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A Comprehensive Guide to Pediatric Oral Surgery

Doctor looking at an x-ray scan

Overview

As a pediatric dentist, you know that oral surgery on young patients requires special care and consideration. Your expertise guides children and their families through necessary procedures with compassion. This comprehensive guide on pediatric oral surgery will further equip you to meet the unique needs of your young patients. In 100 helpful words, you'll find current best practices across common in-office surgeries like frenectomies, extractions, pulpotomies, and space maintenance. Additionally, guidance is provided on referring complex cases to oral surgeons. Lean on this resource when preparing for pediatric oral surgery and upholding high standards of care.

What Is Pediatric Oral Surgery?

Understanding the Specialty

Pediatric oral surgery is a specialized branch of dentistry that focuses on surgically treating various oral and facial conditions in children. Also known as pediatric maxillofacial surgery, it aims to restore children's oral health to 100% through surgical interventions. According to the University Health website, this field cares for conditions affecting a child's head, neck, face, jaws, mouth, and teeth.

Pediatric oral surgeons are specially trained to perform corrective and reconstructive procedures that help return skull, facial, and jaw abnormalities to near-normal. From misaligned jaws and crowded teeth to tumors, cysts, and genetic conditions, these surgeons have the expertise to address a wide range of issues.

Common Surgical Procedures

Some of the most common pediatric oral surgery procedures include:

  • Frenectomy: This involves removing or modifying the frenulum - the fold of tissue connecting the lips or tongue. According to OmaxDocs, a tight frenulum can cause issues with speech, eating, and tooth alignment if left untreated.

  • Tooth extractions: Extractions may be needed to create space for orthodontic treatment like braces. These are performed under sedation for the child's comfort and safety.

  • Removal of decayed baby teeth: Severely decayed baby teeth need to be removed if decay cannot be treated otherwise. This relieves pain and ensures proper development of permanent teeth.

  • Pathology/biopsy: Examining and removing abnormal tissues or growths for diagnosis and treatment of conditions like tumors or cysts.

Other procedures include cleft lip and palate surgery, craniosynostosis surgery, bone grafting, craniofacial surgery, corrective jaw surgery, craniofacial implants, distraction osteogenesis, facial reconstructive surgery, and trauma surgery.

Preparing for Pediatric Oral Surgery

On the procedure day, as outlined by Children's Surgical Center, the child and parent will check in at the surgery center. The child will change into a gown, and vital signs will be checked in the pre-op area. Anesthesia preparations will be explained, and X-rays may be taken in the operating room to identify any additional work needed.

After being given anesthesia through a mask, an IV will be started, and the dental procedure performed. Once completed, the child will recover in a private room while being closely monitored. After recovery, discharge instructions will be provided, and the child can usually go home within 30-45 minutes once stable.

Conditions That Require Pediatric Oral Surgery

Tooth Abnormalities

Tooth abnormalities are among the most common reasons for pediatric oral surgery. Supernumerary teeth, or extra teeth that develop in the mouth, often need to be surgically removed to prevent overcrowding and alignment issues. According to the University of Michigan, impacted teeth that fail to properly erupt can also necessitate surgical intervention. Odontogenic cysts, which are fluid-filled sacs that form around the teeth, may require removal by an oral surgeon.

Dental Infections & Injuries

Severe dental infections in children frequently call for surgical drainage and extraction of affected teeth. As mentioned by CHOP, oral surgeons also treat traumatic injuries to primary and permanent teeth, performing procedures like reimplantation or avulsion when teeth are dislodged or fractured. Cellulitis, a potentially serious bacterial skin infection, may require incision and drainage by a pediatric oral surgeon.

Cysts, Tumors & Lesions

While relatively rare in children, cysts, tumors, and lesions in the mouth and jaw area can occur and often require surgical excision for diagnosis and treatment. Rutgers University notes that dentists monitor children's tooth development with x-rays, which can detect issues like dentigerous cysts, odontogenic keratocysts, and ameloblastomas that may need oral surgery.

