To learn more about the oral surgery procedures that we provide, please select a procedure from the menu below:
- Wisdom Teeth
- Dental Implants
- All-on-4® Treatment
- Bone Grafting
- Facial Trauma
- Oral Pathology
- TMJ Disorders
- Orthognathic Surgery
Wisdom Teeth Removal in Richmond
We offer sedation for a painless experience. You do not have to be awake during the procedure! We have two convenient locations in Midlothian VA for your oral surgery needs. Continue reading to learn more about wisdom teeth removal.
The average adult has thirty-two teeth by age eighteen: sixteen teeth on the top and sixteen teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces while the back teeth, or molar teeth, are used to grind food up into a consistency suitable for swallowing.
However, the average sized mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your third molars, also known as ”wisdom teeth.”
Why Should I Remove My Wisdom Teeth?
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 erupt successfully.
These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth 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 wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.
With an oral examination and x-rays of the mouth, Dr. Padgett can evaluate the position of the wisdom teeth and predict if there may be present or 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.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Padgett has the training, license and experience to provide various types of anesthesia to allow patients to select the best alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques.
What are Dental Implants?
A natural tooth consists of a root and a crown. If you compare natural teeth to implant-supported replacement teeth, you’ll see they have the same basic parts. Both have a crown (the visible part used to chew food). Both have a root that holds the tooth securely under the gum and is anchored into the jaw. The difference is that the implant is made of titanium – the same time-tested material used by surgeons for artificial joints. When you lose a tooth, you lose both the root and the crown. To replace the tooth, the surgeon first replaces the root with a small dental implant.
Time is allowed for bone to heal and grow around the dental implant. The bone bonds with the titanium, creating a strong foundation for artificial teeth. A support post (abutment) is then placed on the implant and a new replacement tooth (crown) is placed on top of the abutment. In many cases a temporary replacement tooth can be attached to the implant immediately after it is placed. If all of your teeth are missing, a variety of treatment options are available to support the replacement teeth.
All-on-4® Treatment Concept
What is the All-on-4® Treatment Concept?
The All-on-4® treatment concept is a cost-efficient, graftless solution that provides patients with a fixed full-arch prosthesis on the day of surgery. Characteristics include:
- Full-arch rehabilitation with only four implants. Two straight anterior implants and two implants tilted up to 45º in the posterior.
- Immediate Function (fixed provisional bridge). For patients meeting criteria for immediate loading of implants Graftless procedure Bone grafting is avoided by tilting the posterior implants, utilizing available bone.
All-on-4® treatment concept Dental Implants and Teeth Restorations
We provide a revolutionary and contemporary treatment plan of replacing your teeth with a full, permanent dental bridge anchored on 4 – 6 implants. If you have no teeth, or few teeth, then the All-on-4® treatment concept will give you the ability to chew and smile normally. Both treatment time and costs are reduced with this treatment plan compared to traditional methods. This concept has been scientifically proven and documented with favorable results in a multitude of clinical studies.
Typically in one surgery, failing teeth are removed, dental implants are placed and a temporary set of teeth can be delivered on the same day. The temporary teeth allow you to lead a normal life immediately after surgery. After a healing period, your dentist will placed the final bridge. Your quality of life is improved, and you can start enjoying your favorite foods again with renewed confidence.
Denture Options for Missing Teeth | Implant Supported Dentures
The Better Solution for Missing Teeth
If you have lost most or all of your teeth, a modern dental solution supported by dental implants is the best alternative to ill-fitting dentures.
Depending on your specific dental situation, as few as two to four dental implants can make a big difference in stabilizing your denture and giving you a full set of fixed teeth.
Dental implants give your new restoration the much-needed stability in your jawbone that has been missing during all your years of denture wearing.
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
We now have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width; it also gives us a chance to restore functionality and aesthetic appearance. The bone graft procedures are referred to as:
- Sinus Lift Procedure: This procedure involves elevating the sinus membrane and placing the bone graft onto the sinus floor, allowing implants to be placed in the back part of the upper jaw
- Ridge Augmentation: In severe cases the ridge has been reabsorbed and a bone graft is placed to increase the ridge height and/or width.
- Nerve Re-positioning: The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw.
These procedures may be performed separately or together, depending upon the individual’s condition. There are several areas of the body, which are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee.
These surgeries are performed in the out-office surgical suite under I.V. sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.
Oral and Maxillofacial Surgeons are trained, skilled and uniquely qualified to manage and treat Facial Trauma.
Dr. Padgett is on staff at the local hospital and provides emergency room coverage for facial injuries including:
- Facial lacerations
- Intra-oral lacerations
- Avulsed (knocked out) teeth
- Fractured facial bones (cheek, nose, or eye socket)
- Fractured jaws (upper and lower jaw)
Injuries to the face , by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.
