We report a significant Spearman correlation between BE and LME (rho = 0.54, P < 0.00001), suggesting a partially shared aetiology of these two types of exostoses. Oral Pathology: Clinical Pathologic Correlations, Philadelphia: WB Saunders Co. 1989; 386-7. We do not endorse non-Cleveland Clinic products or services. Int Dent J 2001; 51:300-4. But the point is, the excess bone can create problems in people of all ages on the buccal/facial and lingual sides. If the tumor is small and there's no evidence of spread to lymph nodes, surgery alone may be enough treatment. Kerdporn D, Sirirungrojying S. A clinical study of oral tori in southern Thailand: prevalence and the relation to parafunctional activity. In some hospitals, a psychologist will be available to provide support if you need them. It has caused me a lot of stress because I worry about it getting worse. Accessed Nov. 28, 2018. This form of exostosis is a rare condition that causes bony growths from the jaw, usually inside the mouth in the back of the teeth. Community Dent Oral Epidemiol 1988; 16:61-4. Development is influenced by four main risk factors. by | Jun 10, 2022 | tabak eimer 1000g luxemburg | bloomberg business reporters | Jun 10, 2022 | tabak eimer 1000g luxemburg | bloomberg business reporters Gareth Ainsworth Salary, An exostosis is an extra growth of bone that extends outward from an existing bone. Exostoses: 27% of adults; male predilection (5 : 1); outgrowths of bone, nodular or sessile frequently on buccal aspects of mandible and maxilla or ascending arch of the palate and more than 90% having concurrent tori (see Fig. I2) ncision from the mid-line where the tooth was and up over the outer gun to create a flap of gum that is lifted up to get to the bone. Early signs of buccal mucosa cancer include symptoms in your mouth that last for two weeks or more. The surgeon will make sure you are good and numbed before he begins and the only thing you will feel is the vibration from the surgical handpiece is he even has to use it. Your healthcare provider will develop a treatment plan based on your diagnosis and the cancer grade and stage. Next review due: 14 October 2022, advice and support to help you quit smoking, numbness and tenderness of the hands and feet, in a good state of healthandlikely to make a good recovery if treated, unable to have chemotherapy for medical reasons for example, because they have kidney disease or are pregnant. In principle, they're the same as bone spurs, except that because they're rounded and smooth, they are largely painless and pose no harm. Mouth cancers most commonly begin in the flat, thin cells (squamous cells) that line your lips and the inside of your mouth. Abstract and Figures. Maxillary buccal exostosis was removed via wedge-shaped mid alveolar ridge bone removal and compression of cortical plate to achieve desirable alveolar ridge shape. No additional exam was necessary, thus proceed exostosis excision and bone regularization with hand piece under continue irrigation with physiology solution 0.9% in ambulatory (Figure 2A-2C). [1] LOL, I know youre not middle aged and yes, its true they were definitely a problem for patients needing partials and dentures. The worst part will only be the sore gums during the healing process. The Management of Torus Mandibularis and Maxillary Buccal Exostosis before Loading Single Complete Denture and Removable Partial Denture . Dental implants can often be put into the new bone so that dental bridges can be made to replace lost teeth. 19, 20, 23 to 26, 28, and 30. right bne is sticking through my gum and let it heal. Surgical removal may also be considered in a case where bone graft is required on other sites. You diagnose a subconjunctival hemorrhage. If you are a Mayo Clinic patient, this could If you're experiencing any of these issues and they persist for more than two weeks, see a doctor. Exostoses of the lingual side of the mandible and buccal side of the . Todays dental advances now allow for regrowth of the lost bone, also known as guided tissue bone regeneration. } What is exostosis. Buccal exostoses are benign, broad-based surface masses of the outer or facial aspect of the maxilla and less commonly, the mandible. [0002] The invention relates to a series of pyrimidine and pyridine compounds that are useful as therapeutics in the treatment of cancer in mammals. 