Pediatric Oral Surgery
A Caring Approach to Pediatric Oral Surgery
Pediatric patients are not just “miniaturized” adult patients. Most pediatric patients are developing intellectually, emotionally, and socially—as well as physically which can significantly impact their treatment. It is our goal to create a safe place for your child so they feel comfortable in our office. From a baby tooth extraction to impacted wisdom teeth or releasing a tongue-tie to a biopsy for pathology or craniofacial surgery, we understand every child or teen has different needs requiring different approaches.
Pediatric Oral Surgery
When parents bring their child to Carolina Oral & Facial Surgery, PA, we do everything we can to help them feel secure and safe. It is important for us to spend extra time getting to know your child and family as we take a surgical journey together. We work with each family to develop a treatment plan that meets each child’s unique needs.
Dr. Williams emphasizes a team approach with our pediatric patients. He and our entire team work closely with your orthodontist, pediatrician, or other indicated specialists to ensure the best possible outcome for your child. We often schedule outpatient cases involving multiple medical specialties when there are overlapping treatment plans and objectives that can be accomplished with one trip to the OR. Communication among all doctors is essential for successful outcomes and the positive spirit of each family.
It is our mission to turn a potentially frightening situation into as comfortable and positive experience as possible by providing the compassion and reassurance children and their parents need.
Oral Surgery for All Kids
We are honored to offer oral surgery for all kids, including special needs kids and young patients with compromised health. Whether affected by physical or mental challenges, your child will receive great care in experienced hands. Many of our young patients with Autism or those diagnosed with a developmental delay are treated in our office but occasionally, some may need to have their care provided at Prisma Children’s Hospital or a pediatric ambulatory surgery center.
Pediatric Radiography
Adequate images of teeth are required when planning for extraction, whether erupted or un-erupted. Localization of impacted teeth with cone beam CT (CBCT) imaging prior to surgery enables greater precision and usually shortens the time of procedure. Minimization of radiation exposure is always paramount but with the extremely low doses used for our CBCT, this is usually more than offset by the decreased anesthesia exposure and surgical manipulation. When scheduling a child for hospital care and adequate radiographs are not possible, radiographs may be taken at the hospital in the OR.
Parent Resources
Our goal is to create a safe, welcoming environment where your child feels comfortable and cared for from the moment they arrive. These resources are designed to help parents understand what to expect before and during surgery, and how to best prepare children of all ages for a positive experience.
Our Pediatric Services
Pediatric Pathology
A wide spectrum of oral lesions occurs in children, including soft and hard lesions of the mouth and surrounding areas. Although most of these lessons are ordinary, it is important to check for growths that are more serious. Abnormal tissue is sent for microscopic examination.
Types of Biopsies
It is recommended to biopsy a lesion that persists for greater than two weeks after removal of suspected causes. An incisional biopsy is done when just a piece of a lesion is removed, and an excisional biopsy is when the entire visible lesion is submitted for evaluation.
Common Pediatric Oral Lesions
Some of the most common pediatric oral lesions are a mucocele, irritation fibroma, pyogenic granuloma, and squamous papilloma sometimes called an oral wart.
A mucocele occurs when one of the thousands of tiny minor salivary glands lining the mouth is damaged from biting trauma and becomes a recurring spongy swelling most often on the lip, cheek, or tongue. Although it may come and go, surgical removal with an excisional biopsy is usually required for resolution.
An irritation fibroma is a firm fibrotic bump or tag of tissue that develops usually after biting or chewing trauma. This gum lesion may be thought of as thickened scar tissue from trauma. Again, excisional biopsy is usually curative unless the area continues to be traumatized.
A pyogenic granuloma is usually a chronically irritated area with disturbed healing and more of an abnormal exaggerated healing response. Excisional biopsy is curative if the chronic irritation is addressed.
A squamous papilloma is a growth of mucosa in response to virally induced local irritation. An excisional biopsy is diagnostic and curative as well.
Abnormal or Extra Teeth
It is common for a disturbed tooth development to create abnormal shapes with too many or too few teeth. One or more normal appearing extra teeth are called supernumerary teeth. The most common extra tooth is found behind the upper front teeth and is known as a mesiodens. This midline tooth often interferes with the normal eruption and position of the upper front teeth if left in place.
Extra teeth by themselves are usually not the problem but they can damage adjacent teeth or cause crowding issues. Occasionally, mesiodens can be upside down and erupt into the floor of the nose if not addressed in a timely fashion.
Abnormal extra teeth that look like a blob or multiple mini teeth are called an odontoma. These are usually found on a routine x-ray and they may crowd out normal teeth. Despite the scary sounding name, these blobs are rather ordinary. I have used the analogy that odontomas are leftover tooth material much like leftover cookie dough after using a cookie cutter to cut out “tooth” cookies. Once these “extra” teeth are gone, they will not grow back. Fair warning for the tooth fairy, I have seen twenty or more mini teeth come out of one blob at a time.
