- + Wisdom Teeth Removal
The average adult has 32 teeth, 16 on the top and 16 on the bottom. Each tooth in the mouth has a specific name and function. The 6 front teeth (incisors, canines) are designed for grasping and incising/biting food into smaller pieces. The molars and premolars, back teeth, are used to grind food up into a texture suitable for swallowing.
Wisdom Teeth, the third and final set of molars, usually erupt during the late teens to early twenties. In a majority of people, wisdom teeth erupt abnormally or remain impacted.
Why Should I Remove My Wisdom Teeth?
Teeth that fail to erupt normally into the mouth may require extraction. Poorly positioned teeth or teeth that are only partially erupted into the mouth can be difficult to clean and can result in dental decay and predispose the patient to infections which can result in pain, swelling, stiffness and even severe illness. Also, pressure from impacted wisdom teeth may result in crowding and misalignment of the other teeth. In rare cases, tumors and cysts can also form around impacted teeth resulting in destruction of the surrounding bone with possible loss of other healthy teeth in the area.
Studies have shown that early removal of impacted teeth can prevent many of these problems along with decreasing the surgical risk to the patient. It is recommended that a patient be evaluated beginning in the teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon in order to prevent future problems.
Oral Examination & Medical Evaluation:
A thorough examination along with dental x-rays can help to reveal details about the patient and their teeth that will be important for the surgery to be successful. With an oral examination and x-rays of the mouth, Dr Hopkin can evaluate the position of the wisdom teeth and determine if there may be present or future problems.
The removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) or intravenous sedation. These options, as well as any surgical risks, will be discussed with you at time of consultation and Dr. Hopkin will help you choose the appropriate level of anesthesia prior to the procedure.
After your surgery, you will remain resting in our office under our supervision until you are ready to be taken home. Upon discharge you will be provided with a post-operative packet containing post-operative instructions, gauze, prescriptions and an irrigation syringe.
- + Orthognathic Surgery
Orthognathic surgery is the process of realigning the jaws in order to obtain proper function and improve esthetic appearance. It is needed when jaws don’t meet correctly and/or teeth don’t fit properly within the jaws. Orthodontic treatment is first required to properly position the teeth after which dental models and x-rays are taken for planning and discussion of treatment options.
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 resulting in a host of problems that can affect chewing, speech, long-term oral health, and appearance. While orthodontics alone can correct many bite problems, orthognathic surgery may be required if tooth movement alone is not enough. The following conditions may benefit from treatment with orthognathic surgery:
Difficulty in chewing, biting or swallowing
Chronic jaw or TMJ pain
Open bite (front teeth don’t overlap)
Most individuals are referred to us by their orthodontist because they believe treatment results will be better if braces are offered in conjunction with orthognathic jaw surgery. During your initial consultation, Dr Hopkin will evaluate your unique situation including:
Medical and dental history
Occlusion (bite), Teeth
Study models (molds of your teeth)
During the pre-treatment consultation we will summarize the goals of surgery, the recommended procedure(s), the potential risks, and the alternatives to orthognathic surgery. Dr Hopkin will send a summary of his evaluation and treatment recommendations to your Orthodontist. Our office will request a predetermination of benefits from your insurance carriers. Your insurance company may cover orthognathic surgery depending on your particular situation.
Always feel free to ask any questions that you have regarding your treatment. We will not proceed until you are satisfied and all questions have ben answered.
- + Dental Implants
Many people in Utah seek dental implants to restore their lifestyles back to normal. When you lose a tooth, be it for any reason like decay, periodontal disease, trauma or age, it greatly affects your quality of life. Dr. Dustin J. Hopkin is one of the most renowned oral surgeons in Salt Lake City who places dental implants for patients on a daily basis.
What is it that patients look for in dental implants when they lose a tooth? Knowing the ways tooth loss can affect one’s life can easily explain why they look for good oral surgeons in Salt Lake City to place their dental implants.
The lost tooth means lost function- Patients find that they can’t chew their food as efficiently as they used to. It can greatly impair their ability to chew and digest their food adequately, requiring more effort and more chewing time.
Added stress on other teeth and the muscles- This is because they must shift the food to alternate teeth to chew it more efficiently, adding stress on the masticatory muscles and teeth being used excessively.
Impaired ability to speak- the teeth help in the pronunciation of important speech sounds and even a single lost tooth can greatly impair that ability, along with affecting the person’s self-confidence.
Damaged esthetics and self-esteem- looking good always makes one feel good, and if a lost tooth is visible, it can immensely affect the individual’s esthetics and self-confidence and literally damage self-esteem, creating psychological issues.