The Nature of Maxillofacial Trauma
There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries account for many. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bony injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
Soft Tissue Injuries of the Maxillofacial Region
When soft tissue injuries such as lacerations occur on the face, they are repaired by “suturing”. In addition to the obvious concern of providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat, injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). Dr. Padgett is a well-trained oral and maxillofacial surgeons and is proficient at diagnosing and treating all types of facial lacerations.
Bone Injuries of the Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient. When an arm or a leg is fractured, a “cast” is often applied to stabilize the bone and allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. However, certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small “plates and screws” at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of “rigid fixation” has profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner. Importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is “hidden”.
Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth which have been displaced or “knocked out”. These types of injuries are treated by one of a number of forms of “splinting” (stabilizing by wiring or bonding teeth together). If a tooth is “knocked out”, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better for the survival of the tooth. Therefore, the patient should see a dentist or oral surgeon as soon as possible.
Never attempt to “wipe the tooth off”, since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.
The proper treatment of facial injuries is now the realm of specialists, well versed in the emergency care, acute treatment and long term reconstruction and rehabilitation of the patient.
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer.
The following can be signs at the beginning of a pathologic process or cancerous growth:
- Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
- A sore that fails to heal and bleeds easily
- A lump or thickening on the skin lining the inside of the mouth
- Chronic sore throat or hoarseness
- Difficulty in chewing or swallowing
These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.
We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body’s most important warning systems. Do not ignore suspicious lumps or sores, please contact us so we may help.
TMJ ( temporomandibular joint ) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.
No one treatment can resolve TMJ disorders completely and treatment takes time to be effective. Dr. Padgett can help you have a healthier and more comfortable jaw.
Trouble with Your Jaw?
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. Or, you may have a damaged jaw joint due to injury or disease. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noises when you open your mouth, or trouble opening your mouth wide.
Do You Have a TMJ Disorder?
- Are you aware of grinding or clenching your teeth?
- Do you wake up with sore, stiff muscles around your jaws?
- Do you have frequent headaches or neck aches?
- Does the pain get worse when you clench your teeth?
- Does stress make your clenching and pain worse?
- Does your jaw click, pop, grate, catch, or lock when you open your mouth
- Is it difficult or painful to open your mouth, eat or yawn?
- Have you ever injured your neck, head or jaws?
- Have you had problems (such as arthritis) with other joints?
- Do you have teeth that no longer touch when you bite?
- Do your teeth meet differently from time to time?
- Is it hard to use your front teeth to bite or tear food?
- Are your teeth sensitive, loose, broken or worn?
The more times you answered “yes,” the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they’re treated.
There are various treatment options that Dr. Padgett can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder , the doctors will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care as well as professional care.
Orthognathic surgery is needed when jaws don’t meet correctly and/or teeth don’t seem to fit with jaws. Teeth are straightened with orthodontics, and corrective jaw surgery re-positions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.
Who Needs Orthognathic Surgery?
People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and, in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health, and appearance. Injury to the jaw and birth defects can also affect jaw alignment. While orthodontics alone can correct bite problems if only the teeth are involved, orthognathic surgery may be required if the jaws also need re-positioning.
Difficulty in the following areas should be evaluated:
- difficulty in chewing, biting or swallowing
- speech problems
- chronic jaw or TMJ pain
- open bite
- protruding jaw
- breathing problems
Any of these can exist at birth or may be acquired after birth as a result of hereditary or environmental influences or, trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with x-rays. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.
Dr. Padgett uses modern computer techniques and three-dimensional models to show you exactly how your surgery will be approached. Using comprehensive facial X-rays and computer video imaging, we can show you how your bite will be improved and even give you an idea of how you’ll look after surgery. This helps you understand the surgical process and the extent of the treatment prescribed, and to see the benefits of orthognathic surgery.
If you are a candidate for Corrective Jaw Surgery, Dr. Padgett will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.
At this visit, your doctor will assess you needs and desires and discuss various treatment options. He will also review your expectations and the probable outcome of treatment. You may be shown several before and after photographs, but remember, results vary with individuals. Your doctor will provide literature for you to review at home and request you return at a later date to finalize the type of procedure you desire and schedule the surgery. At this time, before and after photographs may be taken of the area to document your results. For smaller procedures, a surgery date may be made at the initial visit.
Please assist us by providing the following information at the time of your consultation:
- Your surgical referral slip and any x-rays if applicable.
- A list of medications you are presently taking.
- If you have medical insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
IMPORTANT: A parent or guardian must accompany all patients under 18 at the consultation visit.
A pre-operative consultation is mandatory for patients undergoing IV anesthesia for surgery. Please have nothing to eat or drink 6 hours prior to your surgery. You will also need an adult to drive you home.
Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e. diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.)
If your physician or dentist has taken X-Rays, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional films are necessary, they can be taken at our facility.