Cleft Lip & Palate Repair

Children born with cleft lip and/or cleft palate frequently require multiple surgical procedures performed by an oral and maxillofacial surgeon. The CHOP team collaborates with plastic surgeons and orthodontists to repair cleft defects and address any associated dental and facial issues in a comprehensive, individualized manner.

Anesthesia for Pediatric Oral Surgery

Depending on the child's age, medical status, and complexity of the procedure, pediatric oral surgery may be performed under local anesthesia, conscious sedation, or general anesthesia. As outlined by Children's Hospital of Pittsburgh, general anesthesia administered by a pediatric anesthesiologist is common for extensive dental work or multiple procedures done together. Careful monitoring and home care instructions are provided post-operatively.

No matter the condition, pediatric oral surgeons have specialized training to safely perform necessary mouth and jaw procedures in children while prioritizing their unique needs and comfort levels. Early intervention and regular check-ups can help avoid more invasive treatments down the road.

Procedures That Require an Oral Surgery

When it comes to pediatric oral surgery, there are several procedures that may be necessary to address various dental and oral health issues in children. These procedures are typically performed by experienced oral surgeons who specialize in treating young patients. Here are some common procedures that require oral surgery:

Tooth Extractions

One of the most common procedures in pediatric oral surgery is tooth extraction. This may be necessary when a baby tooth is severely decayed or damaged beyond repair, or when it needs to be removed to make room for the proper alignment and eruption of permanent teeth. Extractions for orthodontic needs are often performed under sedation for the child's comfort and safety.

Removal of Impacted or Ankylosed Teeth

In some cases, teeth may fail to erupt properly or become "stuck" in the jawbone, a condition known as impaction or ankylosis. This can occur with deciduous teeth or permanent teeth like third molars (wisdom teeth). Surgical intervention may be required to remove these teeth and prevent further complications.

Frenectomy

A frenectomy is a procedure that involves the removal or modification of the frenulum, which is a fold of tissue that connects the lips or tongue to the gums. When the frenulum is too tight or short, it can restrict tongue movement or cause gaps between the front teeth, making a frenectomy necessary.

​Biopsy and Lesion Removal

In some cases, children may develop abnormal growths or lesions in the mouth, such as cysts, tumors, or other pathologies. A biopsy may be performed to remove a sample of tissue for examination and diagnosis. If the lesion is found to be non-cancerous or pre-cancerous, surgical removal may be recommended to prevent further complications.

Corrective Jaw Surgery

In cases of severe jaw misalignment, such as underbite or overbite, corrective jaw surgery may be necessary to realign the jaws and improve the child's bite, chewing ability, and facial appearance. This type of surgery is typically performed in later childhood or adolescence, once the jaw has reached its full growth potential.

During any oral surgery procedure, it is crucial to ensure the child's comfort and safety. Pediatric oral surgeons are trained to work with children and may employ various techniques, such as sedation or general anesthesia, to minimize discomfort and anxiety. Additionally, specialized equipment like the No-No® pediatric arm immobilizer can help keep the child's arm immobilized and comfortable before and after surgery.

When Will a Dentist Refer a Patient to an Oral Surgeon?

Common Reasons for Referral

While pediatric dentists are equipped to handle most routine dental procedures and simple extractions, there are certain complex cases where they may refer patients to an oral surgeon. This typically occurs when the required dental work is beyond their expertise or involves surgical intervention in the mouth, jaws, or face.

Some common reasons for referral include:

  • Difficult or impacted wisdom teeth removal, especially at a young age before roots are fully developed. Oral surgeons specialize in these extractions, making the procedure easier and safer.

  • Surgical corrections of facial deformities caused by genetics, injuries, or other factors. This may involve procedures like cleft lip and palate repairs, which oral surgeons are specially trained to perform.

  • Complex issues that require removal of gum tissue or part of the jawbone, such as certain types of cysts or tumors.

When Dental Implants Are Needed

While dental implants are generally not suitable for children due to potential issues with jaw growth, there may be rare cases where they are part of an orthodontic treatment plan. In such instances, a pediatric dentist would likely refer the patient to an oral surgeon for the surgical placement of the implants.

