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Services

IMPACTED TEETH

Surgical removal of all wisdom teeth and impacted teeth.

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What are wisdom and/or impacted teeth?
Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the “Age of Wisdom.” Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn’t leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth. A tooth becomes impacted when there is a lack of space in the dental arch and its growth and eruption are prevented by overlying gum, bone or another tooth.

Who benefits from impacted teeth / wisdom teeth removal?
Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. This will result in swelling, stiffness, pain, and illness. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Not all problems related to third molars are painful or visible. Damage can occur without your being aware of it. As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, impacted wisdom teeth are more likely to cause problems as patients age. No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer and there is less chance of damaging nearby nerves or other structures. It isn’t wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process. Research found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth.

With an oral examination and x-rays of the mouth, Dr. Botha can evaluate the position of the wisdom teeth and predict if there are present or may be future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.

In most cases, the removal of wisdom teeth is performed under general anesthesia or local anesthesia. All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding, bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment is provided.

DENTAL IMPLANTOLOGY

Planning, placement, and exposure of dental implants. Immediate implant placement after extraction. Customized guides and stents.

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What is a dental implant?
A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants may be an option for people who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.
Dental implants are classified as: 1) endosteal (in the bone) or 2) subperiosteal (on the bone). Endosteal implants are the most commonly used type of implant. The various types include screws, cylinders or blades surgically placed into the jawbone. Each implant holds one or more prosthetic teeth. This type of implant is generally used as an alternative for patients with bridges or removable dentures.

Dental implants are truly able to enhance the quality of life, while helping them gain the confidence that comes from a well-functioning smile that looks good and feels natural. Dental implants improve patients’ overall health.

There are many benefits to replacing missing teeth with dental implants which include: 1) maintenance of the integrity of bone structure after tooth loss, 2) preservation of the health of adjacent teeth, since there is no need for bridgework, 3) replacement of loose-fitting dentures, 4) distribution of bite forces evenly throughout the mouth, 5) function and feel like natural teeth, 6) improvement of speaking ability when bulky dentures are eliminated, 7) improvement of facial appearance by preventing bone loss.

Who benefits from placement of dental implants?
Losing a tooth can be devastating, not only because it affects the way you look, but also because it can lead to other physical problems that may affect your health and prevent you from smiling with confidence. It is vitally important to replace missing teeth with dental implants promptly in order to prevent health consequences such as bone loss, shifting and drifting of the teeth, alteration in the bite as a result of shifting teeth, jaw joint problems, difficulty in chewing properly and additional stress on the remaining teeth.

ORAL MUCOSAL LESIONS, ULCERS AND INFECTIONS

Emergency treatment of all head and neck infections. Prompt investigation and management of mucosal lesions and ulcers.

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What are head and neck infections?
Infections in the head and neck area can come from a variety of sources. The most common source is an tooth abscess. Infection follows the path of least resistance, so the location of facial swelling varies depending on which tooth is involved. Everyone responds differently when an infection occurs. Some patients are able to keep the infection localized and under control while in other cases, the infection may spread and cause fever, swelling, sore throat, and a general malaise. It is important to seek consultation whenever an area of pain exists in the mouth, to prevent serious complications from developing. Do not ignore the important signs of pain and fever, as they usually indicate the likelihood of a significant infection.

Who benefits from the treatment of head and neck infections?
Most infections are treated by antibiotic medications, and most importantly, by removal of the source of the infection. Warm salt water rinses are also helpful to increase blood flow to the area. Serious infections require surgical drainage of the involved area. This is known as an “incision and drainage” procedure.

Usually, an infection of a tooth in the lower jaw will lead to swelling in and around the lower jaw. A small infection like this can cause an abscess that can spread down the throat, and can even travel to the chest cavity. Infections of the upper teeth usually spread to the cheek and the area under the eye. Some of the veins in this area do not have valves, so blood can flow backward and in extremely severe cases, spread infection to an area under the brain, known as the cavernous sinus.

FACIAL TRAUMA

Treatment of hard tissue (bone and teeth) and soft tissue (skin) trauma which include fractures, abrasions, lacerations, etc.