By eliminating all of the above concerns for his patients, Dr. Hopkin has become one of the top oral surgeons in Salt Lake City. Known for his immense compassion, he treats his patient’s implant needs with expertise, giving top priority to their happiness and satisfaction.
Benefits of Dental Implants
Dental implants become part of the body – They permanently integrate within the jaw bones, becoming naturally part of their structure. This allows for complete replacement of the lost tooth’s root while also giving extremely stable support to the dental prosthesis it is meant to hold, such as a crown, bridge or denture.
Feel completely natural- As the implant integrates with the bone completely, patients can’t tell they ever lost their tooth and feel as if the implant is one of their own natural teeth.
Look totally natural – The implants not only feel but look entirely natural in the mouth. The superior esthetic results to just crowns and bridges alone are what make dental implants the best and most esthetic option for replacing lost teeth.
They keep adjacent teeth safe – Implants require adequate jaw bone for their placement, hence there is no need to cut and shape the adjacent teeth as with bridges.
Efficiently restore natural feel, esthetics and function – Patients who have had dental implants placed can smile freely, feel comfortable and chew as well as they could before they lost their tooth.
Easy oral hygiene – Implants are like natural teeth, so brushing and flossing are just as simple as always, without the need for floss threaders.
Renewed self-confidence and self-esteem – Patients with dental implants firmly believe that Dr. Hopkin is the oral surgeon responsible for how amazing they look and feel once again!
- + Bone Grafting
Major and Minor Bone Grafting:
Once a tooth is extracted, the bone surrounding the area atrophies or is reabsorbed. This can result in insufficient bone for placement of dental implants. When this occurs, bone grafting may be needed to augment the area in preparation for placement of dental implants.
The size of the bony defect often dictates from where the bone can be obtained. Small areas associated with the loss of 1 or 2 teeth can most times be grafted using bone obtained from the tissue bank. These bone products are cleaned and sterilized and rendered safe for use and have a long track record of safety. Bone can also be obtained from other areas of the body including the chin, jaw and hip. We are happy to discuss all options with you and help you determine which option is best for you.
Major bone grafts are typically performed to repair defects of the jaws secondary to traumatic injuries, tumor surgery, or congenital defects. These defects are repaired using the patient’s own bone harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are performed in an operating room and require a hospital stay.
- + Oral Pathology
The oral mucosa, the pink colored skin of the mouth, is typically smooth and shiny. Alteration in its appearance can be a sign of serious pathological processes, the most serious of which is oral cancer. Signs of the beginning of a pathologic process or cancerous growth include the following:
A sore that fails to heal and bleeds easily
Red patches or white patches in the mouth
A mass or thickening of the skin lining the inside of the mouth
Difficulty with chewing or swallowing
Chronic sore throat or hoarseness
These changes can be slight and can occur at any location inside the mouth including the lips, tongue, cheeks, floor of the mouth and palate. Unfortunately, most oral pathology is not usually associated with pain and the only signs that something is occurring are these changes in the oral mucosa. Regular oral self-evaluation is recommended to check for these changes.
Pathology can also occur inside the jaws. Signs that tumors or cysts may be forming include widening of the jaws, increases in the spacing between teeth, and loss of sensation to the face and/or teeth. Dental x-rays along with an evaluation can often detect any problems.
Biopsies are required to make a final diagnosis and to help in treatment planning. Biopsies can be performed under both local or general anesthesia. Dr. Hopkin will help you through the process of diagnosis and treatment. Please call us with any questions or for a consultation.
- + TMJ Disorders
Dr. Hopkin is the premier TMJ Specialist in Utah, finding most of his treatment success in providing non-surgical treatment modalities for his patients. By approaching treatment in this non-invasive way, Dr. Hopkin provides relief to many desperate people suffering from these disorders without the cost or recovery of surgery. Open TMJ surgery is not considered unless the jaw can’t open, is dislocated and non-reducible, has severe degeneration, and/or the patient has undergone appliance treatment unsuccessfully.
The TMJ (temporomandibular joint) is the hinge between the lower jaw and the skull. Disorders can develop for many reasons, including clenching or grinding of teeth or over activity of the jaw muscles resulting in stress on the TM joint. Trauma can also be the result of injury or disease to the joint. This in turn can result in damage to the interarticular disk, a cartilage disk located between the jaw and skull that functions as the “cushion” of the jaw joint. This damage can be in the form of holes or tears in the disk or retrodical tissue, the elastic tissue connecting the disk to the skull. This damage can then allow the disk to slip out of position resulting in popping, grinding and pain. This in turn leads to difficulty with mouth opening, misalignment of the jaws and pain on chewing.
