Introduction: Oral and Maxillofacial Reconstruction: Thinking Beyond the Dental Complex in Diagnosis and Treatment

Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.

— Francis of Assisi

Dennis Song, DDS, MD

Dennis Song, DDS, MD, is a diplomate in the American Board of Oral and Maxillofacial Surgery and the National Dental Board of Anesthesiology and a fellow in the American College of Dentists, International College of Dentists and International Congress of Oral Implantologists. He is Chief of Dentistry at Sutter Health California Pacific Medical Center in San Francisco, an adjunct associate professor at the University of the Pacific Dugoni School of Dentistry, and in private practice in San Francisco. Dr. Song also serves on the CDA Government Affairs Council. Conflict of Interest Disclosure: None reported.

Comprehensive patient care involves opening the mind to new diagnostic possibilities and therapeutic interventions. What may have been on the cutting edge of research while in school or training, even recently, may have become accessible to mainstream dentistry today. Health care is a team concept where the primary provider, whether a dentist or a physician, bears tremendous responsibility to stay abreast of the literature. Much of the disease and pathology in dentistry is microscopic in origin, which directly impacts the prognosis and treatment. A familiarity with etiology, diagnosis and appropriate treatment modalities is essential to successful communication with our patients. Our discussions need to provide them with comfort, hope and information they can understand.

The dental profession has come a long way from clients getting teeth extracted in a barber’s chair. Our dentist predecessors came to understand the microbial basis for dental disease and pioneered the use of anesthesia for surgical care. Beyond infectious microbes, dentistry must be prepared to treat disease resulting from changes at the cellular level: squamous cells, osteoclasts, mucous secreting cells and even synovial lining cells. There are many variables to be considered.

A patient presenting with head pain from a failed occlusion, whether from rampant caries or periodontal failure to genetic predisposition or even lack of access to care, is often one of dentistry’s most interesting challenges. Dr. Rishi Gupta and colleagues present a guided prosthosurgical approach to reconstruction of short-span restorations to complete aesthetic rehabilitation of an edentulous mouth using 3D imaging and printing. The ability to dimensionally navigate the anatomical aspects of the hard and soft tissue to ensure optimal success of the implant fixtures can provide a safer, faster approach while improving outcomes.

Trauma is another variable to consider. A patient could have fallen and hit their chin resulting in painful, progressive trismus. Dr. Rebeka Silva and colleagues discuss the temporomandibular joint complex and its dysfunction. This area has been fraught with mixed literature and weakly supported treatment modalities. Comprehensive care for true temporomandibular joint disease involves understanding the underlying pathology and appropriate application of treatment options that may apply to a given patient. After a proper diagnosis is made, only then can the patient return to function through minimally invasive therapy or primary surgical intervention.

A patient may find that they are waking with headaches or falling asleep while waiting at stoplights. Dr. Stanley Liu and his co-author discuss the surgical treatment of sleep-disordered breathing. They present the ever-increasing understanding that obstructive sleep apnea and the anatomic masticatory complex are intertwined. The reader can conceptualize why these treatment modalities might be effective and how the dental complex is intimately involved. Potentially, dental intervention may contribute to reducing morbidity, improving quality of life and potentially extending the lifespan of the patient.

The patient may also have a painful ulcer that has persisted for a year. Dr. Robert Julian and his coauthors discuss oral and pharyngeal cancer and provide a down-to-earth presentation covering causation, diagnosis, treatment and complications. Whether there is early screening or late treatment, the patient can survive a cancer diagnosis with appropriate intervention and maintain facial form and function with the dental team.

The authors present recent advances in these areas. These are not experimental discussions or dreams of what could be available in the future, but what is known and can be done today. A primary care dental team must assimilate the information and communicate with dental and medical subspecialties to coordinate care for their patients.

This issue, followed by an upcoming issue on head and neck cancers, will augment health care providers’ understanding of several technical and complex areas of dentistry. It is not just about the teeth, but also what is connected to them, as the mouth is a part of the rest of the body. As we continue to advance our understanding of the oralsystemic connection, the dental profession is in a rapid phase of advancement with therapeutic interventions that may have direct effects elsewhere in the body. The astute provider will keep up with these approaches to provide the best guidance and foundation for a patient to start their process of healing, reconstruction and rehabilitation — both orally and systemically. The dental team can absolutely do the impossible.