1, 2 Though the . You diagnose these bumps as A. Bednar's aphthae B. Epstein's pearls C. Buccal tumors D. Exostosis. In throat cancer, it's often the first treatment to be given, in combination with chemotherapy medicine (chemoradiotherapy). However, in buccal cancers, the primary cancer in the mouth is usually noticed before it reaches these lymph nodes. Matt graciously offered to share his story. The mutations changes tell the cells to continue growing and dividing when healthy cells would die. The implants will be left in for 1 to 8 days, during which time the cancer cells will receive a much higher dose of radiation than the rest of your mouth. I2) ncision from the mid-line where the tooth was and up over the outer gun to create a flap of gum that is lifted up to get to the bone. For advanced mouth cancer, you'll need treatment with surgery, radiotherapy and medicine over a period of at least 4 months. An exostosis, also called a bony spur or osteoma, occurs when a bony growth extend beyond a bone's usual smooth surface. 1 If the cancer is more advanced, radiation, chemotherapy, or both may be used to shrink the tumor before or after surgery to reduce the risk of the cancer coming back. If the cancer is large or has spread to your neck, a combination of surgery, radiotherapy and chemotherapy may be needed. [2] Its main function is to support your mouth when youre eating and chewing. 5 How is an exostosis removed from a tooth? Treatment Typically, no treatment for buccal exostoses is indicated. Well, Im 46 years old male I had my first Boney Exotosis remove when I was 35, it was both lower outer gums, Suregy took about 35 min and post surgery was pretty easy, Just follow the instructions they give you, Ice on 20 min then off 20 min, we used frozen bags of peas. The most commonly occurring bone growths are found in the mouths roof (torus palatinus) and beneath the tongue (torus mandibularus). The cause is actually neoplastic (abnormal growth of cells) and not predetermined by personality type nor parafunctional habits, such as grinding. An exostosis is an extra growth of bone that extends outward from an existing bone. The 2023 edition of ICD-10-CM M27.8 became effective on October 1, 2022. Ask a Dentist - For Nervous Patients Only. 04 October 2019. Etiology is still not established, but it has been suggested that the bony overgrowth can . Betel nut, a fruit grown in Asia and Africa that contains a stimulant that people grind, wrap in a leaf and chew. Mouth cancer signs may include red sores that don't heal. Neville BW, Damm DD, Allen CM, Bouquot JE. A biopsy assesses the shape and structure of the cells compared to surrounding normal, healthy cells: Cancer staging uses categories to help your healthcare provider understand how severe the cancer is and how to treat it. The dentist offered removal but since the only time they bother me is when she presses her mirror on them while working on my teeth I opted to forgo the procedure and asked her to hold my lip aside in the most troublesome area with her fingers. If your tongue is affected, part of it will have to be removed, called a partial glossectomy. Get useful, helpful and relevant health + wellness information. It usually grows under the nail, especially the big toe. It can leave you feeling helpless. It may also affect your appearance. By targeting them, cetuximab prevents the cancer from spreading. Mouth cancer can occur on the: Lips Gums Tongue Inner lining of the cheeks Roof of the mouth Floor of the mouth (under the tongue) Cancer that occurs on the inside of the mouth is sometimes called oral cancer or oral cavity cancer. He said in his 30 year career, my exostosis was in the top 3 worst hes seen. I reported them to QIO of Tennessee. It tends to appear in early adolescence. What is exostosis. Has anyone else had this? Buccal mucosa cancer is a rare cancer that develops in the inner cheek in your mouth. I could probably get on fine without having it removed, but it happens to be positioned in an uncomfortable place, so Im thinking I might as well just get it taken out. It is believed to be tied to teeth-grinding. Lets hope I never need dentures! My dentist informs me that if we can do it that way it will bean buying less bottled bone and reduce my bill for the graft procedure. I do not, however, have a Type A personality, although I do sometimes grind my teeth. 1.Viral conjunctivitis. If we combine this information with your protected Chemotherapy is a powerful cocktail of chemicals that kills the cancer. buccal exostosis or cancer. Hello, I'm Dr. Katharine Price, an oncologist at Mayo Clinic. I never had the privilege to work with kids (Pedodontics) so I never saw them in the younger generation. This paper reports two cases showing multiple bony overgrowths in the mouth. Immunotherapy helps your immune system find and kill cancer cells. A form of exostosis on the midline of the palate is referred to as torus palatinus and on the lingual mandible as torus mandibularis. Learn more about mouth cancer, also called oral cancer, from oncologist Katharine Price, M.D. It looks very much so like bone, or as though there's a thin layer of skin over some bone. National Institute of Dental and Craniofacial Research. Again, its been years