dr. barrett

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?

Immunotherapy 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 cancer 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 West Texas Oral Facial Surgery, our commitment to your care, comfort, health and safety is evident from the minute you walk through our door. Call us at Lubbock Office Phone Number 806-792-6291 for more information about oral cancer.

3D Printers and Bone Grafting

'3D printed bone graft'There 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 Lubbock Office Phone Number 806-792-6291.

Dental Implant Success

What do you use your teeth for? Eating, drinking, speaking, laughing, the list goes on! How are these affected when you have tooth loss?
If you have missing teeth, you could be missing a lot! A very reliable and safe method for replacing teeth is dental implants.

'implant in between teeth'

Dental implants permanently attach prosthetic teeth to small posts or “roots” that are embedded in the jaw. These posts are made of titanium, and securely fuse to the jaw bone, this helps restore the full functionality of previously missing teeth.

Dental implants not only effectively and reliably replace missing teeth, but also help prevent the loss of jawbone density, restore the support of facial structures, and provide you with the support you need to effectively use your teeth.

The procedure for dental implants can be a quick and easy, and in some cases, can be done in a single day. Your implants become part of you, so they eliminate the discomfort of removable dentures. They also prevent the embarrassment of removing dentures at every snack or meal, as well as the need for denture adhesives.

Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain. Nearby teeth are not altered in order to support a dental implant, thus more of your own teeth are left intact, improving oral health in the long-term as well as your oral hygiene.

Dental implants are very durable, lasting several years, and if they are in good care, can last a lifetime.
Don’t miss out with missing teeth, get your smile back and feel better about yourself!
Here at West Texas Oral Facial Surgery we specialize in dental implants, so give us a call today on 806-792-6291 to discuss your future implant success!

Oropharyngeal & Oral Cancer

'cancerous cells in mouth'Worldwide, 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 incudes 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 West Texas Oral Facial Surgery to schedule your routine dental check up and oral cancer screening today 806-792-6291

Little Medium Big Bone Grafts

'tooth surrounded by bone'

Bone 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 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:

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 806-792-6291 today for a consultation with West Texas Oral Facial Surgery

Wisdom Tooth Removal – Aftercare

'woman smiling after wisdom teeth removal'

Having your impacted wisdom teeth removed is a serious surgical procedure, and post-operative care is extremely important! Read on for instructions on how to care for your sore mouth, and how to minimize unnecessary pain and complications.

Immediately Following Surgery

Keep a firm, yet gentle, bite on the gauze packs that have been placed in your mouth to keep them in place. You can remove them after an hour if the bleeding is controlled. If the surgical area continues to bleed, place new gauze for another 30 to 45 minutes.

Be careful!

Do not:
• Rinse vigorously
• Probe the area
• Smoke (hopefully you don’t!!)
• Participate in strenuous activities
You can:
• Brush gently (but not the area)
• Begin saltwater rinses 24 hours after surgery (mix 1 tbs of salt with 1 cup of water). Make sure to swish gently. These rinses should be done 2-3 times a day, especially after eating.

Enjoy some down-time!

Keep activity level to a minimum! Enjoy a day of couch or bed-rest, as being active could result in increased bleeding. Avoid exercise for 3-4 days, and when you do begin exercising again, keep in mind your caloric intake has been reduced so you may feel weaker.

Bleeding

As you’ve just had surgery, some bleeding will occur and it’s not uncommon to ooze blood for 24-48 hours after your procedure. REMEMBER-the blood you see is actually a little blood mixed with saliva, so don’t panic!
If excessive bleeding persists:
1. Try repositioning the packs. They may not be putting enough pressure on the site.
2. Sit upright and avoid physical activity.
3. Use an ice pack and bite on gauze for one hour.
4. You can also try biting on a moistened tea bag for 30 minutes (the tannic acid in tea promotes blood clotting).
5. If bleeding persists, please call our office at 806-792-6291.

