oral & maxillofacial surgery
Monday – Friday
7:00 AM to 3:00 PM
11 Green Lane East, Remuera, 1050, New Zealand
What Is Oral & Maxillofacial Surgery?
Oral & Maxillofacial Surgery (OMS) is the surgery of the mouth, face and jaws. Oral and Maxillofacial Surgeons train in both dentistry and medicine. They are specialists in diagnosing and treating a broad range of disorders, such as impacted teeth, dental implants, facial trauma, oral cancer, salivary gland disease, temporomandibular joint disorders, cysts and tumours.
How our Specialist Oral Surgeon, Nigel Parr, can help
Our highly qualified Specialist, Nigel Parr, carries out Oral & Maxillofacial Surgery procedures and treatments with kindness and care as well as achieving excellent results.
He has over 20 years of valuable private practice experience. He utilizes both advanced onsite technology and his professional expertise to deliver the best in modern mouth, face and jaw care.
With many years of treating patients and their families, he comes with a special level of knowledge and a reputation that puts patients at ease.
Oral and Maxillofacial Surgery appointment
Most people have four wisdom teeth – two in the upper jaw and two in the lower jaw. It is not uncommon for these teeth to become impacted. An impacted tooth is one that has not grown through the gum into the mouth or has grown only part way part-way and is in an abnormal position. This is an unhealthy situation and the tooth should be removed for a number of reasons, the main one is that recurrent infections are common if they are not removed.
Often young people when growing, do not have enough space for all teeth to erupt into their mouths. If these teeth are essential for ideal bite and function, surgical exposure of these teeth may be necessary. Usually, a referral from an Orthodontist is recommended for these types of extractions.
Severe tooth decay, gum disease, infection or trauma may lead to the necessary removal of a tooth. Your dentist may prefer to refer you to a specialist.
As we age our bone becomes denser and our teeth become more brittle making them very difficult to remove. Through years of chewing the teeth become very cemented to the bone- known as Ankylosis. Most elderly patients will find that removal of a tooth with an Oral Surgeon under some sedation is a more pleasant way to have your tooth removed. Nigel Parr has had years of experience of doing these extractions and has developed great techniques to put you at ease and take great care of you.
A dental implant is an artificial root (aka fixture or screw) that serves as a replacement for a missing tooth. Implant surgery can take up to 3 or 4 stages. This will depend on whether you are missing one or several teeth and whether the bone is sufficient to sustain an implant. Sometimes bone grafting may be required. Once you decide to proceed with implant surgery, appointments would be scheduled in conjunction with your dentist who will then place the tooth on top of the implant fixture.
An apicectomy is an operation where the very end of the root tip is removed. It is usually undertaken when a root filling has failed to satisfactorily seal the root canal. When this occurs, an abscess can form. This may lie dormant for many years and then suddenly flare up resulting in an acute abscess.
Types of Anaesthesia Available
- Local anaesthesia
- Local anaesthesia with oral sedation
- Local anaesthesia with intravenous sedation
- General anaesthesia
This is the same as what you experience with your Dentist before a filling.
It involves a small dental needle injection in the mouth to numb the tooth or area for surgery. This will remain numb for approximately 2 hours. There is also a longer-lasting local anaesthetic that can maintain numbness for up to 6 hours.
The same as above with the addition of an oral sedative tablet taken before your procedure.
It has the benefit of you feeling quite sleepy and relaxed throughout your procedure with us.
This is a very pleasant way to have your surgery. We call it a twilight sleep or a light sleep.
This is the most common form of sedation for our patients. Mr Parr has over 20 years’ experience in providing Intravenous sedation for his patients and achieves excellent results where the patient has a very good experience. Most patients have very little memory of their surgery.
Along with the local anaesthetic, you will have a sedative and pain relief administered through a luer (plastic needle) in your arm. You must be medically fit to meet the criteria for IV sedation. This can be carried out at our Green Lane East rooms.
