What Does an Oral and Maxillofacial Surgeon Do? Role, Treatments and When to See One

An oral and maxillofacial surgeon (OMFS) is a dental specialist who does surgery on the mouth, teeth, jaws and face. They remove impacted wisdom teeth, place dental implants and bone grafts, fix broken jaws and facial bones after accidents, correct badly aligned jaws, treat some jaw joint (TMJ) problems, and remove cysts, tumours and suspicious patches in the mouth. In India, they are dentists (BDS) who have completed a three-year MDS in Oral and Maxillofacial Surgery, so they sit between a general dentist and a hospital surgeon.

Quick answer: your general dentist handles check-ups, fillings, cleaning and simple extractions. You are usually referred to an oral and maxillofacial surgeon when a problem needs cutting into gum or bone, involves the jaw or face, or needs sedation or general anaesthesia to be done safely.

What does an oral and maxillofacial surgeon do?

Here are the most common reasons people in India end up in an OMFS clinic or hospital department.

1. Wisdom tooth removal

Wisdom teeth are the last molars to come in, usually in the late teens or twenties. Often there is not enough room, so they stay stuck (impacted) under the gum or come in at an angle. The NHS lists pain and swelling, gum infection (pericoronitis), food getting trapped, decay in the neighbouring tooth, cysts and abscesses as the usual reasons for removal. Wisdom teeth that cause no problems are usually left alone and watched at routine check-ups.

A simple extraction can be done by a general dentist. A tooth buried in bone, lying sideways, or close to the nerve that supplies the lower lip is usually sent to an oral surgeon.

2. Dental implants and bone grafting

A dental implant is a small titanium (or zirconia) post placed in the jawbone to hold an artificial tooth. If the bone has shrunk after a tooth was lost, the surgeon may first add bone (bone grafting) or lift the floor of the sinus in the upper jaw (sinus lift) so the implant has something solid to sit in. For a sense of what implants involve and cost, see our guide to dental implant cost in Mumbai.

3. Facial injuries and fractures

Road accidents, falls, sports injuries and assaults can break the lower jaw, cheekbones, the bones around the eye or the nose, or knock teeth out. Oral and maxillofacial surgeons work in hospital emergency and trauma teams to wire or plate these fractures and restore both the bite and the shape of the face.

4. Corrective jaw surgery (orthognathic surgery)

When the upper and lower jaws do not meet properly, it can affect chewing, speech, breathing and appearance. Braces alone cannot fix a skeletal problem, so the orthodontist and the surgeon plan together: braces line up the teeth, then the surgeon cuts and repositions one or both jaws. This is a planned hospital operation under general anaesthesia, usually done once growth has finished.

5. TMJ (jaw joint) problems

The temporomandibular joint sits just in front of each ear. Problems here cause jaw pain, clicking, headaches and difficulty opening the mouth. Most TMJ problems settle with simple care such as soft food, avoiding wide yawns, warm compresses, painkillers, a night guard for clenching and jaw exercises. Surgery is reserved for a small number of people with joint damage, locking or conditions that do not respond to these measures.

6. Cysts, tumours and oral cancer

Swellings in the jaw, lumps in the mouth and white or red patches that do not heal can be cysts, benign growths or, sometimes, cancer. The surgeon takes a small sample (biopsy) to find out what it is and, if needed, removes it. India has a high burden of oral cancer, closely linked to smoking, gutka, khaini, paan with tobacco and areca nut (supari), and alcohol, so early checks of any non-healing ulcer or patch matter a great deal. Larger cancer operations are done by hospital teams that include maxillofacial, head-and-neck and reconstructive surgeons.

Also read: Single Sitting RCT: How a One-Visit Root Canal Can Help With Dental Fear

Oral surgeon vs dentist vs other specialists

When should you see an oral and maxillofacial surgeon?

Your dentist will usually refer you. It is worth asking for a specialist opinion if you have:

• Repeated pain or swelling around a wisdom tooth

• A tooth that needs removing but is broken at the gum line or buried in bone

• Missing teeth and too little bone for an implant

• A jaw that does not close properly, or long-standing jaw pain and clicking that has not improved with simple care

• A lump, swelling or patch in the mouth that has not healed

Get help the same day (a dentist, hospital casualty or emergency number) if you have a facial injury, a tooth knocked out, swelling spreading to the eye or neck, difficulty swallowing or breathing, bleeding that will not stop, or fever with dental pain. Spreading facial swelling can be serious and should not be treated with home remedies.

See a dentist or doctor within about two to three weeks for any mouth ulcer, white or red patch, or lump that has not healed in that time, especially if you use tobacco or areca nut.

What to expect before and after oral surgery

Before: the surgeon will examine you, take X-rays (often an OPG, a single panoramic X-ray of both jaws, or a CBCT scan for implants and impacted teeth) and ask about your medicines. Tell them if you take blood thinners, diabetes medicines or bone-strengthening drugs, have heart problems, or are pregnant. Do not stop any medicine on your own; your doctor and surgeon will decide together.

Anaesthesia: most procedures, including most wisdom tooth removals, are done under local anaesthesia with you awake. Sedation or general anaesthesia is used for difficult surgery, anxious patients and hospital operations.

After: the NHS says pain, swelling, bruising and a stiff jaw can last up to two weeks after wisdom tooth removal, usually improving after a day or two. General after-care advice includes:

• Take only the painkillers or antibiotics your surgeon advises

• Eat soft food; avoid very hot drinks, smoking and alcohol while it heals

• Go back if pain gets worse after a few days, or you notice a bad taste or fever (possible dry socket or infection)

Numbness of the lip, chin or tongue can occur when a tooth lies close to a nerve. It usually improves, but may take weeks or months, so ask your surgeon about this risk before surgery.

Also read: Transforming Smiles with Digital Smile Designing: A Modern Approach to Perfect Teeth

How to choose an oral and maxillofacial surgeon

• Check that they hold an MDS in Oral and Maxillofacial Surgery and are registered with the State Dental Council.

• Ask for the plan in writing: scans, anaesthesia, number of visits, total cost and what happens if something goes wrong.

• For big operations such as jaw surgery or cancer surgery, a hospital with an anaesthesia team and intensive care backup is the safer setting.

This article was first contributed by Ardent Smiles, a dental clinic in Nerul whose team includes an oral & maxillofacial surgeon in Navi Mumbai. Wherever you are, the checks above apply, and a second opinion before a major operation is always reasonable.

Most tooth problems that end in surgery start small, so regular check-ups help. See why preventive dentistry saves money and our explainer on what a root canal is.

FAQs

What is the role of an oral and maxillofacial surgeon?

They diagnose and surgically treat problems of the teeth, jaws, mouth and face, from impacted wisdom teeth and implants to jaw fractures, corrective jaw surgery, cysts, biopsies and some cancers.

Is an oral and maxillofacial surgeon a doctor or a dentist?

In India, they are dentists (BDS) with a three-year postgraduate MDS in oral and maxillofacial surgery. They are trained in surgery and anaesthesia care and often work in hospitals alongside medical doctors.

Do I need an oral surgeon for wisdom tooth removal?

Not always. A general dentist can remove many wisdom teeth. Teeth that are deeply impacted, lying sideways or close to a nerve are usually referred to an oral surgeon.

Is maxillofacial surgery painful?

The surgery itself is done under local or general anaesthesia, so you should not feel pain during it. Soreness and swelling afterwards are normal for a few days and are managed with the painkillers your surgeon recommends.

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