Pain

Unfortunately, some pain is to be expected after surgery. Try not to let the anesthetic wear off before taking your prescribed pain medication. Drs. Barrett or Higley will have discussed a plan to manage your pain, make sure you follow these instructions.

Diet

Eat nourishing food that takes little effort.
Avoid:
• Extremely hot foods
• Straws (for the first few days)
• Chewing (until tongue sensation has returned)
• Smaller foods that can become stuck in the socket area
• Skipping meals—while eating may seem like a lot of work, you need your nourishment to be able to heal and feel better!

Day 2 and 3 Following Surgery

Swelling

Swelling is a completely normal occurrence. Keep in mind, swelling will usually be at it’s worst in the 2-3 days after surgery. You can minimize swelling by applying a cold compress (covered with a towel) firmly to the cheek next to the surgical area. Apply the pack with 20 minutes on, and 20 minutes off for the first 24-48 hours. Also make sure to take the medication prescribed by Drs. Barrett or Higley. This helps with pain and swelling.

Keeping your mouth clean

Keeping your mouth clean is very important! Continue saltwater rinses as often as you’d like, but at least 2-3 times a day. Begin your normal oral hygiene (remember to brush softly and don’t do anything that hurts)!

Healing

Everyone heals differently, but your timeline should look similar to this:
1. Day 1-2 will be the most uncomfortable and you will experience some swelling.
2. Day 3 you should be more comfortable and while still swollen, you should be able to begin a more substantial diet.
3. Day 4 and on you should see a gradual and steady improvement.

Other Normal Things

• Discoloration. Bruising is a normal post-operative occurrence you may notice 2-3 days after surgery.
• Stiff jaw muscles. You may find it difficult to open your mouth wide in the days following your surgery. This is normal and usually resolves itself within a week after surgery. Stretching these muscles may help to speed up recovery.
Since no two mouths are alike, do not take advice from friends (even well-intended advice could cause a healing set-back). The advice given to you from Drs. Barrett or Higley and the West Texas Oral Facial Surgery team are tailored to fit your needs. Please call us at 806-792-6291 if you have any questions or concerns about your recovery. Happy healing!

Types of Jaw Surgery

'side profile of man'

Your jaw consists of two parts; the maxilla or upper jaw and the mandible or lower jaw . Sometimes these are misaligned and need to be put back into place for bite reasons, or for aesthetic purposes. Corrective jaw surgery straightens or aligns the jaw, and is often referred to as “orthognathic” surgery; “orthos” meaning to straighten and “gnathic” relating to the jaw.

There are a few different types of jaw surgery, depending on which part of your jaw requires correcting;

Maxillary Osteotomy (Upper Jaw)
This type of surgery corrects a significantly receded upper jaw, cross bite, or when you have too many or too few teeth showing. It also can adjust an open bite.

Mandibular Osteotomy (Lower Jaw)
This surgery corrects a significantly receded lower jaw. The surgeon moves the jawbone forwards or backwards depending on the best adjustment and bite alignment.

Genioplasty (Chin)
A deficient chin often accompanies a severely receded lower jaw. Typically, surgeons can alter the jaw and restructure the chin during the same surgery.

Once your jaw is aligned, tiny screws and plates hold the bone into position. These screws and plates are osseo integrated and are specially formulated to be compatible with your body. They become integrated with your bone over time and do not have to be taken out.

Extra bone can also be added to your jaw if there is insufficient bone. This can be grafted from your hip, leg, or rib.

Often these types of jaw surgeries are performed entirely inside the mouth without any evidence on the skin surface as to what procedure has been performed. There are no facial scars on the chin, jaw or around the mouth.

Often with extensive jaw surgery, the process is carried out after you have had braces, so your teeth are aligned and ready for your jaw to be moved. Braces are placed anywhere from 9 to 18 months before jaw surgery.

Jaw surgery can take up to 2 years to complete, but the results are for life! Know your jaw facts; Talk to us today to discuss your options!