since I worked as a dental assistant, so Im a bit rusty on my dental terminology. PDT can also be used to temporarily control cancer where it's been decided thatfurther conventional treatment will not provide a cure or benefit. Reichart PA, Neuhaus F, Sookasem M. Prevalence of torus palatinus and torus mandibularis in Germans and Thai. The thought of having reconstructive facial surgery can be worrying. Weitere Informationen ber die Verwendung Ihrer personenbezogenen Daten finden Sie in unserer Datenschutzerklrung und unserer Cookie-Richtlinie. If you'reexposed to any light at all over this period, you'll develop serious burn to your skin. 2 Haglund's deformity (foot) 3 Paranasal sinus osteoma. Garcia-Garcia AS, Martinez-Gonazalez JM, Gomez-Font R. Current status of the torus palatinus and torus mandibularis. A buccal exostosis is the formation of an exostosis (bone mass) on the outer, cheek-facing side of the maxilla (upper jaw) just above the teeth or the cheek-facing side of the mandible (lower jaw). It may not display this or other websites correctly. Here is the procedure: 1) Linocane injections in the palate and outer gum. I have a lot of patients with these. Bone felt like it was coming out of gum and went back to dentist was very nervous with all that i read but grateful for (joni1977 dental assistant) He was right dentist filed it down with in 5 minutes and was smooth to touch with tongue and feel the difference! If mouth cancer is found early, surgery may be used, which has a high chance of curing the cancer so it does not come back. Metastases (cancer growths that have spread to other parts of the body). The torus palatal, mandibular tori and exostoses of the jaws are bony outgrowths and well defined. 3 (2020): July-September 2020. They are often the result of some trauma or injury to the gums and bones underneath. Buccal exostosis - This exostosis affects the jawbone. Conclusion: The optimal aesthetic outcome was achieved for the patient by eliminating the buccal bone exostoses. Be informed. Blaggana A, Blaggana V. Surgical management of an atypical case of multiple mandibular exostoses: a case report. Buccal exostoses are benign bony protuberances that may grow over time but rarely result in functional alterations. and i am definately a type A personality! Sometimes chemotherapy is combined with the radiation. information submitted for this request. Appointments & Locations. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Condition 2. Advanced Search Coronavirus articles and preprints Search examples: "breast cancer" Smith J"breast cancer" Smith J Especially if they were missing several teeth. clip-path: url(#SVGID_6_); Mouth cancer refers to cancer that develops in any of the parts that make up the mouth (oral cavity). You may also find it helpful to talk to other people who've had the same operation. These categories include: Stages range from 1 to 4. The buccal exostosis is found only on the facial surface of the alveolar bone, usually the maxillary alveolus. Pursuing basic and translational research across 9 programs and 100+ labs, Focusing on clinical cancer research and population health, Bridging the lab and the clinic through translational research, Fostering interdisciplinary collaborations between laboratory scientists and clinicians, Partnering with other academic and research institutions, Offering state-of-the-art resources for our researchers, Offering a curriculum with a focus on cancer, Connecting college seniors to future careers in biomedicine, Mouth Cancer Doctors, Surgeons & Other Experts. Cleveland Clinic is a non-profit academic medical center. Int J Dent Clinics 2010; 2:48-51. FIGURE 16-1 A, Torus mandibularis: bilaterally symmetric sessile bony masses on the lingual aspect of the mandible. @Darwin: yes, they are called tori (tor-eye). Visit your dentist regularly and let your dentist or provider know if you have symptoms that dont go away within two weeks. This is an online support group for anyone who is very afraid of dentistry or who suffers with dental phobia. Larry Bird Wife Photos, Advertising revenue supports our not-for-profit mission. What's the coolest thing you've ever found. No cancer really on either sides of my family. After receiving the medicine, light is directed on to the cancer using lasers. If the tumor is large, reconstruction may be required. For advanced mouth cancer, you'll need treatment with surgery, radiotherapy and medicine over a period of at least 4 months. Buccal exostoses are typically found on the buccal surface of the maxillary or mandibular alveolar ridge adjacent to premolar teeth. Most often they begin in the flat, thin cells that line your lips and the inside of your mouth. If you dont receive our email within 5 minutes, check your SPAM folder, then contact us Is it a