Wagner Oral Surgeon & Dental Implant Specialists


The quick answer is that women, on average, have smaller anatomy than men and their smaller anatomy does not handle the stresses on the joint system placed by other variations in anatomy and physiology as well as it does for men. (2019 American Association of Oral and Maxillofacial Surgeons 0278-2391/19/30453-7)  The most common main cause of TMD (temporomandibular dysfunction – a term used to group a wide variety of primarily muscular disorders of the jaw apparatus) is an imbalance in the way the jaws guide past each other in various movements such as side to side and front to back. This is primarily affected by abnormal tooth positons. The most typical of these is a jaw growth variation where the molar teeth are providing the guidance in the side to side jaw movements – what we call “balancing guidance.” The typical patient has a “reverse curve” to their bite. These problems can usually be addressed by orthodontic treatment alone, or in conjunction with jaw surgery (orthognathic surgery).

The truth is there are so many variables that come together from the joint anatomy, to the joint and capsule anatomy, to the jaw and facial anatomy, to the tissue receptors, to the chemistry of the joint structures, to psychological influences, to etc., etc. It is almost amazing that our jaw joints, in fact our bodies, function normally at all. Fortunately, our bodies have considerable ability to accommodate and compensate for abnormalities, injury, and disease processes.

When we consider internal joint diseases such as arthritis and autoimmune conditions we enter into another very wide realm of conditions and disorders that may have a significant effect on joint pain and joint problems. All of these things need to be fleshed out as we analyze joint conditions. On a very basic level my approach is to first make sure that the medical concerns are being dealt with and then deal with the physical problems addressing the obvious “big” problems first and keeping our eyes open to the other significant variables as we move forward.

If you have jaw joint problems discuss them with your dentist. Seek out consultations with a board certified orthodontist and oral surgeon. Get as much information as you can and watch out for “TMJ specialists.” Many of them do a good job, but there are way too many who are providing unnecessary therapies and treatment regimens without the likely chance of a solution.


Dr. Richard M. Wagner is a member of the Alpine Valley Ski Patrol and has been a ski patroller for over 25 years. “Rich” is an Oral and Maxillofacial Surgeon in Racine and Kenosha Wisconsin and has served in a number of capacities with ski patrol including OEC and toboggan instructor.

You will find him patrolling the hills at Alpine Valley Ski Resort in Delavan on a typical Saturday afternoon and evening along with a great team of patrollers. Last year, as a group, they received the Outstanding Patrol Award given to the patrol team who exemplifies excellence in ski patrolling.

His friends call him “Rich” and he sums up his Ski Patrolling experience this way; “Ski Patrol has been a very important part of my life. I of course love the sport and I have been able to share it with my wife and our 4 children. My son John has been a Ski Patroller for over 10 years and being able to patrol along with him is a great joy for me.”

As it relates to volunteerism, Dr. Wagner is involved in a number of other activities and pursuits. For over 18 years he has been involved in international missions work. He, along with his family members and staff, have been all over the world working with a medical/dental team providing care for underserved third world areas. They typically go on 2 of these trips per year. In 2007 he received the Distinguished Alumni Award from UW Parkside for his work with international missions.

Locally, he participates in the annual Mission of Mercy with the Wisconsin Dental Association. This is a huge team involving hundreds of volunteers. They set up in various cities around the state providing free of charge dental care to underserved people. People come mainly from underserved communities, but they also get individuals traveling from surrounding states and regions to use this service. Locally, we participate in Give Kids a Smile Day and also in support of our community care clinic.

On a personal level, Dr. Wagner’s Christian faith is very important to him. He is involved in his church and church related activities. He serves as a leader in men’s ministry and music ministry.



History of Wisdom Teeth

Most people need their wisdom teeth removed, so why do we have them in the first place? Here’s a quick history lesson of wisdom teeth and the important role they once played!

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.

Today, 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. Are you worried that your child may need wisdom teeth removal? Call our office at Racine Office Phone Number 262-634-4646 to find out more.

