons are experts in this field and can analyze TMJ problems and provide appropriate treatments for patients more professionally.
Oral and maxillofacial surgeons can also help patients with sleep apnea, make oral appliances for patients, and open the blocked airway by moving the jaw forward. If surgical treatment is required, oral and maxillofacial surgeon will reposition the patient's jawbone to expand the space behind the tongue, reducing the possibility of obstruction. The principle is like a crowded house. If you want more space in the house, in addition to removing the furniture in the house, you can also consider rebuilding to make the overall space larger.
If the patient does not know when need to find a specialist in OMFS, the general dentist will know whether the patient needs a referral after the examination. And in different situations, the oral and maxillofacial surgeon will also cooperate with other doctors.
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