Most people develop 32 teeth by the time they reach 18 years of age. However, the average mouth is only big enough for 28 teeth. The last 4 teeth to erupt are the wisdom teeth, usually coming in during the late teens and early twenties. Wisdom teeth frequently become stuck as they try to erupt, remaining partially under the gum tissue. When a wisdom tooth fails to erupt normally it is termed “impacted.” Impacted wisdom teeth may cause problems in the future such as infection, periodontal disease, cysts, and crowding.

Infection:

Impacted wisdom teeth create an excellent environment for bacteria to thrive. Because wisdom teeth are so difficult to keep clean, bacteria tend to multiply around them and cause infections and cavities. The best time to remove wisdom teeth is in the teens to early twenties, before they begin causing these problems.

Periodontal Disease:

Also known as gum disease, periodontal disease is frequently seen around wisdom teeth. This is because they are difficult to clean given their position in the back of the mouth. Periodontal disease is a slowly progressive, chronic condition by which the bone supporting the tooth is lost. When present around a wisdom tooth, periodontal disease often affects the molar in front of the wisdom tooth. Additionally, the wisdom tooth can serve as a reservoir of bacteria that affect the rest of the mouth.

Cysts:

Although rare, cysts and benign tumors can form around impacted wisdom teeth. These lesions are similar to a water balloon surrounding the wisdom tooth. As they expand they destroy the jaw bone and move other teeth.

Crowding:

Wisdom teeth may contribute to the crowding of front teeth, particularly the lower front teeth. Orthodontists frequently request their patients have wisdom teeth removed prior to taking off braces in order to facilitate orthodontic stability.

FREQUENTLY ASKED QUESTIONS

Do I have to have my wisdom teeth removed?

The best way to determine if wisdom teeth need to be removed is to have a consultation with one of our surgeons. Occasionally, a wisdom tooth erupts normally and becomes a healthy, functional tooth. In this case, it may not need removal.

When is the best time to have my wisdom teeth removed?

The best time to remove wisdom teeth is in the teens to early twenties. At this age patients tend to heal well and recover quickly. By removing wisdom teeth at an early age we can minimize the risk of complications and ensure the best possible outcome for the patient.

Can I be asleep during my wisdom teeth removal?

Yes. Drs. Poyourow, Chandra, and Pham have extensive training and are licensed to provide general anesthesia in order to maximize your comfort during the procedure. We utilize cutting edge monitoring equipment, along with well trained and highly experienced staff to ensure patient comfort and safety.

When can I go back to school or work?

Yes. Drs. Poyourow, Chandra, and Pham have extensive training and are licensed to provide general anesthesia in order to maximize your comfort during the procedure. We utilize cutting edge monitoring equipment, along with well trained and highly experienced staff to ensure patient comfort and safety.
Many people live with facial deformities, whether congenital or induced by some type of physical trauma. Fortunately, oral and maxillofacial surgeons can employ surgical techniques capable of reconstructing the face and jaws. The goal of treatment is to optimize function and improve the overall appearance of the face. Techniques utilized by our surgeons include distraction osteogenesis, obtaining bone grafts from the hip/ribs/tibia/calvarium, stem-cells, and growth factors.

DID YOU KNOW…

It is possible for an oral surgeon to make fine cuts into the facial bones to reposition them in a more ideal position? Many types of conditions qualify for facial and jaw reconstruction at Alamitos Oral Surgery, including:

FREQUENTLY ASKED QUESTIONS

Am I a candidate for facial or jaw reconstructive surgery at Alamitos Oral Surgery?

Both children and adults can undergo facial or jaw reconstructive surgery for traumas, deformities, and birth defects. However, the only way to know if this type of procedure is right for you, is by visiting your oral surgeon for a complete consultation. Contact our office today for more information about facial and jaw reconstruction. We’ll be happy to answer any questions you may have and set up an appointment to meet with one of our surgeons as soon as possible.

What should I expect during the surgical process?