The initial goals of treatment are to relieve joint pain and relax the muscles. This is usually accomplished with an anti-inflammatory pain reliever and/or muscle relaxant. Additional treatment can also involve the injection of steroids into the joints to reduce pain and inflammation. Joint rest can also play an important role in resolving the pain and include:
Eating soft foods
Applying ice and heat
Practicing good posture, lips together with teeth apart
Physical therapy can also be helpful, as well as splint therapy with a clear plastic appliance to allow for joint rest. An occlusal splint or night guard fits over your teeth and helps keep your teeth apart allowing the joint to rest resulting in muscle relaxation and pain reduction. Occlusal splints are typically worn during the sleep hours and can help reduce the grinding and clenching that result in joint inflammation and pain.
TMJ disorders resulting in misalignment of the jaws or teeth may require treatment such as occlusal equilibration (bite adjustment), restorative dental work, orthodontics and/or jaw reconstruction. Surgical options such as arthroscopy and open joint repair are sometimes needed.
- + Oral and Facial Trauma
Oral and maxillofacial surgeons evaluate and treat injuries resulting from sporting accidents, motor vehicle accidents, and interpersonal violence.
Dr. Hopkin treats:
Fractures of the upper and lower jaws
Fracture of other facial bones including cheeks, nose, eye sockets and forehead
Avulsed or missing teeth
Lacerations and soft tissue injuries to the facial region
Injuries to the face and its associated structures can result in significant alterations in the appearance of the face and functions of the teeth and jaws. Treatment of these injuries requires preservation and reconstruction of involved structures with the focus on an esthetic functional result. Dr. Hopkin is committed to achieving the most esthetic and functional outcome. Complex injuries often require a staged approach in order to achieve ideal results, this may include multiple surgeries in order to reconstruct post traumatic bony defects and aid in reduction of post traumatic scaring.
Injuries to the teeth and surrounding dental structures
Injuries to the teeth and supporting structures often require the combined effort of multiple dental specialists. Oral and maxillofacial surgeons primarily work to fix broken jaws and supporting bony structures and stabilizing and/or replacing avulsed, knocked out, teeth. Teeth and jaws will typically be stabilized with dental wires and/or tooth colored restorative material. This stabilization will be maintained for 2-6 weeks depending on the injury, during which time root canal therapy may be needed in order to prevent infection and failure of the replanted tooth. Any chips or fractures of the teeth will then be restored by the general dentist.
Knocked out/fractured teeth cannot always be replaced. It depends on how long the tooth was out of the mouth or how the tooth was fractured, and may require additional extraction of any remaining portion of the tooth and reconstruction of the resultant defect with a dental implant or bridge. Dr. Hopkin will evaluate the situation and recommend the best treatment options.
- + Pre-Prosthetic Surgery
Replacing missing teeth with complete or partial dentures often requires alteration of the underlying bone and or gum tissues in order to allow for proper fit and function.
Common problems include:
Exostosis – a developmental bulge of normal bone on the cheek side of the teeth that may interfere with the seating of a prosthesis. These will sometimes slowly enlarge over many years and require excision.
Mandibular torus – an exostosis that typically is found along the gum line on the tongue side of the teeth in the area of the premolar teeth.
Palatal torus – an exostosis that is found on the roof of the mouth.
Epulus – excessive thickening of the gum tissue that can develops under a chronically loose-fitting denture. This tissue is typically inflamed and painful. Once excised the denture should be relined or remade in order to prevent recurrence.
The goal of these procedures is to maximize the fit and comfort of the prosthesis. Adjustments of your prosthesis may be required after surgery. Dr. Hopkin works closely with your general dentist to provide coordinated and timely care.
- + Pre-Operative Instructions
Local anesthesia – Numbing injections are given in the appropriate area(s). It is not necessary to change your eating habits before your appointment. Please take any prescription medications as you normally would. If you are pregnant, then local anesthesia is recommended.
Nitrous oxide and local anesthesia – Nitrous oxide gas is administered to produce a relaxed, awake state. Numbing injections are then given. It is not necessary to change your eating habits before your appointment unless you are instructed otherwise.
Intravenous anesthesia – Intravenous (IV) medications are given to produce a semiconscious or unconscious condition. The numbing injections and surgery are accomplished while you sleep. Following the surgery, you should plan to rest at home for the remainder of the day. Please note the following if you prefer IV anesthesia:
Do not eat or drink anything for at least six hours before the appointment. You may take prescription medications with a small amount of water.
