Oral & Maxillofacial Procedures

Wisdom Teeth

By the age of eighteen, the average adult has 32 teeth: 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspids teeth) are ideal for grasping and biting food into smaller pieces. The back teeth or molar teeth are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four teeth are your “third molars” also known as “wisdom teeth.”

Why should I remove my wisdom teeth?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allow bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Facial Trauma

The dental specialist performs the proper treatment of facial injuries. These professionals must be well versed in emergency care, acute treatment and long term reconstruction and rehabilitation – not just for physical reasons but emotional as well. Oral & Maxillofacial Surgeons are trained, skilled and uniquely qualified to mange and treat Facial Trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of healing these injuries require special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

Dr. Marshall meets and exceeds these modern standards. He is trained, skilled and uniquely qualified to manage and treat facial trauma. He is on staff at Medical City Dallas Hospital and delivers emergency room coverage for facial injuries, which include the following conditions:

  • Facial lacerations
  • Intra oral lacerations
  • Avulsed (knocked out) teeth
  • Fractured facial bones (cheek, nose or eye socket)
  • Fractured jaws (upper and lower jaw)

The proper treatment of facial injuries is now the realm of specialist who are versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient.


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Orthognathic Surgery

Orthognathic surgery is needed when jaws don’t meet correctly and/ or teeth don’t seem to fit with jaws. Usually due to growth, abnormalitic teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

Who needs Orthognathic Surgery

People who can benefit from Orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when repositioning is necessary


Orthognathic Surgery Patient Symptoms include:

  • Difficulty in chewing, biting or swallowing
  • Speech problems
  • Chronic jaw or TMJ pain
  • Open bite
  • Protruding jaw
  • Breathing problems
  • Sleep Disorders


Any of these symptoms can exist at birth, be acquired after birth as a result of hereditary or environmental influences or as a result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with xrays. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.

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Dental Implants

Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth which look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence.

What are Dental Implants?

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

Implants also help preserve facial structure, preventing bone deterioration that occurs when teeth are missing.


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Bone Grafting

Major and Minor Bone Grafting

Over a period if time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants. Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functional and esthetic appearance.

Major Bone Grafting

Bone grafting can repair implant site with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone grafting and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are required using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.

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Sleep Breathing Disorders / Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) affects 5% to 8% of the population. OSA develops as a result of a narrowing of the air passages with the onset of sleep. This occurs because the muscles in the throat, just like the rest of the muscles of the body, relax with sleep onset. The airway becomes narrowed as the tissues are drawn together during inspiration.The movement of the tissue produces the snoring sound. When the oxygen level in the brain becomes low enough the sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp. People with OSA have disturbed sleep and low blood oxygen levels. Loud snoring, with episodes of pauses and gasps during which the snorer struggles unsuccessfully to breathe, is a prominent symptom of OSA. Snoring is present in 90% to 95% of patients with OSA. People with sleep apnea don’t get enough oxygen and their sleep is poor.


The most common symptoms of Sleep Apnea include:

  • Memory Loss
  • Impotence
  • Morning headaches
  • Depression
  • Breathing pauses during sleep
  • Daily sore throats
  • Nightly insomnia
  • Excessive daytime fatigue


Sleep apnea is a serious condition and individuals with OSA may not be aware of a problem. Frequently it is only the bed partner who is aware of this serious disorder.

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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 the 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 pathological process or cancerous growth:

  • Reddish patches (erythroplasia) or whitish patches (leukoplakia) 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 curiously, 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.

We recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body’s most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help. A biopsy or removal of the lesion is usually necessary.

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