There is a wide array of reasons why you may need to undergo facial or jaw reconstruction. Depending on the reason, surgeries may occur during an immediate post-traumatic hospitalization, or planned as an outpatient surgery. Careful pre-surgical planning is done with the aid of 3-D imaging, and often with the use of computer generated 3-D models and surgical planning software. This allows our oral and maxillofacial surgeons to idealize your surgical results through careful pre-surgical planning.

What should I expect during the recovery period?

Your individual recovery experience will be unique to you according to the type of procedure you undergo. It is important to follow your surgeon’s instructions for post-surgical care in the days and weeks following your operation. This is likely to include lifestyle modifications, including dietary and physical restrictions. Take all medications as prescribed, and contact our office if you have any questions. Our team members will always be willing to help coach you through the post-surgical period until you are fully recovered and back to school or work.
The temporomandibular joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet. It permits the lower jaw to move and function. Temporomandibular joint disorders (TMD) are not uncommon. Individuals with a TMJ disorder may experience a variety of symptoms, such as earaches, headaches and limited ability to open their mouth.

FREQUENTLY ASKED QUESTIONS

Is it possible that I could need treatment for TMJ disorder?

There are some signs and symptoms that could indicate the need to visit your surgeon:
When symptoms of the TMJ trouble appear, please arrange for a consultation with our oral and maxillofacial surgeons to correctly diagnose your condition. Diagnosing TMJ disorders can be complex and may require special imaging studies of the joints. Often we also ask the help of other practitioners in dentistry, medicine, and/or physical therapy to allow you to cope with your TMJ disorder (TMD).

What type of treatments are possible for TMJ disorder?

Treatment may range from conservative dental and medical care to complex surgery. Depending on the diagnosis, treatment may include short-term non-steroidal anti-inflammatory drugs for pain and muscle relaxation, bite plate or splint therapy, and the help of our local physical therapists. Sometimes stressful factors in your life may limit the effectiveness of these conservative therapies .

Will I need surgery?

If non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated. Surgery can involve either arthrocentesis (washing out the TMJ and injecting steroids), or arthroscopy (the method identical to the orthopaedic surgery used to inspect and treat larger joints such as the knee). Seldom is it necessary for open joint surgery, as this is reserved for patients with chronic debilitating pain, or with some form of pathology in the TMJ.
Whether for non-surgical or surgical treatment; chronic TMJ pain may never go away completely without life-style modifications and intermittent regular treatment. Our surgeons care for your quality of life and understand that TMJ disorders may be debilitating at times.

DID YOU KNOW…

that TMJ disorders can occur at any point in life, but that they are most commonly diagnosed in young adults between the ages of 20 and 40 years old? The American Association of Oral and Maxillofacial Surgeons also reports that TMJ disorders are far more common among women than men. Though there is no way of knowing exactly how many people suffer from TMJ disorders (many go undiagnosed), the National Institute of Dental and Craniofacial Research estimates that approximately 10 million people in the U.S. currently suffer with TMJ conditions.
Snoring is a turbulent process resulting from a partial obstruction of the airway. It occurs when air flows past relaxed tissues in your throat causing the tissues to vibrate during breathing and creates those irritating sounds. Often, snoring is simply a nuisance but occasionally, it may indicate a more serious condition, better known as obstructive sleep paean (OSA).
People with OSA take shallow breaths and intermittently STOP breathing for brief periods of time while asleep. This is due to a complete blockage of the airway resulting in absent air flow. When the brain experiences low blood oxygen levels, the sleeper partially awakens, often with a loud gasp, to clear the obstruction and resumes normal airflow. This cycle repeats itself throughout the night with similar disruptive sleep patterns, which can ultimately lead to life-threatening cardiovascular problems. It has been associated with the following conditions.

DO I HAVE SLEEP APNEA?

Although many people may suffer from sleep apnea, it often goes unnoticed by the patient as they are asleep when this is occurring. Often, the patients partner will be the first to notice the episodes of shallow breathing, complete cessation, or gasping/choking for air while asleep. A sleep apnea patient may experience a range of symptoms including; severe daytime drowsiness and fatigue, impaired memory, symptoms of depression, and even decreased libido. If you have any of these signs/symptoms, a formal sleep study will be undertaken to evaluate the severity of the disease.
In some cases, snoring can indicate upper airway resistance syndrome (UARS). Unlike sleep apnea, people with UARS do not stop breathing at any point or have decreased blood oxygenation. What they experience is a decreased airflow when breathing in. The airway narrows and breathing becomes more difficult. People with UARS share some of the same symptoms as those with OSA, yet will test negative with sleep testing.

