The Less You Worry, the Easier it Will Be
An upcoming visit to an oral and maxillofacial surgeon is a potential anxiety producer. In this case, the patient is typically most concerned about possible pain and whether the procedure is going to hurt.

The good news is that whether your procedure requires local or intravenous anesthesia, today's technology makes it possible to perform complex surgery in the Dr. Homrighausen's office with little or no discomfort for the patient. Knowing this should start to reduce your level of anxiety.

Extensive Training and Experience in the Control of Pain and Anxiety
The ability to provide patients with safe, effective outpatient anesthesia has distinguished the specialty of oral and maxillofacial surgery since its earliest days. As a surgical specialist of the dental profession, Dr. Homrighausen is trained in all aspects of anesthesia administration. Following dental school, Dr. Homrighausen completed four years of training in a hospital-based surgical residency program alongside medical residents in general surgery, anesthesia and other specialties. During this time, Dr. Homrighausen completed a rotation on the medical anesthesiology service, during which he became competent in evaluating patients for anesthesia, delivering the anesthetic and monitoring post-anesthetic patients.

As a result of this extensive training, Dr. Homrighausen is well-prepared to identify, diagnose and assess the source of pain and anxiety and to appropriately administer local anesthesia, nitrous oxide, and all forms of sedation and general anesthesia. Further, he is experienced in airway management, endotracheal intubation, establishing and maintaining intravenous lines, and managing complications and emergencies that may arise during the administration of anesthesia.

Putting Your Mind at Ease
The best way to reduce anxiety is to make certain you know what to expect during and after surgery. As with most anxiety-producing situations, the more you know, the less you have to be anxious about. Prior to surgery, Dr. Homrighausen will review with you the type of anesthetic to be used, as well as the way you're likely to feel during and after the operation. This is the time to discuss any concerns you may have about any facet of the operation.

During surgery, one or more of the following may be used to control your pain and anxiety: local anesthesia, nitrous oxide-oxygen, intravenous sedation and general anesthesia. Commonly, patients describe their feelings during surgery as comfortable and surprisingly pleasant.

Types of Anesthesia

LOCAL ANESTHESIA: (Novocaine, Lidocaine, etc.) A shot is given to block pain in the area to be worked on. The shot will produce a numb feeling in the area being operated on and a feeling of pressure during surgery. You will be awake and recall the surgery, but there should be no significant discomfort.

NITROUS OXIDE WITH LOCAL ANESTHESIA: Nitrous Oxide (or Laughing Gas) You will be relaxed and somewhat less aware of your surroundings, but will recall most of the surgical event. Nitrous oxide is generally used in conjunction with local anesthesia,

ORAL PREMEDICATION WITH LOCAL ANESTHESIA: A pill is taken prior to giving local anesthesia to produce relaxation before and during your operation.

INTRAVENOUS SEDATION WITH LOCAL ANESTHESIA: Medications are given through a vein in your arm or hand, which will cause total relaxation. You will not actually be unconscious, there will be very little recall (if any) of the events surrounding surgery. Intravenous sedation makes you less aware of the procedure by making you calmer, sleepy and less able to remember the procedure.

INTRAVENOUS GENERAL ANESTHESIA WITH LOCAL ANESTHESIA: You will be completely asleep for the procedure. Medications are given through a vein which will result in total loss of consciousness, complete lack of recall of the event and usually a longer recovery time. General anesthesia has an excellent safety record as an office procedure, but may, if desired, be provided in a hospital setting. (Your health insurance may not cover you unless there is a bona-fide medical reason for hospitalization.)

What are wisdom teeth?
Wisdom teeth, or third molars, begin to appear usually when a person is between 17 and 20 years of age. Wisdom teeth become impacted when they cannot erupt from the gum or can only do so partially. This happens because the human jaw has become too small over time to accommodate them. A majority of people will experience at least one impacted wisdom tooth.

What are the reasons for removing wisdom teeth?

Limited Space. Most patients do not have room in their mouth for wisdom teeth to successfully erupt in the correct position and alignment.
Disease Prevention. The eruption of third molars often leads to periodontal inflammation and disease.
Other Health Concerns. Impacted teeth often are associated with cysts and/or tumors. Removal of wisdom teeth in these cases entails increasingly complex surgery.
Crowding. Erupted wisdom teeth may contribute to crowding of adjacent teeth.

When is the best age to remove third molars?
A recent study indicates that removing third molars before the age of 21 reduces complications and healing times. According to findings published in American Journal of Orthodontics and Dentofacial Orthopedics, recovery was significantly longer for all subjects older than 21 compared to younger patients.

Are postoperative complications more common for older patients?
Yes, risks increase as patients age. Healing times are longer. The return to normal oral (and lifestyle) function is delayed in older patients. Other health issues can affect recovery as well.

Do all wisdom teeth need to be removed?
No, but all third molars need to be monitored. Retained wisdom teeth can change position, resulting in inflammation and disease. When that occurs, these teeth are candidates for extraction.