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What is facial trauma?
Oral and facial injuries are unfortunately very common. Injuries often result from motor vehicle accidents, acts of violence or sporting injuries like cycling, skateboarding, hockey and several others. The skill set of an oral and maxillofacial surgeon is a unique combination of dentistry, medicine and surgery. This collection of skills are never more valuable than when treating a patient with facial injuries. Moreover, the needs of the trauma patient extend above and beyond the advanced skills of the surgeon, requiring the sensitivity and compassion that is often required in managing both the patient and their family. Dr Botha brings these qualities together to treat his patients at the highest level of care and compassion.

Who benefits from facial trauma surgery?
The patients that benefit from treatment by a maxillofacial and oral surgeon, include those patients that have sustained facial lacerations, fractured or avulsed teeth, mandibular fractures, maxillary/midface injuries, zygomatic (cheekbone) fractures, orbital fractures, or a combination of the above.

BENIGN AND MALIGNANT HEAD AND NECK TUMORS

Diagnosis, work-up and treatment of all head and neck tumors. We work in a multidisciplinary team which include radio-oncologists, chemotherapists, plastic- and reconstructive surgeons, physicians, etc.

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What is head and neck cancer?
Head and neck cancer refers to a group of similar cancers that start in the lip, oral cavity (mouth), nasal cavity (inside the nose), paranasal sinuses, pharynx, and larynx. Ninety percent of head and neck cancers are squamous cell carcinomas (HNSCC). HNSCC is the sixth leading cancer by incidence worldwide. HNSCC are not gender, age or race specific, hence anyone can develop it. The five-year survival rate of patients with HNSCC is about 40-50%. Head and neck cancers often spread to the lymph nodes of the neck, and this is often the first (and sometimes only) sign of the disease at the time of diagnosis. Head and neck cancer is strongly associated with certain environmental and lifestyle risk factors, including tobacco smoking, alcohol consumption, UV light, particular chemicals used in certain workplaces, and certain strains of viruses, such as human papillomavirus. These cancers are frequently aggressive in their biologic behavior; patients with these types of cancer are at a higher risk of developing another cancer in the head and neck area. Head and neck cancer is highly curable if detected early, usually with surgery, but radiation therapy may also play an important role, while chemotherapy is often ineffective.

Who may benefit from head and neck cancer surgery?
Head and neck cancer usually begins with symptoms that seem harmless, like an enlarged lymph node, a sore throat or a hoarse sounding voice. However, in case cancer, these conditions may persist and become chronic. There may be a lump or a sore in the throat or neck that does not heal or go away. There may be difficult or painful swallowing, speaking may become difficult and there may be a persistent earache. Other possible but less common symptoms include some numbness or paralysis of the face muscles. Presenting symptoms include:

Mass in the neck
Neck pain
Bleeding from the mouth
Nasal congestion, especially with nasopharyngeal carcinoma
Bad breath
Sore tongue
Painless ulcer or sores in the mouth that do not heal
White, red or dark patches in the mouth that will not go away
Earache
Numbness
Lump in the lip, mouth or gums
Enlarged lymph glands in the neck
Difficulty speaking
Hoarse voice which persists for more than six weeks
Sore throat which persists for more than six weeks
Difficulty swallowing
Change in diet or weight loss

When a patient present to Dr. Botha with one or more of the above symptoms, a biopsy is done to obtain a histological diagnosis. Other important special investigations may include a CT-scan, MRI-scan, PET-scan and some blood tests. A multidisciplinary discussion of the optimal treatment strategy will be undertaken between Dr. Botha, radiation oncologists, medical oncologists, plastic and reconstructive surgeons, physicians and some other members of the multidisciplinary team.

After a histologic diagnosis has been established and tumor extent determined, the selection of appropriate treatment for a specific cancer depends on a complex array of variables, including tumor site, relative morbidity of various treatment options, patient performance, nutritional status, concomitant health problems, social and logistic factors, previous primary tumors, and patient preference.

Surgical resection and radiation therapy are the mainstays of treatment for most head and neck cancers and remain the standard of care in most cases. For small primary cancers without regional metastases, wide surgical excision alone or curative radiation therapy alone is used. More extensive primary tumors, or those with regional metastases, planned combinations of pre- or postoperative radiation and complete surgical excision are generally used.

