Carolina Oral & Facial Surgery, P.A.

Carolina Oral & Facial Surgery Recognizes Oral Cancer Awareness Month

April is Oral Cancer Awareness Month

The Oral Cancer Foundation estimates that close to 42,000 Americans will be diagnosed with oral or pharyngeal cancer this year. Oral cancer’s mortality is particularly high, not because it is hard to detect or diagnose, but because the cancer is often discovered late in its development. Your family dentist or Dr. Williams, as an oral maxillofacial surgeon, is in the best position to detect oral cancer during your routine dental examinations.

Perform a Self-Exam Monthly

Everyone should perform an oral cancer self-exam each month. An oral examination is performed using a bright light and a mirror:

  • Remove any dentures
  • Look and feel inside the lips and the front of gums
  • Tilt head back to inspect and feel the roof of your mouth
  • Pull the cheek out to see its inside surface as well as the back of the gums
  • Pull out your tongue and look at all of its surfaces
  • Feel for lumps or enlarged lymph nodes (glands) in both sides of the neck including under the lower jaw

When performing a self-examination, look for the following:

  • White patches of the oral tissues — leukoplakia
  • Red patches — erythroplakia
  • Red and white patches — erythroleukoplakia
  • A sore that fails to heal and bleeds easily
  • An abnormal lump or thickening of the tissues of the mouth
  • Chronic sore throat or hoarseness
  • Difficulty in chewing or swallowing
  • A mass or lump in the neck

Your mouth is one of your body’s most important early warning systems. Don’t ignore any suspicious lumps or sores. Should you discover something, please contact our office at 864-458-9800 to make an appointment for a prompt examination. Early treatment may well be the key to complete recovery.

The information provided here is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is provided to help you communicate effectively when you seek the advice of your oral and maxillofacial surgeon. A special thank you to American Association of Oral & Maxillofacial Surgeons (AAOMS) for providing this information.

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Assault of the Carolinas in Brevard, North Carolina


This past Saturday, April 11, 2015, I had the wonderful opportunity to once again take part in the Pisgah Forest Rotary Club’s Assault on the Carolinas. The Assault on the Carolinas is a spectacular ride that benefits many local charities. The ride begins and ends in downtown Brevard, North Carolina. Carolina Oral & Facial Surgery’s Brevard office has been open since 2000. We love the town of Brevard and feel blessed to care for members of the community and surrounding areas. On Saturday, I was once again reminded of the true beauty of the area’s countryside and the graciousness of the volunteers and Rotary Club’s members. Thank you to the Pisgah Forest Rotary Club for a great event and giving back to your community in such a special way.

Dr. Bart D. Williams III

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Happy New Year from Carolina Oral & Facial Surgery


The new year is often when one reflects on the events of the past 12 months and looks forward into the next. Many good things happened at Carolina Oral & Facial Surgery  in 2014.  Our medical / dental mission outreach efforts took myself and several team members  to the Dominican Republic in January of 2014.  We continued those efforts with  volunteer work at the Greenville Free Clinic and partnering with local food banks for our BBQ and food bank drive in October of 2014.  Carolina Oral & Facial Surgery joined efforts with The Oral Cancer Foundation and honored April as oral cancer month by conducting free oral cancer screenings in our offices.  We welcomed the addition of Dr. Nathan Lenox in July.  This has allowed the practice to further increase our scope of services in providing additional evaluation and surgical options for head and neck cancer patients.   2015 has us running and thinking of opportunities to better serve our patients.  We are thankful for all the blessings that we have in this country. In addition,  I am very grateful and humbled by the team at Carolina Oral & Facial Surgery.  Our team members give selflessly and provide tremendous care to our patients.  Dr. Lenox and I are very lucky to work with such an outstanding group.  As we look ahead to what 2015 will bring, we welcome the opportunity to reach out to those in need both here and in other countries, as well as doing our best to serve our Upstate community.