big deal? Comparing both sides of my mouth, it isn't alarmingly different in size. Exostosis Types. A nodular protuberance on the hard palate. Seah YH. It's not a tumor, nor is it likely to affect your quality of life. It's possible to have a skin reaction when taking immunotherapy. A power grinder might have been a little less bothersome. Histologically, the two types are indistinguishable. But to make sure we are all on the same boat, I just want to say: It tends to appear in early adolescence. Buccal exostoses are hard bony protrusions on the outside of your gums and are less common. Small changes to the DNA of the squamous cells make the cells grow abnormally. However, I did have one removed accidentally I was having surgery for another problem when I developed asthma and had to be intubated. However, it most definitely is a bit larger on the left side. Cleveland Clinic Cancer Center provides world-class care to patients with cancer and is at the forefront of new and emerging clinical, translational and basic cancer research. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 91:48-53. Lip and oral cavity cancer treatment (PDQ). What are the different types of exostosis in the ear? Mouth cancers form when cells on the lips or in the mouth develop changes (mutations) in their DNA. Some on the lower, but not nearly as prominent. As well as killing cancerous cells, radiotherapy can also affect healthy tissue. Your doctors will make recommendationsabout your treatment with the help and advice of all your care team, but the final decision will be yours. Exostosis, also called osteoma, is a benign growth of new bone on top of existing bone. The bone and muscle used for this replacement is usually taken from the lower leg, hip or shoulder blade. Annals Dent Specialty 2014; 2:110-1. In this video, we'll cover the basics of oral cancer: What is it? These cancers usually occur in the thin, flat cells called squamous cells that line the buccal mucosa and other parts of the mouth. Now, we have got the complete detailed explanation . The prevalence of buccal exostoses in different studies varies from 0.09% to nearly 19%, probably depending on the diagnostic criteria used and the population studied. clip-path: url(#SVGID_2_); Loukas M, Hulsberg P, Tubbs RS. Anyone ever dealt with buccal exostosis? Buccal exostosis (jaw) This is a type of abnormal growth on the upper or lower jawbone. If they suspect something is abnormal, they may conduct a biopsy where they take a small sample of the area for testing. However, there is not always a clear answer to this question. It can occur in many parts of the body. Surgery is the main treatment for oral cancer. Exostosis: Types, Causes, and Treatment. This is the American ICD-10-CM version of M27.8 - other international versions of ICD-10 M27.8 may differ. This can highlight the bone structure in your face, especially your cheekbones and the hollowed-out areas between your cheeks and jawline. Inner cheek cancer is classified as squamous cell carcinoma. Ive never had it done, but I was once a dental assistant. It looks very much so like . For some people, radiation may be the only treatment needed. Most common types of intraoral osseous overgrowths are TP and TM. The largest bumps are over my canines. December 2, 2021 By 0 Comments share This post . Please note that this is NOT a dental problems forum! She says they look like teeth, but she is worried that they may be cancer. Gingival fibromatosis, fibroma formation secondary to irritation, granulomas, abscesses, and oral neurofibromatosis located on the palate . Buccal exostoses are broad-based, non-malignant surface growth occurring on the outer or facial surface of the maxilla and/or mandible, found usually in the premolar and molar region. A buccal exostosis is an exostosis (bone prominence) on the buccal surface (cheek side) of the alveolar ridge of the maxilla or mandible. But doctors have identified factors that may increase the risk of mouth cancer. Cancer on the outer cheeks is considered skin cancer. Sie knnen Ihre Einstellungen jederzeit ndern, indem Sie auf unseren Websites und Apps auf den Link Datenschutz-Dashboard klicken. Our highly-specialized educational programs shape leaders to be at the forefront of cancer care and research. All the way around way from the back left to the back right. If you use any kind of tobacco, cigarettes, cigars, pipes, chewing tobacco, and others, you're at a greater risk. He said he worked like a dog to grind it all down and the gum tissue was paper thin. They begin to develop in early adulthood and may very slowly enlarge over years. #1. are considered to be trauma-induced inflammatory periosteal reactions or true neoplasms. HPV is a sexually transmitted virus and some strains of it can cause cancers in the genital area and