ORTHOGNATHIC SURGERY

Jaw surgery that adjust the upper jaw, lower jaw and chin to correct skeletal discrepancies.

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What is orthognathic surgery?
Orthognathic surgery usually involves the coordinated efforts of the dentist, orthodontist, and oral and maxillofacial surgeon to correct malaligned jaws and teeth (dentofacial deformity). The dentist is responsible for taking care of the teeth and gums, the orthodontist is responsible for straightening the teeth, and the oral and maxillofacial surgeon is responsible for repositioning the jaws or portions thereof to achieve the best dental fit and jaw function as well as improve facial balance.

Who benefits from orthognathic surgery?

Orthognathic surgery may be indicated for adults, teenagers, and children, whose teeth do not fit together, jaws are malaligned, and/or significant esthetic imbalances are present. Jaw and dental malalignment problems can be genetic, congenital (present at birth), or developmental in origin (develop during growth). Injuries and tumors affecting the jaws and jaw joints can also create dentofacial deformities at any age. Symptoms that a person may have with a dentofacial deformity include the following:

Over-development or under-development of either jaw
Facial imbalance and/or asymmetry
Teeth do not fit together
Inabilities to eat and chew properly
Airway problems particularly with breathing
Speech problems associated with the deformity
Open bite where either the front teeth or back teeth don’t touch when other teeth are touching

A dentofacial deformity can exist as a result of problems in the upper jaw, lower jaw, or both jaws. Oftentimes the jaw joints may be involved in the overall process and will need to be evaluated and possible treated.
Osteotomy is the medical term describing the performance of bone cuts through the jaws, so the jaws or portions of jaws can be repositioned into a better balanced and functional relationship. Osteotomies may be indicated for the upper jaw, lower jaw, or both jaws. Breathing difficulties caused by upper airway obstruction can be corrected to provide a good functional airway at the same time as the jaw alignment. During your initial consultation, Dr. Botha will perform a thorough examination and identify the associated problems. He will develop a treatment plan and explain the requirements to achieve a high quality result for you. The risks of the various surgical procedures will also be explained and your questions answered. Dr. Botha will inform your referring doctor and any other health care providers that you wish to be included, as to your diagnosis and treatment plan, unless you request total confidentiality.

TMJ DISORDERS AND FACIAL PAIN

Diagnosis and treatment of all TMJ (Temporomandibular joint) disorders, including joint rinsing, cartilage repositioning, and total TMJ replacement.

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What is TMJ disorders and facial pain?
The temporomandibular joint (TMJ) is the hinge between the upper and lower jaw that allows movement of the lower jaw to facilitate eating, chewing, speech, breathing, etc. TMJ pathology can create jaw dysfunction, noises, dentofacial deformities, pain and headaches. Surgery may be required to correct associated TMJ problems.

Who benefits from TMJ surgery?
There are many different kinds of problems that can affect the TMJ. Since many of the TMJ disorders can progressively worsen, early diagnosis and management can prevent progressive disease. Some TMJ disorders create few obvious symptoms, but many patients with TMJ problems may have one or more of the following symptoms:

Clicking, popping, or grinding noises with jaw movement
TMJ pain and headaches
Pain through the jaws and jaw muscles
Pain down through the neck, shoulders, and back
Earache and ringing in the ears
Lightheadedness / dizziness
Changes in occlusion (fit of the teeth and jaws)
Changes in facial appearance
Jaw dysfunction such as limited ability to open the jaws and loss of side to side movement
Significant changes in the diet with tendency toward a more soft to liquid diet

It is important to understand that TMJ pathology often creates or co-exits with jaw and facial deformities. For patients with co-existing TMJ problems and jaw deformities, correcting just the jaw position and ignoring the TMJ problems, may result in poor outcomes relative to jaw function, esthetics, jaw position, stability and increased pain and headache levels. Therefore, addressing the TMJs, as well as the orthognathic surgical aspects, usually provides the best possible outcome.