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What are dental implants?
A dental implant is a replacement for a missing tooth. It consists of three primary parts:

1) A small titanium post surgically implanted in the jawbone, where it bonds to the bone as the root of a natural tooth does.
2) A smaller post attached to the implant that serves as an anchor for the visible artificial tooth, known as a crown.
3) The crown, mounted to the post to look and function like a natural tooth.

Dental implants are considered to be the best replacement for missing teeth because they prevent the deterioration of bone in the jaw, require no special care (as do dentures), allow for completely normal function, and look like natural teeth. Under normal conditions, an implant is a permanent solution.

Why do patients need them?
Whether extracted or lost by other means, missing teeth not only detract from the normal function and appearance of a person's mouth but can also cause bone, gum and bite problems. Traditionally, dentures have been used to take the place of missing teeth, but they often pose problems with fit, function and appearance. In addition, they must be removed and cleaned every day.

Implants resolve all of the problems associated with dentures. In fact, implants are often recommended as a means of anchoring dentures more securely.

What is the process like?
The procedure for dental implants usually occurs in two stages:

1) First, the implant is placed in the jawbone, where is must be allowed to bond completely with the bone tissue before any significant pressure is applied.

The healing period can last from three to six months, during which time temporary dentures can be used.

In some cases involving front teeth-which tend to be subjected to less pressure during normal use-the crown can also be attached during this stage.

2) In the second stage, the new artificial tooth is mounted permanently to the now-bonded implant post.

At the completion of the procedure, the patient can immediately begin enjoying the benefits of implants-with no restrictions.

Single Implant

Before
After

Implant Retained Denture

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Any facial injury means both physical and emotional suffering for patients. Facial injuries can be caused various ways-violence, work-related, car or motorcycle accidents, sport injuries, or falls. The injuries can be classified into categories:

1. Soft tissue injuries (skin or gums; Figure a)
2. Bones injuries (fractures; Figure b)
3. Injuries to specific regions (facial nerves, eye area, salivary glands)
4. Avulsed teeth (Figure c)

As a trained oral and maxillofacial surgeon with staff privileges at Floyd Memorial, Clark County, Harrison County and Jewish Hospitals, Dr. Homrighausen is eminently qualified to treat facial trauma.

Dr. Homrighausen's skill and knowledge in diagnosing and treating facial injuries qualifies him to restore your appearance and function.

a
b
c

Oral pathology is the branch of dentistry concerned with the diseases of the mouth, including oral soft tissues and mucous membranes as well as the teeth, jaws, and salivary glands. It involves treating conditions causing or resulting from substantial physical or functional changes in the mouth.

The inside of your mouth should normally be smooth and pink in color. Changes in its appearance or how it feels could signal problems. Warning signs in your mouth include:

  • Red or white spots (Figure a)
  • Bumps (Figure b)
  • Lumps (Figure c)
  • A non healing ulcer (Figure d)
  • Difficulty chewing and/or swallowing

Should any of these symptoms occur, please seek treatment immediately. Left unchecked, severe dental conditions lead to both tooth and bone loss. In the case of oral cancer, late detection can be deadly.

To keep potentially harmful situations from occurring, it is important that you carefully examine your mouth on a regular basis for any the above warning signs. You should also maintain regular appointments with your dentist.

a
b
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d

Why is my tooth impacted?
Although all adult teeth should be erupted by the early teenage years, occasionally some teeth can fail to erupt and remain in the jaw bone. This is referred to as an impacted tooth. There can be several reasons as to why the tooth did not to erupt. Dr. Homrighausen will review the reasons as it pertains to your situation.

What can be done to bring my tooth into my mouth?
The procedure to correct an unerupted, impacted tooth is known as exposure and bracket. Dr. Homrighausen will locate the impacted tooth and bond, or glue, a special orthodontic bracket to the impacted tooth. The bracket has a chain attached to it that will allow your orthodontist to bring your tooth into proper alignment in just a matter of a few months.

Is the procedure painful?
No, typically the procedure is not painful. This procedure can be performed with local anesthesia, with nitrous oxide anesthesia, or with general anesthesia. There may be minor discomfort experienced during the recovery period. Dr. Homrighausen will provide you with an in-depth consultation to review all aspects of the procedure.

What is Orthognathic Surgery?
Commonly referred to as corrective jaw surgery, orthognathic procedures are used to correct misalignment of jaws and teeth, as well as other irregularities that interfere with normal chewing, speaking and breathing. Though not its primary purpose, corrective jaw surgery often improves the patient's appearance.

Why do patients need it?
We perform this type of surgical procedure to alleviate diverse problems, including:

  • Improper bite that orthodontics alone cannot correct
  • Difficulties biting, chewing or swallowing food
  • Breathing problems, including apnea and snoring
  • Chronic jaw pain and headache
  • Inability to bring teeth or lips together
  • Injury or birth defect
  • Receding chin or protruding jaw

An interdisciplinary dental team, including the dentist, orthodontist and Dr. Homrighausen, will determine if corrective jaw surgery is appropriate and recommend a course of treatment.

What is the process like?
Orthodontics will usually be needed before and after the corrective surgery, which means that the entire treatment process will most likely span several years.