Trauma or Dental Neglect

If a child has experienced significant dental trauma or shows signs of dental neglect or abuse, an oral surgeon's expertise may be required for comprehensive treatment and reconstruction. According to the American Academy of Pediatric Dentistry, these cases warrant referral to ensure appropriate care.

Postoperative Care & Recovery

The recovery period after pediatric oral surgery is crucial for promoting proper healing and preventing complications. It's essential to follow your dentist's or oral surgeon's postoperative care instructions carefully.

Child wearing the no-no pediatric arm immobilizers

Depending on the type of surgery, your child may need to have their arm immobilized before and after the procedure. The No-No® pediatric arm immobilizer was designed specifically for this purpose, limiting movement at the elbow to prevent interference with sutures, bandages, IVs, or other treatments. Its patented design allows comfortable yet effective immobilization for children and adults.

By carefully following all pre-operative instructions and using appropriate immobilization devices when needed, you can help ensure a safe, successful surgery and smooth recovery for your child.

The No-No® Pediatric Arm Immobilizer

When oral surgery is necessary, utilizing an arm restraint such as The No-No® pediatric arm immobilizer can aid in a seamless recovery process. Created by a plastic surgeon with expertise in cleft palate surgeries, these adjustable restraints offer comfortable immobilization. They effectively restrict certain movements while still allowing some freedom, ensuring the child remains comfortable and the healing process is uninterrupted.

Immediate Care

  • Bite gently on gauze pads provided by your dentist to control bleeding after tooth extraction. Change the gauze as needed until the bleeding subsides, typically within a few hours. Avoid sucking motions or using straws, as this can dislodge the blood clot and delay healing.

  • Use cold compresses or ice packs on the cheek near the surgical site for the first 24-48 hours to reduce swelling and discomfort. Apply them in 20-minute intervals, with breaks in between.

  • Stick to a soft, cool diet for the first few days, such as yogurt, pudding, smoothies, or lukewarm soup. Avoid hot beverages, crunchy, or sticky foods that could irritate the surgical site or dislodge any sutures.

Pain Management

  • Take over-the-counter pain medications like acetaminophen or ibuprofen as directed by your dentist to alleviate discomfort. If prescribed stronger pain relievers, follow the dosage instructions carefully.

Oral Hygiene

  • Gently brush and floss the teeth not involved in the surgery, but avoid the surgical area until instructed by your dentist. Use an antimicrobial mouthwash as directed to keep the mouth clean.

  • After 24-48 hours, you can begin gently rinsing the mouth with warm salt water to promote healing and remove any food debris. Avoid vigorous swishing or spitting, as this could disrupt the healing process.

Activity Restrictions

  • Plan for rest and limited physical activity during the initial healing period, typically 2-3 days for minor procedures and up to a week for more extensive surgeries. Strenuous exercise or activities that could dislodge sutures or blood clots should be avoided.

  • Children may need to miss a few days of school, depending on the surgery and their recovery progress. Communicate with their teachers to ensure they don't fall behind on schoolwork.

By adhering to these postoperative care guidelines, you can help your child recover smoothly and avoid potential complications, ensuring a successful outcome from their pediatric oral surgery.

Conclusion

As you have seen, pediatric oral surgery requires specialized knowledge and great care. From prevention to treatment, you must take a child-focused approach. Work closely with pediatric dentists and use techniques adapted for little patients. Address problems early before they compound. Most importantly, help children feel safe, comfortable and understood throughout procedures. This will build trust, easing anxiety. With the proper training and an emphasis on compassion, you can make surgery a calm, even positive experience for your young patients. They will have healthier mouths and brighter smiles for years to come.

Disclaimer from H & H Research Inc.

H & H Research Inc. provides digital content for informational purposes only and is not a substitute for medical advice. In emergencies, contact local emergency services or visit the nearest emergency facility. Consult your healthcare provider before beginning any health-related program. Our content, including texts, graphics, and other materials, is developed for general information and should not be taken as medical guidance. Always consult a healthcare professional for advice on medical conditions, treatments, or medications. The efficacy and safety of products or treatments mentioned are not guaranteed. Information may change and is not intended to cover all possible health scenarios. H & H Research Inc. does not endorse specific medical tests, products, or professional opinions mentioned in our content.

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