Have a responsible adult with you to drive you home. This is a must! Your escort must be present before and during your procedure, and should plan to stay with you the remainder of that day.
Wear comfortable, loose-fitting clothing. Please remove all jewelry and nail polish before your appointment. If you wear contact lenses, please remove them and wear your eyeglasses instead.
Follow these Instructions:
Do not have anything to eat or drink for six (6) hours prior to the surgical appointment.
If the patient usually takes medications in the morning it is permissible to do so with a limited amount of water. Please call us with any questions 801-277-3942.
If the patient is diabetic and uses insulin or other medication to help manage the condition, he or she should call the office for guidance as to how to take the medication the day of surgery.
A responsible adult must accompany the patient to the office, remain in the office during the procedure, and be able to drive the patient home.
The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes. Jewelry and dentures must be removed at the time of surgery.
- + Post-Operative Instructions
Local anesthetic injections last about 2 hours and it is recommended that you take the prescribed pain medication prior to the anesthesia wearing off. Surgical pain typically peaks at 24 hours and slowly becomes better over the next 4-5 days. Ibuprofen is a useful addition to the prescribed pain medications for most patients. Dr. Hopkin will discuss appropriate medication doses at the time of surgery. We are always available to answer questions. If the pain is not decreasing or is getting worse, please give us a call as this may be a sign of dry socket.
All major bleeding will be controlled prior to your leaving the office, though minor seepage will continue for the next 24 hours. It is common for your saliva to be pink for the first day or two. You will leave the office with gauze packs in your mouth and they should be changed every 30 minutes for the first 2-3 hours after which further packing usually will not be required. If you are able to see blood welling up from the extraction sites, this is a sign that replacing the packing is required. Continue with the gauze packs over the sockets and use firm biting pressure on them for the next 30 minutes. If at the end of this time bleeding is still occurring, a moistened tea bag in place of the gauze pack may help. If after 30-60 minutes you are still unable to control the bleeding, please call the office. Do not rinse or brush your teeth on the day of surgery. Proper healing depends on a blood clot forming and staying in the socket. On the day after surgery, regular oral hygiene may be resumed with gentle brushing in the area of surgery.
Swelling of the cheeks and face can be significant over the first 3-4 days with maximum swelling occurring on the 3rd or 4th day after surgery. Swelling will then typically resolve over the next week. Swelling is very individual and can be different from side to side and patient to patient. In order to decrease swelling, ice packs should be applied to the face for 30 minutes then taken off for 30 minutes over the first 24 hours. Frozen peas and corn also work well as they easily conform to the face. Keeping the head elevated on the day of surgery can also help decrease swelling. Medications may also be prescribed to reduce swelling and should be taken according to the prescription. Bruising on the cheeks, neck and beneath the eyes is normal and does not represent a problem.
Maintaining good nutrition is important after surgery. Following oral surgery, drinking and eating can be difficult until the numbness wears off which usually occurs in about 2 hrs. Once recovered from the numbness, soft foods such as mashed potatoes, apple sauce, soups and milkshakes are appropriate. It is recommended that a normal diet be resumed as you feel comfortable. It can take as much as 10-14 days before you feel like eating foods such as chips. Common sense goes a long way, if your surgery was on one side of your mouth feel free to chew on the other side. Drinking on straws and smoking should be avoided for the first 72 hrs following surgery as the negative pressure can dislodge the blood clot resulting in bleeding and possibly a dry socket.
You should avoid brushing your teeth in the area of surgery for the first 24 hours. The morning following surgery, it is appropriate to begin rinsing with warm salt water (1 tsp of salt in 8oz of water is appropriate). Mouth washes with alcohol can inhibit healing and should not be started until the third day following surgery. Once brushing is resumed (after the first 24 hours) it is common to see minor bleeding for the next week. Do not be alarmed. This is normal.
Most patients do not experience nausea or vomiting following surgery. Anesthesia and pain medications can however cause some unfortunate individuals to have an upset stomach and make it difficult to maintain proper nutrition and hydration. If you have a history of nausea following surgery we will administer medications during the surgery to help eliminate these effects. If the nausea is associated with the pain medication, ibuprofen and plain acetaminophen can be used and will usually eliminate these effects. Occasionally, additional medication must be prescribed to alleviate the nausea. If the nausea and vomiting continues beyond 6-8 hours please give us a call.