Scott A. Hum, DMD, PA

Immunotherapy and Oral Cancer

You may have heard: Immunotherapy is proving to be very promising in the treatment of a variety of cancers, in particular lung cancer and advanced melanoma. However, immunotherapy has not found its way (yet!) into the treatment regimen for head and neck cancers.

What is immunotherapy?

Iimmunotherapymmunotherapy is the process of enlisting the patient’s own immune system in the fight against cancer cells. Several drugs have been used successfully to aid in the treatment of advanced lung cancers and melanoma, giving patients a longer prognosis in many cases.

Cancer Cells are Tricky

Cancer cells are notoriously sneaky – their ability to hide from immune cells is one of the reasons that cancer is so hard to treat. This is where “checkpoint inhibitors”, one of the most common classes of immunotherapy drugs in cancer treatment, come in. These drugs help to block the activation of proteins that help cancer cells hide from immune cells.

The Connection with Oral Cancer

Recurring head and neck cancers are very difficult to treat. Often they are resistant to the best chemotherapy drugs, so the hope has always been that immunotherapy drugs may some day step in to assist with the oral pathology fight. A recent trial in the UK has shown that the day may be coming sooner than we thought! The trial proved successful in extending prognosis for many of the patients.

Reduced Side Effects

The research also noted that side effects were reduced to give patients a better quality of life during treatment.

More Testing Needed

While more research is needed before the drugs receive FDA approval for the treatment of oral cancer, the good news is that because these drugs are already approved and on the market for other cancers, the application process for use in oral cancers will be quicker (and smoother) than it would be for a new drug.

At Wake Oral & Maxillofacial Surgery, our commitment to your care, comfort, health and safety is evident from the minute you walk through our door. Call us at Wake Oral & Maxillofacial Surgery Raleigh NC Office Phone Number 919-783-9920 for more information about oral cancer.

Why do we have wisdom teeth anyway?

Wisdom teeth were once an extremely valuable asset to our ancestors. When a typical diet consisted of chewy plants and uncooked meat, third molars (wisdom teeth), which fit easily into our ancestors’ larger jaws, were absolutely necessary. Wisdom teeth were the evolutionary answer to the need for chewing power to combat excessive wear.

why-do-we-have-wisdom-teethToday, our diets are not as rough as those of our ancestors. With modern marvels like forks, spoons, and knives, as well as softer food, the need for wisdom teeth is virtually nonexistent. And yet, on average, about 65% of the human population is born with wisdom teeth which usually erupt between the ages 17 and 25.

Although wisdom teeth were incredibly advantageous for our ancestors, they pose a bit of a problem for the modern mouth. Humans have evolved to have smaller jaws, and so wisdom teeth are often either too big for the jaw or the jaws themselves are just too small. Either way, third molars crowd the mouth. Because of this lack of space, molars often grow sideways, only partially emerging from the gums, or actually get trapped inside the gums and jawbone.

These impacted wisdom teeth can be chronically contaminated with bacteria associated with infection, tooth decay, inflammation, and gum disease. And because they’re so far back in the mouth or trapped underneath gums, it’s difficult and sometimes impossible to keep them clean. Even when wisdom teeth come in fully, they are so far back in the mouth that it’s just too easy for food to get trapped, leading to plaque, cavities, and gum disease.

Although wisdom teeth were very important to our ancestors, nowadays, they pose a serious problem to oral health. Call Wake Oral & Maxillofacial Surgery to find out if your wisdom teeth are ready to come out!

3D Printers and Bone Grafting

3d-printersThere is exciting news in bone grafting technology that will hopefully find its way into the oral surgeon’s office over the next decade! Researchers have been able to create a synthetic bone material using 3D printers that may be better than what is being used now.

3D printers create three-dimensional objects out of a variety of materials using a computer as a precise guide. Although the concept has been in the news a lot recently, the practice actually dates back to before the 21st century. In fact, 3d printing’s roots go back to the early 1980s. Since then, everything from jewelry to synthetic human organs has been printed, much to the amazement of modern society!

And now, surgeons have successfully implanted the 3D-printed synthetic bone grafting material into animals with bone defects. This “hyperelastic bone” was made using just the right combination of bioactive materials and polymers to make a material that could be layered while still wet, allowing for better adherence between layers.

Here are some of the expected benefits of this new material:

  • Very elastic, allowing for cutting without crumbling, which can be a problem with current grafting materials.
  • Blood vessels move in quickly because the material is porous.
  • Biodegradable as the body replaces it with genuine tissue.
  • Doesn’t dry out right away.
  • So far the animals haven’t rejected the implant, which could mean less complications for humans as well.
  • Could be a great option for children since it will grow with them.

While human trials are potentially five or more years away, the news is very exciting for the surgical community, and we are can’t wait to see what benefits this will bring to our patients.