DID YOU KNOW…

that you can reduce your chances of snoring or developing apnea by changing a few simple habits? According to the American Association of Oral and Maxillofacial Surgeons, one of the most effective ways of alleviating apnea and snoring is by losing weight. The AAOMA suggests that just 10 pounds can be enough weight loss to help open up the airways and reduce apnea symptoms. Other ways of preventing the condition include changing your sleep position, avoiding tobacco products, and maintaining regular sleeping habits.

FREQUENTLY ASKED QUESTIONS

What can I expect at my initial consultation?

Oral and Maxillofacial Surgeons are uniquely qualified to recognize the difference between OSA from other types of airway resistance problems. At your first visit, the doctors will begin with a detailed medical history and assess the anatomic relationship between your upper and lower jaws. A digital scan will be necessary to ascertain the degree and level of obstruction. Sometimes, underdeveloped maxillofacial bones maybe the culprit and will determine the type of surgical treatment necessary. Occasionally, adjunctive diagnostic tool such as a flexible fiber-optic camera may be used to better evaluate the nasal and posterior pharynx. Finally, to confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.

Do I need surgery for my sleep apnea?

Your treatment will depend on the extent of your symptoms. In mild to moderate cases, conservative approaches are used first. Patients who do not respond to these methods may be fitted for an oral appliance, given a pressurized airflow mask, or otherwise advised to undergo surgery to open up the airway.

Are there any steps I need to take to improve my outcome?

You may be able to avoid more invasive treatments by finding ways of reducing the severity of your symptoms. Some patients find it beneficial to sleep with their heads propped up, whereas others find relief by sleeping with a tennis ball under their backs. Talk with your Los Alamitos dentist about the options available to you and ways that you can contribute to the management of your condition.
The surgeons at Alamitos Oral Surgery treat a wide scope of oral pathology from tooth related cysts to early oral cancer. Often your dentist or physician will detect a suspicious lesion during a routine exam, and ask for our surgical advise for treatment. However, if you notice an unusual growth or lesion in your mouth or jaws, we encourage a consultation as soon as possible. Early detection and diagnosis through a thorough head and neck exam during your consultation will allow appropriate and timely treatment.

DID YOU KNOW…

that the American Association of Oral and Maxillofacial Surgeons recommends that everyone – regardless of risk factor – perform a self-examination for oral cancer every month? It only takes minutes, but could save your life. To start, take off removable appliances and restorations, such as dentures and retainers. Using a bright light and a mirror, inspect all surfaces of the mouth, including the roof, floor, cheek walls, tongue, and the gums. Then, use your finger to inspect all surfaces for lumps or swollen lymph nodes.

FREQUENTLY ASKED QUESTIONS

Do I need an oral pathology screening at Alamitos Oral Surgery?

You may need to see your oral surgeon if the results of your self exam (or from your dentist or physician) have revealed lumps, masses, or unusual red or white patches in your mouth. You should also see your surgeon if you have any mouth sores that have failed to heal or if the tissues of your mouth have thickened. Chronic sore throat or difficulty swallowing may also be a sign of oral cancer.
Keep in mind that there are certain risk factors that increase your chances of developing oral cancer. They include using tobacco, excessive alcohol consumption, and even simple poor hygiene. The human papilloma virus has also been associated with oral cancer development, as has age and infectious disease.

What should I expect during your consultation?

Your consultation will include a thorough head and neck exam, and possibly a screening cone beam CT scan conveniently in our office. Our surgeons may then recommend a biopsy. This can be done under general anesthesia in our office for your comfort. During this procedure, your mouth will be numbed and a small section of the affected tissue removed. The sample tissue will be sent to pathology laboratory for examination. Once the results are obtained after a short period, your surgeon will discuss your options for treatment.