Common TMJ pathologies include:

Displaced Articulating Disc:
The most common TMJ disorder is a displaced disc in the joint. This can cause any or all of the above listed symptoms. Various treatment methods are available to treat this problem, and aid in improving jaw function and decrease or eliminate symptoms. The treatment may be only a conservative measure or may need surgical correction depending on the extent of the disease.

Adolescent internal condylar resorption (Cheerleader Syndrome):
This condition affects predominantly teenage females but can also affect teenage males (9:1 female to male ratio). This condition usually develops during pubertal growth (ages 11 to 15) and involves a displaced TMJ disc. In addition, the condyles of the lower jaw begin to dissolve away causing the lower jaw to slowly become more retruded and the teeth to come apart in the front. Treatment is aimed at correcting the TMJ pathology by repositioning the disc (this arrests the disease process) as well as correction of the dentofacial deformity.

Condylar hyperplasia (mandibular prognathism):
In this condition the lower jaw overgrows in a forward direction and off to one side, creating significant facial deformity. This TMJ disorder is caused by overgrowth of the lower jaw condyle. The growth problem usually becomes evident, or significantly worsens during pubertal growth. Treatment is aimed at the correction of the particular problem by eliminating the abnormal excessive growth of the lower jaw as well as establish good facial balance and jaw function.

Osteochondroma:
This pathological process is a benign tumor of the lower jaw condyle, which causes overgrowth and overdevelopment of one side of the lower jaw and face, generally creating significant facial asymmetry. It can occur anytime during life but more commonly in the teenage years. Treatment is aimed at the correction of this particular problem by eliminating the pathology as well as re-establish good facial symmetry and function.

End-stage TMJ disease:
These diseases include such pathologies as:
Multiply operated joints
Ankylosis
Connective tissue autoimmune disease (i.e. rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis)
lupus, scleroderma, Sjogren’s syndrome, ankylosing spondylitis, reactive arthritis
Severe trauma destroying the joints
Failed previous autogenous grafts (patient’s own tissue) or alloplastic implants (artificial materials)

For these pathological conditions, a total joint prosthesis may be the best treatment as well as orthognathic surgery to correct an associated jaw deformity.

OBSTRUCTIVE SLEEP APNEA SYNDROME

Various procedures are performed to correct sleep apnea which include chin repositioning, upper and lower jaw repositioning, tongue reduction, muscle advancement, etc.

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What is obstructive sleep apnea syndrome?
Sleep apnea is a condition where significant airway obstruction problems develop during sleep. The most common cause of airway obstruction involves nasal airway obstruction and/or a decrease in the oropharyngeal airway space (space between the back of the tongue and the back of the throat). Obstructions can also occur from the trachea into the pulmonary system, or caused by central nervous system pathology.

Signs and symptoms of sleep apnea syndrome include:
Recurrent episodes of cessation of breathing while sleeping
Snoring
Frequent awakening and restless sleep
Mouth breathing
Nightmares
Restless or jerking legs when sleeping
Daytime sleepiness
Headaches
Poor work or school performance

A number of medical conditions can develop as a result of sleep apnea syndrome which include high blood pressure, cardiac arrhythmias, right side heart failure, pulmonary hypertension, carbon dioxide retention, cyanosis, blood disorders, brain damage, stroke, heart attack and death.

Who benefits from sleep apnea surgery?
Surgery to correct airway obstruction and sleep apnea may be indicated for adults, teenagers, and children who have difficulty breathing.

Nasal airway causes of obstructive sleep apnea syndrome that can be surgically corrected include narrow nostrils, deviated nasal septum, hypertrophied turbinates, enlarged adenoidal tissue, and nasal polyps. Oral airway causes of obstructive sleep apnoea syndrome include small and/or retracted jaws, large tongue, enlarged or excessively long soft palate and uvula, and enlarged tonsils.

 

Dr. Botha can provide a comprehensive treatment plan for you. A number of techniques are available to treat sleep apnea syndrome and has been able to eliminate this condition in almost all patients who are afflicted with it, when the causative factors involve upper airway obstruction. At your evaluation, Dr. Botha will provide a diagnosis and detailed treatment plan for you. Treatment may involve correcting the obstructive nasal deformity, and contributory jaw deformity, as well as soft tissue procedures to provide an adequate functional airway.

We will gladly assist you with your need.

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