Pre-Implant Bone Augmentation

'man lifting weights'

We are all unique, and so is your mouth! Sometimes, your jaw needs to be beefed up a little, and we’re not talking a hefty workout at the gym.
You may have lost teeth due to gum disease which has resulted in bone loss, or you could just have been “born that way” and need a little help expanding!

Don’t let life get you down! We’ve got these options for you;

Sinus Lift or Sinus augmentation:
A sinus lift is often performed on people who have lost teeth in their upper jaw or are lacking adequate bone density. This procedure adds bone between your jaw and the maxillary sinuses (which are on either side of your nose), the area of your molars and premolars. To make room for the bone, the sinus membrane has to be moved upward, or “lifted.”
The new bone means implants can be placed. This procedure does not affect speech, intonation or cause sinus problems.
Sometimes this procedure is required in the alveolar ridge. The alveolar ridge is the part of the gums immediately behind the upper front teeth. Alveolar ridges contain the sockets, or alveoli, of the teeth. You can feel it on the upper palate if you say words like “tight”, “dawn” because the consonants are made with the tongue tip or blade reaching for this alveolar ridge.

Ridge Expansion or modification: If your jaw isn’t wide enough to support dental implants, bone graft material can be added to a small ridge, or space that is created along the the jaw. Malformation in the lower jaw can result in not enough bone to place dental implants and it can also cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain.

During ridge expansion, the bony ridge of the jaw is increased and bone graft material is inserted and allowed to heal before placing the implant.
Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come. It can enhance your restorative success both aesthetically and functionally.

Whether you require a lift or expansion, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. However, in some cases, the implant can be placed at the same time the ridge is modified.

What are you waiting for? Ask us today what your implant options can be!

Pediatric Facial Trauma

'child holding soccer ball in front of face'

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.

Considering how much energy children have, pediatric facial trauma is actually very rare! Of all facial trauma, only 15% is pediatric (0-18 years).

The 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 West Texas Oral Facial Surgery a call at Lubbock Office Phone Number 806-792-6291

Oral Cancer and Hepatitis C

'Oral Cancer' 'Hepatitis C'

The Journal of the National Cancer Institute (JNCI) recently found that individuals infected with the hepatitis C virus are two to five times more likely to develop head and neck cancers. The JNCI study found that the risk for hepatitis C patients of developing head and neck cancers more than doubled for oral cavity and oropharynx cancers, and increased nearly five times for larynx cancers. As well, patients that are hepatitis C virus-positive were also more likely to test positive for human papillomavirus (HPV).

The question remains, how does hepatitis C virus increase oral cancer risk?

The JNCI research found that patients infected with the hepatitis C virus had a higher odd ratio of having cancer of the oral cavity, oropharynx, or larynx than those without hepatitis C virus infection. Enhanced replication of hepatitis C virus in oropharyngeal tissues may in fact contribute to chronic inflammation, ultimately prompting cancer development. Human papillomavirus is known to suppress local immune response, which may accelerate the production of hepatitis C virus in oropharyngeal cells. The JNCI notes that human papillomavirus and hepatitis C virus may play a “synergistic role” in the development of oropharyngeal cancers by stimulating loss or destruction of tumor suppressor proteins p53 and retinoblastoma protein.

The JNCI notes that one of the study’s limitations is that it didn’t include individuals with hepatitis C virus who didn’t have oral cancer. All and all, it is important to take away from The Journal of the National Cancer Institute’s study that it is important to educate Hepatology (study of liver, gallbladder and pancreas health) and infectious disease specialists. These doctors who treat patients with hepatitis C virus need to understand that the hepatitis C virus not only drastically affect liver health, but it’s also a systemic infection that can drastically affect oral health.

Your oral health is important to us. If you suspect that your oral health is at risk, give West Texas Oral Facial Surgery a call today and schedule an oral cancer screening!