To find out more about bone grafting in general or to set up a consultation with our office, please call us at Wake Oral & Maxillofacial Surgery Raleigh NC Office Phone Number 919-783-9920.

How Are Wisdom Teeth Removed?

HowAreWisdomTeethDon’t be worried about your wisdom tooth extraction, let us outline the whole process for you:

Treatment Development

During late adolescence, wisdom teeth start to appear and occasionally are accompanied by oral pain, as well as an increased risk of dental issues such as pericoronitis, gum disease, and tooth decay. Through evaluation, your oral surgeon will determine the number of wisdom teeth present, as well as how they are developing in relation to the rest of your teeth. Using advanced imaging technology, an oral surgeon will discover if the teeth are partially or fully impacted, and then will create a strategic treatment plan in order to remove the teeth and ensure successful recovery.

Preparation

Although sedation is not always necessary, many patients have found anesthesia to be helpful in relaxation and reducing pain during the procedure. If sedation is chosen, there are certain preparations that must be made: patients must enlist the help of family or friends to bring them back home after their surgery.

The Procedure

Local anesthesia is applied to the area. Then, a surgical tool is used to reveal the bone and tooth. After the tooth is clearly visible, it is removed. Once the tooth is extracted, the gums and bone are left to heal.

Healing

Following the procedure, there may be some swelling in the tissue and cheeks near the treatment site. To promote a successful recovery, patients should avoid strenuous activity, smoking, and eating hard foods. Patients should not touch the treatment area with their tongue, or use straws, as this could potentially dislodge the developing blood clots and expose the area to food and bacteria.

Wisdom tooth extraction can be an uncomplicated procedure that ultimately will protect your long-term oral health. For more information about wisdom tooth extraction, schedule your consultation at Wake Oral & Maxillofacial Surgery today!

Little, Medium, Big Bone Grafts

LittleMediumBigBoneGraftBone grafting is a straightforward procedure that is immensely beneficial for numerous reasons. In the instance of a missing tooth (or teeth), the jaw bone can begin to slowly degrade. The jaw bone is holds teeth in place, and once a tooth is no longer present, the bone doesn’t have anything to support. There are different types of bone grafts, and depending on your situation. Outlined below are several different types of bone grafts:

Little Bone Graft

In the case of a simple, single lost tooth, the ideal course of action is to not lose excess bone. In this process, sterile, demineralized human bone granules are packed into the tooth socket immediately after tooth extraction. This procedure is very simple, and does not add anything to your recovery time. Over the next several weeks, your own bone will fill the tooth socket and preserve the bone height enough for you to have the area restored.

Medium Bone Grafts

If a tooth was removed a long time ago, there is likely to already be some bone loss impeding the restoration of the area. In this case, the area of the missing tooth is opened with a small incision, the bone surface is prepared, and demineralized bone graft granules are used to build up the area. Many surgeons prefer to use a little bit of the patient’s own bone in this procedure in order to ensure the best results possible. If your own bone is used, your surgeon will take it from another area of the jaw bone, usually near the wisdom tooth area, shaving off tiny granules and combining them with the demineralized bone. The bone graft will heal and integrate with the surrounding bone tissue. This type of graft can be used for one or multiple areas of missing teeth.

Big Bone Graft

Patients who have many missing teeth and who have been missing many teeth for many years, have often experienced advanced bone loss. In those who wear dentures, the lower jaw bone often recedes so severely that they can no longer wear them. Extensive bone grafting is necessary in order to consider restorative methods. A combination of demineralized, sterile human bone and the patient’s own bone is used to restore the jaw bone, creating enough width and height to consider dental implants. The patient’s bone is supplied by another part of the jaw, hip, or tibia. Bone granules are also used to enhance and strengthen the graft.

Bone grafting is a surgical procedure that takes time. However, it plays an essential role in making new teeth possible, and will ultimately be a positive process! For more information, call 919-783-9920 today for a consultation with Wake Oral & Maxillofacial Surgery

Oral & Oropharyngeal Cancers

OropharyngealCancerWorldwide, over 550,000 new cases of Oral, Head and Neck cancer are diagnosed each year.

Oropharyngeal cancer is slightly different from oral cancer. Oropharyngeal cancers are related to HPV (Human papilloma virus) and usually occur in the tonsils or at the base of the tongue, while oral cancers are in the mouth and usually associated with tobacco use.

The Oral Cavity
The oral cavity includes the lips, the inside lining of the lips and cheeks, the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, and the bony roof of the mouth – also known as the hard palate.

The Orpharynx
Behind the wisdom teeth is considered the oropharynx, which is part of the throat just behind the mouth. It also includes the base of the tongue, the soft palate (back of the mouth), the tonsils, and the side and back wall of the throat.

Categories
Oral and Oropharyngeal cancers are sorted into 3 categories: Benign (non-cancerous), harmless growths that may develop into cancer, and cancerous tumors. This is why regular check-ups with your dental professional are key to your overall well-being.