Oral Health: Get Your Oral Cancer Screening

Did you know that mouth cancer is the sixth most common cancer worldwide? The sad truth is that oral cancers are more than twice as common in men as in women, and the fastest growing group of oral cancer patients are young, healthy, nonsmoking individuals. Now is the time to be proactive and get yourself checked for oral cancer.

Remember—early detection saves lives! It is more important than ever for young adults, as well as older men and women, to get regular screenings whether they think they’re at risk or not.

What are the risks?
Knowing the risks can help you make educated decisions about your health. There are several risks that increase your chances of developing oral cancer:
• Smoking and using tobacco products are a known long-term historic cause of oral cancer.
• Heavy alcohol usage also makes you more susceptible to develop oral cancer.
• The HPV virus, a sexually-transmitted disease, is the leading cause of oropharyngeal (the back part of the mouth) cancer.

What are the signs and symptoms?
The mouth is one of the body’s most crucial early warning signs in the fight against oral cancer. In between regular dental visits, it’s important to be aware of the mouth’s signs and symptoms. Remember, if you see any of these signs or symptoms, schedule an appointment at the office if you don’t see improvement within two-three weeks:
• Hoarseness, chronic sore throat, or change in voice
• The development of white, red, or speckled (white and red) patches in the mouth
• Lumps, thickening tissues, rough spots, crusty or eroded areas
• Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
• A change in the way your teeth or dentures fit together when you close your mouth
• Dramatic weight loss
• Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
• Unexplained bleeding in the mouth

Don’t wait any longer. Be proactive about your oral health, and get checked today!


Nobel Biocare created the Diamond Partner Status to recognize an elite group of doctors – those who are the most skilled and experienced in the art of dental implants. Dr. Wagner has exhibited a commitment to furthering the science and knowledge of dental implants. He actively promotes the advantages of dental implant care. His years of dedication to excellence in dental implant care and his continued commitment to that care is appreciated. This award is a small token of that appreciation.

How to Take Care of Your Dental Implant

Cleaning and taking care of your implant is just as important as cleaning your natural teeth. Here are some things you should know about caring for your implant.

Your implant and your natural teeth are similar because they both rely on healthy tissue for support! Just like with real teeth, plaque buildup can be harmful. It’s important to remove that plaque because it can develop into an infection. If the infection isn’t properly treated, it can result in a loss of bone around the implant which could progress to the loss of the implant itself.

It’s important to get your teeth cleaned on a regular basis so your dental hygienist can get biofilm off your teeth and keep your teeth infection-free. As always, you should be brushing your teeth and flossing twice a day.

Dental implants are the closest thing you can get to real and natural teeth. They don’t require any special products or treatment, just a simple brush and floss will do the job! If they are properly cared for, they can last a lifetime, avoiding any further dental work down the road.

With a dental implant, you can still enjoy all your favorite foods. It will not loosen or fall out if you are chewing something hard.

Overall, dental implants are meant to make life better and easier! You don’t have to go out of your way to take care of them – a simple brush and floss will ensure that they improve your overall quality of life for many years to come.

If you think a dental implant may be right for you, call Wagner Oral Surgery & Dental Implant Specialists at 262-634-4646 to schedule a consultation!


Over the years, I have used a number of different procedures for genioplasty procedures. I have watched my colleagues use various implant materials, but (I feel) luckily I have shied away from them. I have also avoided the use of metal bone screws and plates for these procedures as these have shown to cause long term problems.

My standard procedures are for bone sculpturing for reduction genioplasties and a sliding osteotomy with absorbable bone screws/plates (LactoSorb) for augmentation/advancement procedures. I prefer the use of either native bone or allogeneic bone if a graft is needed. Bone taken from the hip or tibia provides a wonderful graft, but the procedure to harvest the graft is way worse than the genioplasty. The results of genioplasty especially in combination with orthognathic surgery gives typically subtle yet cosmetically satisfying results.