Will I need to follow any special instructions following a biopsy?

After a biopsy, it is normal to experience some minor bleeding and swelling after the procedure. Apply ice to help minimize swelling, and for bleeding apply pressure by biting on gauze afterwards. Please allow 5-10 days for your surgeon to received the results from the pathologist. These results will be discussed at a followup appointment. All results will be discussed in person and kept confidential.
Today’s modern anesthetic and sedative drugs enable us to perform surgical treatment comfortably, without pain and anxiety. Each patient has the option of anesthesia for a procedure, ranging from local anesthesia, oral sedation, nitrous oxide (laughing gas), intravenous sedation, or general anesthesia. Drs. Poyourow, Chandra, and Pham are expert in the administration of all types of anesthesia, including general anesthesia. Each has performed thousands of cases of general anesthesia from operating room to office.
Alamitos Oral Surgery is equipped with the most advanced monitoring equipment to ensure a safe and comfortable experience.

REQUIREMENTS FOR GENERAL ANESTHESIA

Food & Drink:

You cannot have food or liquid for 8 hours prior to your appointment.

Driving:

An adult driver must be present during your surgery and drive you home afterwards. You cannot drive the rest of the day even though you may feel fine.

Medications:

If you take medication in the morning, please ask your surgeon if you should take this medicine the morning of the surgery. Generally, you may take your daily medication with a small sip of water, but there are some exceptions.

Supervision:

After surgery, an adult must be available to supervise you at home for a few hours.
A dental implant is made from surgical grade titanium and supports a permanent crown or denture. It is analogous to the “root” portion of a tooth. Depending on the situation, implants can be placed the same day as removing a tooth or years after a tooth has been lost. Modern root-form dental implants have been in clinical practice for over 30 years. Recent advancements have improved the speed of healing, success rates, and expanded the clinical scenarios where implants can be utilized. It is truly an exciting time to be involved with implant dentistry.
At Alamitos Oral Surgery we use the top implant brands which are backed by decades of research, have proven track records, and the support of a large company. We partner with Straumann, Nobel Biocare, Astra, and Biohorizons to achieve exceptional results.
Whether replacing a single tooth or an entire arch, dental implants are helping adults of all ages recreate beautiful smiles.

DID YOU KNOW…

Approximately 30 million Americans have no teeth in one or both jaws? More and more patients are opting for dental implants as a means of tooth replacement. The American Academy of Implant Dentistry reports that 3 million Americans currently have dental implants – a number that is rapidly growing by about 500,000 per year. Titanium implants were first developed in the 1950’s, but archeologists have determined that ancient Egyptians and Mayans were the first cultures to implant artificial teeth.

FREQUENTLY ASKED QUESTIONS

How successful are implants?

In healthy non-smokers, implants are between 95-98% successful.

How long do implants last?

There are still patients chewing with the original Branemark root-form implants, placed over 30 years ago. Much like a tooth, the longevity of an implant depends on how well it is maintained. There is no accepted lifespan for an implant, but when maintained they are expected to last a very long time, on the order of decades.

Are dental implants right for me?

If you are an adult and need to replace one or more teeth, a dental implant may be the best option for you. Generally, implants are not placed in the jaw until a patient has stopped growing, which is usually age 16 for females and 18 for males. There is no such thing as too old. Patients in their 90s and older are getting implants every day and have success rates equal to younger patients. The best way to determine if a dental implant is a good treatment option for you is to have a consultation with Dr. Poyourow, Dr. Chandra, or Dr. Pham.

What is the process of getting an implant?

Dental implant treatment ranges from simple to complex depending on each patient’s oral condition. At Alamitos Oral Surgery, we utilize 3D Cone Beam CT imaging to visualize the bone beneath the gums in all dimensions with fine detail. We can reconstruct this data into a 3D image and precisely measure the distance from the proposed implant site to vital structures like nerves, the sinus cavity, and other teeth. Furthermore, for complex cases we have the capacity to perform guided surgery using the 3D data from the CT scan and achieve levels of precision previously unimaginable.
Looking at the simplest situation of replacing a single tooth, after proper imaging, consultation, and planning, the implant in inserted and allowed to heal for 2-3 months. You may have a temporary crown during this time or a metal cap that sits atop the implant and shapes the gum tissue. During the healing phase a patient’s bone becomes intimately engaged in the microscopic crevices of the implant. After healing is complete an impression of the implant location is made and sent to the lab. A crown is fabricated and subsequently cemented or screwed onto the implant.

