Surgical Procedures

Anesthesia

During your initial consultation, Dr. Berwick will take a comprehensive history designed to help recommend the safest and most effective anesthesia/deep sedation for your operation. Your anesthesia plan will involve a combination of agents that target pain both during and after the operation. General anesthesia may be administered intravenously. Conscious sedation may be delivered intravenously or in a gas form such as nitrous oxide or “laughing gas.” Local anesthesia is injected into the site to provide pain relief both during and following the procedure. Local anesthesia is often not completely effective for more complicated procedures in which sedation may be recommended. Oral medications provide post-operative pain control and can be self-administered in the days following the procedure.

It is important to understand what anesthesia is planned for your procedure and to follow pre-operative instructions precisely. Many types of anesthesia require that you do not eat or drink anything for at least six hours prior to surgery. In addition, patients are required to arrange an escort to assist with transportation following the procedure.

Wisdom Teeth

Wisdom teeth, or third molars, are the last teeth to develop and appear in your mouth. They usually appear during the late teens and are positioned behind the upper and lower second or twelve-year molars. A person’s jaw is often not large enough to accommodate wisdom teeth and as a result can create complications if they are not removed. A result can be pain or infection, crowding of teeth or damage to the surrounding teeth.

Removal of wisdom teeth is usually performed in our office under IV sedation with local anesthesia. The surgery usually lasts about 45 minutes. Once the teeth have been removed, Dr. Berwick provides each patient with detailed post-op instructions. Patients will need a few days to recuperate and may have some swelling and discomfort. Patients will be given a prescription for pain management and possibly an antibiotic. It is essential to maintain good oral hygiene throughout the recovery process.

The removal of Wisdom teeth is a common procedure with minimal side effects. Although rare, Dr. Berwick will provide a comprehensive explanation of any risks and complications associated with the procedure; the most common are infection, dry socket, numbness and sinus complications.

Pediatric Maxillofacial Surgery

Dr. Berwick treats children using general and local anesthesia in the office, including the full range of pediatric care including extractions, pathology, and corrective surgery.

Maxillofacial Trauma

There are numerous causes of facial trauma which can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Trauma to the face is usually classified as soft tissue injuries (skin and gums), bony injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

When soft tissue injuries occur, they are repaired by suturing. In addition to repair any damage for cosmetic purposes, care is taken to inspect for and treat, injuries such as facial nerves, salivary glands and salivary ducts.

Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient.

Dr. Berwick is an expert in the treatment of fractures in the supporting bone or in replanting teeth which have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting or the stabilization by wiring or bonding teeth together. Displaced teeth should be placed in salt water or milk. The sooner Dr. Berwick is able to re-insert the tooth into the dental socket, the better chance it will survive. Displaced teeth should never be wiped off since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

Cleft Lip and Palate

A cleft is a separation of parts of the lip or roof of the mouth formed in early development of the fetus. Infants with these defects are born with all parts present but fail to fuse along the midline of the face prior to birth. In most cases, surgery is necessary to align and join these parts. Dr. Berwick has been involved in the Cleft Palate Team in Denver, CO and San Antonio, TX. He received recognition for his care in this area when serving abroad in Panama.

Cleft Lip

A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose.

Cleft Palate

The palate is the roof of your mouth. A cleft palate can occur in early pregnancy when separate areas of the face have developed individually do not join together properly. A cleft palate occurs when there is an opening in the roof of the mouth. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Dental Implants

Dental implants are permanent fixtures of very durable, tiny titanium posts which are inserted into the jawbone where teeth are missing. The metal anchors act as tooth root substitutes. They are surgically placed into the jawbone; the bone then bonds with the titanium, creating a strong foundation for artificial teeth. Small posts are then attached to the implant, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.

People often consider implants because a sliding lower denture makes chewing and talking difficult. Implants require the same maintenance as real teeth, including brushing, flossing and regular dental check-ups. Dental implants can help restore almost anyone's smile even if natural teeth have been lost. The success rate for implants is impressive with a 98 percent for lower implants and 95 percent for upper implants!

Dr. Berwick was first trained to use the current implant systems in 1986 and has more than 20 years of experience with dental implants.

TMJ Disorder

TMJ (temporomandibular joint) disorders related to the jaw joint. TMJ disorders develop for many reasons and may result in a misaligned bite, pain, clicking or grating noises when you open your mouth, or trouble opening your mouth wide. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

There are various treatment options that Dr. Berwick can utilize to improve the function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Berwick will determine the proper course of treatment.

Orthognathic (Corrective Jaw) Surgery

Orthognathic surgery is a corrective and reconstructive surgery designed to establish proper jaw and facial alignment. Candidates for orthognathic surgery often have discrepancies in the facial skeleton, the treatment for which requires the teeth to be straightened with orthodontics followed by corrective jaw surgery to re-align the jaw.

Not treating the problem may prevent you from being able to bite and chew your food, close your lips together, and to speak clearly. The health of the teeth, gums and particularly the jaw joint (TMJ) may be in jeopardy if surgery is not done. While not often a primary reason for orthognathic surgery, the appearance of your face may be made to look more balanced or normal.

Most orthognathic surgeries are performed in the hospital and the surgery can last from two to three hours, depending on the severity of your condition.

Dr. Berwick has had a very active practice in this area and has performed hundreds of these surgeries!

Reconstructive and Cosmetic Surgery

Reconstructive and cosmetic surgery entails Dr. Berwick correcting the jaw, facial bone and facial soft tissue problems as the result of previous trauma or removal of pathology. This surgery to restore form and function often includes moving skin, bone, nerves, and other tissues from other parts of the body to reconstruct the jaws and face. These same skills are also used when Dr. Berwick performs cosmetic procedures for improvement of problems due to unwanted facial features or aging.

Oral Pathology

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:

• Reddish patches or whitish patches in the mouth
• A sore that fails to heal and bleeds easily
• A lump or thickening on the skin lining the inside of the mouth
• Chronic sore throat or hoarseness
• Difficulty in chewing or swallowing

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology and is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

Dr. Berwick would recommend performing oral cancer self-examinations monthly and not to ignore suspicious lumps or sores.