The Team Involved
The treatment of head and neck cancers does not involve just your dental team, the assistance of many different professionals contributes is required. There may be surgeons, radiation oncologists, medical oncologists, dentists, nutritionists, and speech therapists all involved in your treatment.

Oral cancers are found as late stage three and four diseases about 66% of the time.
It is very important for you to check yourself at home as well as visiting your dentist.

Call Wake Oral & Maxillofacial Surgery to schedule your routine dental check up and oral cancer screening today 919-783-9920

Learning the Lingo – Dental Implants

Dental implants are a safe and effective replacement for a missing tooth or teeth. The implant is placed in your jawbone and integrates with your natural bone. This implant then forms a stable, sturdy base for your new teeth.

What They Are

Implant: The implant itself is a rod that is screwed into the jawbone.

Abutment: This is the connection between the implant and the crown.

Crown: A tooth shaped cap that is attached to the abutment. It is the part of the tooth that is visible above the gum line.

What They’re Made Of

LearnTheLingoImplantsTitanium: Most implants are typically made of titanium, a biocompatible metal.

Zirconia: Often used for crowns and bridges and can be used as a metal-free option. Zirconia is biocompatible just like titanium.

Where They Go

Endosteal Implants: Placed in the jawbone. These implants are typically shaped like small screws, cylinders or plates, and they are the most commonly used.

Subperiosteal Implants: Placed under the gum, but on or above the jawbone. These implants are mostly for people with smaller jaws or shallow jawbones.

What Happens To Them
Osseointegration: Creates strength and durability by fusing directly to the bone and is bio-compatible. Bone cells attach themselves directly to the titanium/zirconium surface, essentially locking the implant into the jaw bone. Osseointegrated implants can then be used to support prosthetic tooth replacements of various designs and functionality. Anything from a single tooth, to all teeth in the upper and lower jaws. The teeth/crowns are usually made to match the enamel color of the existing teeth to create a natural appearance.

Bone augmentation: Some people do not have enough healthy bone to support dental implants, so bone must be built. Procedures can include bone-grafting which means adding bone to the jaw.

Talk to us today at Wake Oral & Maxillofacial Surgery to discuss your options with an implant specialist!

Pediatric Facial Trauma

We’ve all had our share of trips, bumps, and even broken bones in our childhood years! (If you haven’t, then you’re very lucky!)
As the saying goes, children are very resilient, and this is actually due to their biology. Children have “bendy bones” which are more likely to bend and crack under pressure rather than break.
The term is referred to as greenstick fractures; similar to when a green branch of a tree bends and cracks, but doesn’t break off.

 

PediatricFaceTraumaThe maxillofacial region is related to a number of vital functions, such as vision, smell, eating, breathing and talking. It also plays a significant role in appearance.
When treating children’s maxillofacial injuries, we take into consideration the difference anatomically between adults and children. Facial trauma can range between minor injury to disfigurement that lasts a lifetime if not treated correctly.

Children have much more flexibility in their facial bones, as well as smaller sinuses, multiple fat pads and unerupted teeth. In adolescents an increase in risk-taking behavior and the reduction of parental supervision results in an increase in facial fractures. Contact sports, physical play, riding bicycles, and even road traffic accidents all contribute to pediatric facial trauma.

A full treatment plan is always taken into consideration when we deal with facial trauma. The age of the patient, anatomic site of the trauma, complexity of the injury and how long since the injury occurred is taken into account. Ideally, don’t put off your incident for more than 4 days! This is prime healing time, and if any longer, could extend the healing and complicate the treatment process.

This is why it is very important to always wear protective gear! Remember to always have your children wear seatbelts, and invest in booster or car seats so your children can receive the full protection of seatbelt coverage.
During play, remember shin guards, mouth guards and helmets! Especially when riding a bike!

Play it safe, and if life throws a curve ball (at your face!) give Wake Oral & Maxillofacial Surgery a call at [PRACTICE_NUMBER]

NC MOM

Dr. Hum was privileged to spend this past Saturday at the NC MOM Clinic held in Fuquay Varina, NC. NC MOM is a community outreach program of the NCDS. Volunteer Dentists, Staff and community members give their time to reach out to our fellow North Carolinians who have difficulty accessing needed dental care. WAKE OMS contributed to the event through a donation to sponsor the mid-day meal for all the volunteers!

Complex Treatment Planning

We again welcomed Dr. Geoffrey Cunningham to our 2016 Seminar Series this past week. I enjoyed one particular pearl from Dr. Cunningham’s lecture. In complex, full arch treatment planning, especially with the occlusal plane in doubt, “make a denture”. This allows both the surgical and restorative team to get a clearer picture of incisal edge position and appropriate positioning of implants for a successful restoration. Thanks Dr. Cunningham !