back of the throat. A study of 30 people with buccal mucosa cancer found 53% of them were alive five years after treatment. buccal exostosis or cancer. Last reviewed by a Cleveland Clinic medical professional on 06/28/2022. Bruce I, Ndanu TA, Addo ME. Page last reviewed: 14 October 2019 j dept med ser [Internet]. Extraction of ante. ahhhh! Scand J Dent Res 1986; 94: 233-40. . Buccal mucosa is another name for the inside lining of the cheeks. Radiotherapy uses doses ofradiation to kill cancerous cells. Tobacco and alcohol use are the main risk factors for this condition. With time they may spread inside the mouth and on to other areas of the head and neck or other parts of the body. (9) Buccal - It affects the jawbone. Accessed Nov. 28, 2018. certain conditions originating in the perinatal period (P04-P96)certain infectious and parasitic diseases ()complications of pregnancy, childbirth and the puerperium ()congenital malformations, deformations and chromosomal abnormalities ()endocrine, nutritional and metabolic diseases (E00-E88)injury, poisoning and certain other consequences of external causes () The oral mucosa is the mucous membrane lining the inside of the mouth.It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed lamina propria. Buccal Mucosa Cancer (Inner Cheek Cancer) Inner cheek cancer (also called buccal mucosa cancer) is a type of head and neck cancer that begins when the cells that make up the inner cheek grow out of control and form lesions or tumors. Occasionally, other bones, such as cheekbones, may have to be removed to get rid of the cancer completely. MSKs experts are among the most experienced in the nation at treating cancers that arise in the mouth. His vision is normal, with no decrease in extraocular movements. You must log in or register to reply here. He also has bilateral preauricular lymph nodes that are inflamed. According to an article published in the Journal of International Oral Health, some causes could include genetic factors, environmental factors, excessive chewing (masticatory hyperfunction), teeth grinding (bruxism), and continued jawbone growth. A type of immunotherapy medicine called a checkpoint inhibitor is used to treat mouth cancer that has spread or cannot be removed through surgery. During a buccal fat removal procedure, plastic surgeons make an incision on the inside of the cheek and remove the fat pad that's responsible for the creating a full, round face.. Kelishadi said though this procedure is currently requested a lot because of celebrity speculation, he does it sparingly because people naturally lose facial fat as they age. Click the card to flip Ive been really sore till today 12/14/09 and noticed that I still have half of the sharp edge coming through my gum. A very rare case of bilateral buccal-sided maxillary exostoses and its management with surgical exploration is presented. Al-Bayaty HF, Murti PR, Matthews R. An epidemiological study of tori among 667 dental outpatients in Trinidad & Tobago, West indies. The most commonly occurring bone growths are found in the mouth's roof ( torus palatinus) and beneath the tongue ( torus mandibularus ). They can also use a power grinder or a chisel. J Periodontol 2000; 71: 1032 -42. Exostosis of the mouth or jaw is called buccal exostosis. An exostosis can occur on any bone, but is often found in the feet, hip region, or ear canal. Going to the dentist monday, but as i said imsure i had it last time i went and nothing was said! It does not cause all the side effects of standard chemotherapy and is usually used in combination with radiotherapy. If you have it on both sides of your mouth (even if one side is slightly larger than the other) it is very unlikely that it is anything more than this. 06 September 2019. more money. The symptoms, diagnosis and treatment. At physical examination, multiple exostoses were observed on buccal aspect maxila and mandible (Figure 1A). for video What is mouth cancer? The condition usually disappears once the tobacco habit is stopped. Wisdom teeth removal fears, possibly no sedation. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. It is not a big deal, just make sure you follow all post-operative instructions, such as proper rinsing especially after meals, avoiding spicy foods and keeping the incision area clean while the gums heal. I sometimes wonder if the First Lady has this problem on the lower jaw. In the normal lower jaw, the bone is smooth and extends essentially straight down from the lower teeth. Branchburg, N.J.: Eli Lilly and Company; 2018. http://www.erbitux.com. Learn about and meet Memorial Sloan Ketterings renowned team of mouth cancer doctors, surgeons and other experts specializing in caring and treating patients with mouth cancer. it is also asymptomatic and can pose problem when fabricating dentures. Appointments 216.444.5725. For a better experience, please enable JavaScript in your browser before proceeding. Surgical removal is indicated only when their sizes have negatively impacted periodontium, esthetics, interfered with mastication, speech or prosthesis, induced ulcer and impaired healing. Bilateral removal of maxillary posterior exostosis as well as removal of upper left posterior dentition prior to fabrication of a denture. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Now it seems that the extostoses might benefit me. Exostoses or tori, are benign outgrowths of bone. The average age of those diagnosed with oral cancer is 63. Exostosis can be painless, or it can cause severe pain and require surgical removal. The diagnosis of a buccal exostosis is made based on the clinical and radiographic findings. 2020 Roland Garros Towel, Side effects of chemotherapy are common and include: These side effects usually stop once treatment has finished. Early symptoms are sores, raised patches and bleeding in your mouth. Could be osteomas. Your surgeon should explain the operation to youin detail and answer any questions you have. Stephen A. Signs of inner cheek cancer may include the following: Inner cheek cancer is highly curable when diagnosed early. Epidemiological aspects of oral tori in a Ghanaian community. Available from: https://he02.tci-thaijo.org/index.php/JDMS/article/view/248649, Torus mandibularis, Buccal exostosis, Denture, Vol. This is a small study and may not reflect your individual outlook. Surgical Procedures of Buccal Exostosis Resection on orangecountysurgeons.org During buccal exostosis resection, a benign bone protuberance is removed from the facial side of the lower or upper jaw. This is called metastatic cancer. Antoniades DZ, Belazi M, Papanayiotou P. Concurrence of torus palatinus with palatal and buccal exostoses: case report and review of the literature. Buccal exostosis or osteoma I also have really large mandibular tori inside my lower jaw. Early buccal mucosa cancer that only involves this top layer is called carcinoma in situ. Here is the procedure: Chemotherapy uses powerful cancer-killing medicines, which damage the DNA of the cancerous cells, interrupting their ability to reproduce. Oral cancer, also called mouth cancer, forms in the oral cavity, which includes all parts of your mouth that you can see if you open wide and look in the mirror. One-year follow up showed that there was minimal bone loss, dentures had good retention and functioning well. @joni1977: I am not middle aged, and I am certainly not missing any teeth! Make a donation. It's a soft, wet mucous membrane that's made up of several layers of tissue. How to Market Your Business with Webinars. Your surgeon will remove as much of the tumor as possible. If the oral cancer has spread to lymph nodes in the neck or is large and invading different areas of the mouth, more treatment is required after surgery. They are painless and self-limiting, but occasionally may become several centimet The buccal mucosa extends from the inside of your lips and cheeks to just behind your last teeth. As with any surgery, patients were very nervous, but the hardest part was getting past the anesthesia. 2021 Jan. 4 [cited 2023 Mar. Subcommittee of Development National Essential Medicines and National expert working group for Dental drug selection. Oral cancer is a chronic mouth condition that can result in various types of sores or ulcers on the oral cavity. It's not clear what causes the mutations in squamous cells that lead to mouth cancer. Mayo Clinic, Rochester, Minn. July 18, 2018. Its a type of head and neck cancer. Buccal exostoses occur as bilateral, smooth bony growth along the facial aspect of the maxillary and/or mandibular alveolus. In some cases, the first sign of buccal cancer could be a lump in the neck. Wenn Sie Ihre Auswahl anpassen mchten, klicken Sie auf Datenschutzeinstellungen verwalten. Torus (tori) is genetic and is usually located on the roof and the floor of the mouth. Learn about our approach to care. The bony growths may form on the outer check facing the jaw above the tooth line. Talk to your dentist or healthcare provider if you notice any sores, raised patches or bleeding in your mouth that last longer than two weeks. They begin to develop in early adulthood and may very slowly enlarge over years. To provide you with the most relevant and helpful information, and understand which Just based on your description, it sounds very much like a buccal exostosis. enable-background: new; Well when I was in the dental field, I found it to be more common in middle aged men and women. In any case, I am glad it isnt. Fell free to contact me direct if you have further question ggoldsm590@aol.com make sure to place oral surgery in the subject line.