This is the anaesthetic where you are completely asleep. A general anaesthetic is only administered by an anaesthetist at a private hospital. Dr Parr will carry out this surgery at either Quay Park Surgical Centre or Ormiston Hospital (for more on these facilities see Links). Click here for the Quay Park Surgical Centre Anaesthesia Assessment form.
Oral ulcerations appear as necrotic or eroded areas on the oral mucosa, including the tongue. Most such lesions are idiopathic (aphthous) or of viral etiology (eg, herpes simplex virus [HSV]; rarely herpes zoster [VZV]). Oral ulcerations also may be caused by fungal, parasitic, or bacteriologic pathogens; by malignancy; or by other systemic processes.
Historically, it has been difficult to determine which abnormal tissues in the mouth are worthy of concern. The fact is, the average person routinely has conditions existing in their mouths that mimic the appearance of pre-cancerous changes and very early cancers of the soft tissues. Any sore, discolouration, prominent tissue, irritation, or hoarseness, which does not resolve within a two-week period on its own, with or without treatment, should be considered suspect and worthy of further examination.
The glands are found in and around your mouth and throat. We call the major salivary glands the parotid, submandibular, and sublingual glands. Besides these glands, there are many tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa), and extensively in other linings of your mouth and throat. Salivary glands produce saliva to moisten your mouth, initiate digestion, and help protect your teeth from decay.
There are oral lesions whose diagnosis can be made relying on data gathered during the history and/or physical examination, but there are others where studies are needed to confirm the presumed clinical diagnosis. Biopsy is a surgical procedure to obtain tissue from a living organism for its microscopical examination, usually to perform a diagnosis. Biopsy is indicated for diagnostic confirmation of suspected malignant lesions, precancerous lesions, and chronic ulcerations of unknown cause. It is also indicated for the histological confirmation of certain systemic disorders, and is recommended for apparently inflammatory lesions that do not improve within two weeks of removal of local irritants.
Lichen planus is a chronic mucocutaneous disease. The mouth is involved in 50% of cases and is often the only affected area. The usual areas affected are the inside of the cheeks and the sides of the tongue, but the gums and lips may also be involved.
Soft Tissue Surgery
When teeth are twisted and then undergo orthodontic rotation with braces to correctly straighten them, there are small fibres of the tooth ligament that are stretched like “rubber bands”. When the orthodontic rotation is completed, these fibres need to be severed to release the forces, otherwise the tooth will move back to its poor alignment.
When young people have spaces between their teeth where a frenum is attached, closing this space by orthodontic braces can squeeze the tissues. This may mean that once the bands are taken off the “pent up” forces may force the teeth apart. By careful removal of the frenum and reducing the squeezed tissue this movement does not occur. This procedure is called frenectomy.
TMJ is short for “temporomandibular joint”. It attaches your lower jaw (mandible) to the base of your skull on each side of your head. The TMJ acts as a hinge. It allows your mouth to open and close, and moves from side to side when chewing. Muscles surrounding and attached to the TMJ control its position and also control jaw movements during talking, chewing and yawning. Some people suffer from disorders affecting one or both TMJs, muscles and surrounding tissues. These disorders can often cause pain and restricted jaw function. For most people, symptoms are temporary and usually go away without treatment. Discomfort in the TMJ and chewing muscles is common and usually not a cause for major concern. About seven people out of every ten have had signs of a TMJ disorder at some point in their lives. About one person in four is aware of symptoms or reports them. Of the 50 people in every 1,000 who seek treatment, only two may require surgery.
Most of the time the pain is caused by clenching of the chewing muscles which results in myo-facial pain which can be excruciatingly sore. When these muscles are tight they limit the movement of the jaw joint which can result in a “clunky” or noisy joint.
Orthognathic (ortho = straight, gnathic = jaw) surgery involves correction of the position of the bones of the face and jaws to a more ideal relationship. This includes operations on the upper or lower jaw or a combination of both and occasionally operations on the chin and cheek bones. We always work alongside your Orthodontist to achieve optimal results.
We do require a referral from a Specialist Orthodontist if you are contemplating Jaw Surgery.