Reference: (J Oral Maxillofac Surg 73:1583-1591, 2015)



Surgically assisted palatal expansion, also called rapid palatal expansion, is a common orthognathic procedure that can be done on individuals of any age. (J Oral Maxillofac Surg 72:2278-2288, 2014). In the younger patient it involves just a loosening of the structures. In the teen and older patient I typically do a complete osteotomy as it is not a particularly invasive procedure, our patients do well with a quick recovery (usually outpatient), and with low risk.

There are 2 basic techniques or patterns that we follow and these depending upon the bite. The first of these is a midline osteotomy which means separating the upper jaw down the center of the palate to widen it. The other is called a paramedian separation which is usually right behind the lateral incisor teeth or eye teeth and then separation down the palate. All of this is done through the mouth and just through a small incision under the upper lip and gums. This is a procedure that is done in concert with the orthodontist who manages the dental movements during the healing process using the palatal appliance as shown. Basically, we are making small cuts in what are thin bones and then very slowly (orthopedically) moving the bone, teeth, and tissue during the bone healing process. This improves the jaw position and actually adds your own bone and tissue to the jaw in the process. This is a procedure we have done for over thirty years with good results.



There was an article in our journal in August 2019, from a Chinese source studying the use of orthodontic traction to help erupt wisdom teeth that have a high risk of nerve injury. (J Oral Maxillofac Surg 77:1575.e1-1575.e6, 2019)

There are certain cases where I feel this could be used and I would be happy to provide this care and coordinate this care. Having said that, there are three important points to consider; 1.) In our practice we take care of many patients with a high risk for nerve injury. We rarely have problems with this as we use advanced imaging to localize the risk ahead of time, and we are careful and gentile in our technique. 2.) The cost of treatment will be significant using the orthodontic technique as there will necessarily be at least two surgical procedures (one to locate and attach the appliance and one to ultimately remove the tooth as it is erupted) and there will be orthodontic fees. 3.) There are no guarantees that the procedure will work. As with any orthodontic eruption procedure – there are a number of variables that we do not control that can interfere with success.

If you are interested in pursuing this care for impacted wisdom teeth we would be happy to discuss it at your consult.


In our practice we have never seen a case of Gardner Syndrome – at least any that we have been aware of (J Oral Maxillofac Surg 77:1617-1627, 2019)  Gardner Syndrome is characterized by uncountable adenomas throughout the colon and rectum, with a high risk of developing colorectal cancer (CRC). If left untreated it has almost 100% penetrance. The syndrome also is characterized by extraintestinal manifestations, such as osteomas, odontomas, supernumerary teeth, impacted teeth, and a multitude of soft tissue tumors, including lipomas, fibromas, epidermoid cysts, and desmoids. A simple dominant mechanism of inheritance has been implicated. It is caused by a mutation in the adenomatous polyposis coli (APC) gene, located on chromosome 5q21. Mutations of the APC gene result in a protein product that loses the ability to degrade beta-catenin, which in turn promotes fibroblastic proliferation. What this means is that the body can produce various abnormally excessive tissues which include benign growths – such as we see in the mouth with multiple bony projections on the jaws (exostosis or “tori”) – typically small, round, raised, tissue covered “bumps.”

Exostoses appear normally in the general population. About 15% of all groups have these in varying amounts. Some people have a few small ones, some have many and/or large ones.

What I have observed over time is what I believe to be a partial penetrance of the gene expression. We have seen a number of patients who show the multiple osteomas/exostoses who also show a family history of colon cancer. The truth is that this may just be a coincidence as they may fall into the normal 15% of the overall population. But anecdotally, I have observed that those patients where we have seen the two things together – colorectal cancer and a history of multiple exostoses – the exostoses are more significant in size, number, and location.

For me, in my practice, I just observe and report when I see multiple exostoses. I will ask about family history for colorectal cancer and I will advise the patient about the possible relationship. This is informational, is presented in a non-alarming way, and could help to make an early diagnosis of a potentially serious condition.