Before surgery, orthodontic braces are used to move teeth into a new position that will be correct once the jaw surgery has been completed.

The procedure, performed under general anesthesia, will reposition the jawbones. The surgeon may add, remove or reshape bone and use plates, wires and other means of securing jaws in their new positions. Incisions are made inside of the mouth if possible to avoid visible scarring.

Post-operative care includes a modified diet and control of pain, which is easily accomplished with medication. Patients can usually return to work or school in 1-3 weeks. Complete healing of the jaws takes 9-12 months.

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What is bone grafting?
Bone grafting reverses bone loss caused by:

  • Gum disease
  • Facial trauma
  • Poor-fitting dentures
  • Missing teeth

Why do patients need it?
When bone loss occurs, it negatively alters a person's appearance by causing a hollow or sunken appearance to the cheeks or jaw. At this point, it is often necessary to fill the empty socket with natural or synthetic material. With removable prostheses, bone grafting will enhance the fit and comfort, often eliminating pain caused by poor-fitting dentures.

In addition, bone grafts are frequently used to create a solid base for a dental implant when bone loss has occurred. Your existing bone mass can be built up to create the secure foundation dental implants require.

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Facial cosmetic surgery has long been the solution of choice for the correction of physical malformations resulting from aging, disease, injury and birth defects. In recent years, however, a growing number of men and women of all ages are choosing facial cosmetic surgery to improve their appearance and reduce the signs of aging.

Thanks to the development of advanced medical devices and biomaterials, many of today's facial cosmetic procedures are minimally invasive and can be performed in the office setting using local and/or intravenous anesthesia. Some procedures may require use of an outpatient or same day surgery center or hospital.

Because of surgical and dental background, Dr. Homrighausen is uniquely qualified to perform cosmetic procedures that involve the functional and aesthetic aspects of the face, mouth, teeth and jaws. Extensive education and training in surgical procedures involving soft tissue (skin and muscle) and hard tissue (bone and cartilage) finely attune the oral and maxillofacial surgeon to the need for harmony between facial appearance and function.

Following are some of the procedures available to you. Make an appointment with Dr. Homrighausen to discuss your personal situation.

Common procedures

Botox® Injections can reduce wrinkles and lines between the eyebrows, on the forehead and around the eyes (Crow's feet) by relaxing the muscles. Tiny injections around the wrinkles will begin to show results approximately 3-5 days after the procedure. The results of Botox® last 3-6 months and by starting at an early age, decreases the rate of wrinkling over time.

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After
After

Injectable Fillers (Restylane®) administered by tiny injections, this material plumps wrinkles around the eyes or grooves in the area of the cheek and chin. The product can also be used for temporary lip augmentation. The results are instantaneous and may last up to six months. Sometimes bruising may occur after treatment but fades after 3-5 days.

Chin Surgery (Genioplasty) increases or reduces the length and projection of the chin.

Facial and Neck Liposuction can help sculpt the face by removing excess fat. Neck liposuction is often performed simultaneoulsy with such procedures as genioplasty and corrective jaw surgery.

Lip Enhancement can reshape the upper and lower lip to give a more aesthetic or youthful appearance. Augmentation of the lips is accomplished using various materials that help "plump" the lips, creating fullness and decreasing vertical lines.

A Patient's Guide

When You Need an Apicoectomy

A root canal is the most common form of endodontic therapy, which treats an infection in the root by removing the inflamed or infected nerve tissue and cleaning and filling the canals. However, root-canal systems are very complicated with many small off-shooting branches. In fact, when the endodontist is treating the tooth, the view of the canal system is usually somewhat flattened in profile and may contain branches or extra canals not visible or accessible using traditional techniques.

Therefore, occasionally, areas of the canal system can remain infected, preventing healing or causing re-infection later. When re-infection occurs it is usually due to an unusual and undetectable tooth anatomy, canals that are too small to be treated, cyst formation or a cracked tooth. If the tooth becomes re-infected, the patient may not feel any pain and X-ray evidence is usually required to diagnose the problem.

The tooth can be saved in most of these situations with the exception of a severely cracked tooth. A tooth may be "retreated" during which the root canal procedure is basically repeated.

The Procedure

The surgery itself is performed in our office operatory using local anesthesia and/or general anesthesia and involves accessing the tip of the root directly. By making an incision in the gum tissue overlying the tooth, we gain access to the tip of the root and remove the diseased tissue. A few millimeters of root tip is also removed and its canal is cleaned. The root tip is then filed with a biocompatible material to prevent further leakage and seal the tooth. A few sutures are used to close the incision.

One of the benefits of seeing Dr. Homrighausen for an apicoectomy is you have the option of intravenous sedation or general anaesthesia rather than local anesthesia that an endodontist would use.

Postoperative recovery and Follow Up

After a healing period, the gum tissue returns to normal. After several months, new bone will fill in the cavity previously containing the abscess, completing the healing process. Refer to our post-op instructions for care after treatment. Apicoectomy has an overall success rate of 80-85%.