What is it like after the surgery?

Similar to having a tooth removed, mild discomfort is typical and well managed with ibuprofen or prescription analgesics. Often patients report less discomfort after an implant compared to a tooth extraction.
A good bite is important to overall health. Inability to chew food well can lead to poor nutrition. An unstable bite can cause headaches and muscle pain. Furthermore, unhappiness with one’s physical appearance can result in negative psychosocial consequences.
Due to growth disturbances, the upper and lower jaws may fail to meet normally. The lower jaw may protrude past the upper teeth resulting in an “underbite.” Conversely, the lower jaw may rest far behind the upper teeth, producing an “overbite.” Many other jaw deformities that can occur such as asymmetry, excess vertical growth, deficient vertical growth, or a narrow upper jaw. Sometimes these malocclusions (irregularities in jaw and tooth relationship) can be corrected with braces alone. However, when the magnitude of the problem exceeds the capabilities of orthodontics alone, corrective jaw surgery can help.
Orthognathic surgery (corrective jaw surgery) has both functional and esthetic goals. Functional improvements are achieved in the bite, chewing, and airway. Esthetic improvements are seen by creating facial harmony. Patients can obtain dramatic results in both their bite and physical appearance, both of which are life transforming.

YOU MAY BENEFIT FROM CORRECTIVE JAW SURGERY IF…

IS CORRECTIVE JAW SURGERY RIGHT FOR ME?

You may be a candidate for corrective jaw surgery if you have a malocclusion (bad bite) caused by poorly aligned jaws. In some cases, bad bite can be treated with orthodontics alone. In others, a combination of orthodontics and surgery will correct alignment problems. After a thorough consultation with Dr. Poyourow, Dr. Chandra, or Dr. Pham you will know if orthognathic surgery can benefit you.
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BOTOX

Botox is a safe, FDA-approved cosmetic treatment that has been popular among healthy American men and women since its FDA approval in 2002. Millions of people have undergone Botox injections to help smooth facial lines and restore a younger appearance. Botox is injected into the facial muscles, helping to block nerve impulses and relax the muscles. Without contracting facial muscles, lines become less evident and are prevented from worsening.

ACCORDING TO AMERICAN SOCIETY FOR AESTHETIC PLASTIC SURGERY…

Botox was the most frequently administered non-surgical cosmetic treatment in the United States for 2012. More than 4 million people underwent Botox injections – up approximately 10 percent over the year before. Demand for minimally invasive aesthetic treatments continues to rise, and Botox is at the forefront.

FREQUENTLY ASKED QUESTIONS

Am I a candidate for Botox treatment at Alamitos Oral Surgery?

Although many patients are candidates for Botox injections, a thorough consultation with one of our oral and maxillofacial surgeons is necessary. Indications for use include myofascial pain and myospasm related to TMJ disorders, along with minimizing wrinkles that occur with facial expression. For facial wrinkles, Botox is most affective around the forehead, brow, and eyes. For more information about Botox and whether it is right for you, schedule a consultation with us at your earliest convenience.

What should I expect during a Botox injection?

Botox is a rapid cosmetic treatment that takes just minutes to perform from the comfort of our office. The injection is administered using a very fine needle that induces only mild discomfort. You can return to work immediately after the injection.

How long do the results last with Botox treatment?

You will begin to notice the effects of your treatment within just a few days. The results will continue to improve over the course of approximately 4 weeks and may remain for up to 6 months.

FACIAL FILLERS

Facial fillers are substances injected beneath the skin to help smooth fine lines and boost facial volume. Also known as dermal fillers, these injections are in-office procedures that are minimally invasive alternatives to cosmetic surgery. Patients often undergo facial filler injections to achieve a more youthful appearance with as little down time as possible. Fillers are available to target nearly any area of the face, including crow’s feet, laugh lines, and thin lips.