Missing Teeth
Congenitally missing teeth can be a challenge and inconvenience since definitive replacement options need to wait until skeletal growth is complete. Retained primary teeth often can substitute for missing permanent teeth unless there is a growth or crowding issue and, in some kids, may last for years. Dental implants are an excellent tooth replacement option when skeletal growth is complete as it is the most dentally conservative and longest lasting option for a tooth replacement.
Frenectomy
A frenectomy is a simple surgical office procedure to release the connection of the frenum which is a kind of connective tissue tether between the tongue and floor of mouth (lingual frenectomy) or the upper lip and upper jaw gum (buccal frenectomy). The lingual frenectomy releases a tongue-tie (ankyloglossia) to help with speech in toddlers or breastfeeding in neonates. The upper lip frenectomy may help with breastfeeding but is commonly removed to help close front tooth gaps with braces in later years. There has been recent renewed interest in the impact of frenectomies on improved oral motor function with growth and development.
When a child or teen starts orthodontics, one of the challenges is closing spaces between teeth. One of the most common problems is a gap between the front teeth also known as a “diastema.” This may be complicated by a thick band of gum tissue lying between the upper front teeth known as the “frenum.”
The best time to do the frenectomy is after your orthodontist has closed the space. The thought is the healing tissue that forms may help maintain the teeth in their current positions. Removing the frenum before the space is closed creates some scar tissue that may effectively make it hard to close the space as it may tend to hold the teeth apart during treatment. It is also wise to use a fixed wire retainer on the front teeth for at least a year after a frenectomy to prevent any drifting of the front teeth that could allow regrowth of some of the removed tissue.
Impacted Canine Teeth
Almost any tooth can get stuck or crowded out as it tries to erupt into the mouth. However, the impacted canines in the maxilla are a frequent problem in orthodontics. These big teeth come in later to form the “corners” of your smile, so they have less room and are more likely to be blocked from erupting. The absence of a canine or another front tooth is noticeable when you smile and can be quite challenging to replace. Therefore, it is worth the extra effort to get them to erupt into a normal position.
Uncover and Bracket a Tooth
When a tooth does not seem to be erupting like the other dentition in the mouth, a combined surgical and orthodontic plan is created to bring a stubborn tooth into place. Surgically, the impacted tooth is uncovered by creating a window in the gum over the tooth’s crown and placing an orthodontic bracket to engage the tooth. Braces are then used with gentle orthodontic forces to encourage and guide its eruption. Rarely, the impacted tooth may be ankylosed or stuck and leave no option other than extraction.
There is also the issue of disturbed eruption such as when teeth stick to the jawbone (ankylosis) or fail to stick out of the gum. Ankylosed baby teeth can prevent the eruption of permanent teeth and may even cause deformity of the jawbone over time. This is another instance that may require extraction of the offending tooth to allow permanent teeth to erupt.
Surgical Uprighting of Molars
A common issue with a crowded bite is that the second molars do not have enough space to properly erupt. In some cases, the lower second molars become trapped as they tilt under the first molar. This can be further complicated when a third molar (wisdom tooth) pushes on the second molar from behind.
Orthodontists can sometimes upright a tilted second molar if there is enough exposed tooth to place a bracket. However, when the tooth is mostly covered or inaccessible, orthodontic uprighting alone may not be possible.
Surgical uprighting is a procedure that exposes and repositions the second molar so it can be properly aligned with orthodontic treatment. In some situations, the impacted third molar is also removed during the procedure to create the necessary space to upright the second molar.
Cleft Lip & Palate
Children born with facial differences may undergo a variety of procedures and therapies as they grow, and managing those needs can feel overwhelming. The goal of Dr. Williams and the team at Carolina Oral & Facial Surgery is to assist families in streamlining and coordinating visits to specialists and the hospital so that multiple specialists can provide you and your child with a unified plan of care here in Greenville, South Carolina, or in collaboration with leading craniofacial programs across the United States.
Asymmetries and Misalignments in Jaw Growth
Some children’s jaws grow abnormally, resulting in a large overbite, underbite, open bite, or facial asymmetry. This affects your child’s ability to eat or speak. Dr. Williams is an expert in corrective jaw surgery (orthognathic) to rectify facial imbalance and improve jaw function.
Facial Trauma
Dr. Williams participates on the facial trauma and oral surgery call teams for Level 1 Trauma Center Prisma Health System. He has participated in adult and pediatric call for over 25 years. We hope that your family never needs our expertise in reconstructive surgery, but we are here for your family if needed.
Anesthesia Options Available for Surgery
Local Anesthesia
Patients who have undergone fillings or other minor dental procedures may have previous experience with local anesthesia. Local anesthesia is a numbing medication that is injected directly around the area to be treated.
IV Sedation
IV sedation allows patients to enter a deeply relaxed, sleep-like state during a procedure. It is commonly used for more complex surgical treatments or for individuals with significant dental anxiety.
General Anesthesia
Some people are best managed in a hospital or surgery center. This may be due to the complexity of the surgery, health of the patient, or in cases of severe anxiety, emotional immaturity, or developmental delay.
We Are Here to Help You Prepare
At Carolina Oral & Facial Surgery, we are committed to providing the highest level of care and treatment for every patient. See helpful information to guide you before and after your surgery.