DID YOU KNOW…

that non-surgical cosmetic treatments like Restylane and Juvederm are the fastest growing form of aesthetic medical enhancements in the U.S.? The American Society of Plastic Surgeons reports that minimally invasive cosmetic procedures were up by 6 percent in 2012 over 2011 despite surgical procedures being down by 2 percent. More than 1.4 million dermal injections were administered to American patients in 2012 alone – up from 1.3 million in 2011.

FREQUENTLY ASKED QUESTIONS

Am I a candidate for facial fillers at Alamitos Oral Surgery?

You may be a candidate for dermal facial filling if you are unhappy with your facial volume or are looking for a non-surgical way of smoothing fine lines. These are also terrific adjuncts to look more youthful for patients already undergoing corrective jaw surgery, or having facial implants placed. Many types of facial injections are available; and our staff would be happy to help you find out which filler is right for you. Contact us today to schedule a consultation, or find out more about dermal injections.

What should I expect during a facial filler injection?

Getting a facial filler is as easy as dropping by our office on your lunch break. Using a very fine needle, your filler will be injected just beneath the surface of your skin. Sometimes injection of local anesthetic can be used to avoid any discomfort. You will experience little or no discomfort afterwards, and can return to work immediately after the procedure.

What types of results can I expect from a facial filler?

Results vary from patient to patient and are never guaranteed. However, most patients begin to see visible results within just days of undergoing a dermal injection. Results may continue to improve over the course of several weeks. Depending on the location of your injection and the type of filler used, the effects of your filler may last as long as 6 months or more. Occasionally additional injections may be needed to allow desired results.
There are many reasons why a patient may need a bone graft. When a tooth is lost the supporting bone is resorbed over several years due to lack of function. If a patient subsequently desires a dental implant, often this bone must be recreated through a grafting procedure. Common terms for grafting in the mouth are socket preservation, guided bone regeneration, block graft, and sinus lift.

Socket Preservation:

In this procedure a bone graft is placed in an extraction socket after a tooth is removed. This ensures maximal regeneration of bone during healing. As mentioned previously, when a tooth is removed the surrounding bone tends to resorb due to lack of function. Bone is a living tissue and responds to mechanical forces. In the absence of mechanical forces from chewing, bone can atrophy. Socket preservation is frequently used if a patient desires an implant after and extraction and is not a candidate for immediate implant placement at the time of extraction.

Guided Bone Regeneration:

GBR is a bone grafting technique where a bone graft is placed at a deficient site and covered with a membrane to separate bone from overlying soft tissue. The graft is allowed to heal for 5-6 months before the site is re-evaluated. Membranes can be resorbable (collagen) or non-resorbable (titanium, plastic).

Block Graft:

A block graft takes a square or rectangle of bone from another area on the jaw or body and fixates it to the recipient site. If a small graft is needed it can be harvested from other sites on the jaw. If a large graft is needed the hip (Iliac Crest) is commonly used.

Sinus Lift:

A sinus lift can be direct/lateral approach or indirect/crestal approach. The direct/lateral approach makes a small window into the maxillary sinus, whereupon the lining of the sinus is lifted and bone graft placed underneath. In an indirect/crestal approach the graft is inserted through the hole made to place the implant. Generally, the direct/lateral approach is used for large sinus grafts and the indirect/crestal approach is used for small sinus grafts.
Patients may also lose bone as a result of trauma, infection, or treatment of a jaw tumor. In these cases a larger graft is needed. These larger grafts are typically taken from the hip (iliac crest), knee (tibia), or rib (costochondral). Drs. Poyourow, Chandra, and Pham have extensive training in all bone grafting procedures from major to minor.

SOURCES OF A BONE GRAFT

There are 4 possible sources of a bone graft: synthetic (man made), animal (coral, cow, horse), cadaveric (human tissue bank), and the patient’s own bone. The choice depends on patient preference, surgeon’s preference, size of the bone defect, location of the graft, and final goal.
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