Happy New Year,

Dr. Bart D. Williams III, M.D, D.M.D, FACS


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Dr. Williams becomes Fellow in the American College of Surgeons

FACSWe wanted to share a new honor for Dr. Williams.  In October of 2014, he became a fellow of the prestigious and selective American College of Surgeons. He was fortunate to have his wife, Suszanne, by his side during ceremony activities in San Francisco.   This event had special meaning for him as it was a return to his roots in the traditions of medicine and surgery.  Please learn more about the American College of Surgeons at  Congratulations Dr. Williams!



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Fall, Friends, and Food Bank Donations at Carolina Oral & Facial Surgery

On Wednesday, October 22,2014,  Carolina Oral & Facial Surgery held its 11th annual BBQ and Canned Food Drive.  It was a day filled with friends, food, and fun! We would like to thank each of the doctors and team members that were able to attend and more importantly their efforts to assist us in giving back to the community! This year we were happy to announce that approximately 2,700 cans were donated to Miracle Hill Ministries, Salvation Army, and Berea First Baptist. Each year we are so impressed with the outpour of our friends and their desire to embrace the needs of our community! We are already looking forward to 2015!


In South Carolina over 17% of the population lives in poverty, and over 23% of South Carolina children live below the poverty line. That means one in six South Carolina families will not have enough food to feed themselves each night. The food banks, within our community, continue to always remain in need of food items to place on their shelves and feed those in their time of need. The generosity of our guests was especially appreciated this year! We encourage our patients and their families to make food bank donations, especially in the coming months.


“They told me I have this lesion, now what?”

Demystifying Your Initial Pathology Consultation

As oral & maxillofacial surgeons, fellow dentists, and physicians commonly seek our expertise with “suspicious” findings in the mouth, on the face, or within deeper structures of the neck or facial bones (as may be evident on dental x-rays, CT scans, or other imaging tests). Medical and dental professionals may initially refer to these suspicious areas as “lesions,” “masses,” “growths,” “tumors,” “cysts,” or “ulcers” (just to name a few). Unfortunately, these terms are really only useful in a descriptive sense and offer very little information regarding treatment or prognosis. The purpose of this entry is to “clear the air” a bit and provide a logical, down-to-earth explanation of some of the confusing and often-redundant medical jargon you may encounter before your first consultation. Additionally, I will attempt to explain a little about what exactly a biopsy is and how it fits in with clarifying all this confusing terminology. Hopefully, if I can untangle some of these fundamentals, you’ll feel a little less intimidated by your first pathology consult and have a better underlying appreciation for the rationale we use in diagnosis and therapy.

 What is a “lesion?”

A lesion is simply something that’s not supposed to be there. It could be anything. It could be an area of tissue that’s a different color, it could be an area of tissue that is raised up, it could be an area of tissue that looks raw, it could be a spot on an x-ray that looks out of place. The possibilities are nearly endless. When your doctor says, “you have a lesion,” it simply means they have noted something that’s not supposed to be there and they don’t know exactly what it is… yet. A lesion is not always bad; a lesion may go away on its own with time. For example, some patients may develop white areas on the sides of the tongue related to the tissues rubbing against a tooth or dental restoration over time – termed “frictional keratosis.” With proper adjustment of the teeth or dental restoration and correction of any related underlying habits (tongue biting for example), the white area will usually go away within a couple of weeks. Thus, the original white lesion represented a case of frictional keratosis, a totally reversible process.

By removing the original insult (mechanical rubbing on the tongue) and observing that it went away, we have arrived at the diagnosis. From then on, we no longer have to refer to that white spot as a lesion because we know exactly what it really was. By the same token, that same white lesion on the side of the tongue could also represent early cancer or pre-cancer of the tongue. Even though the chances are much less likely, it’s still important not to neglect the possibility as we proceed. So, in conclusion, don’t lose sleep if you’re found to have a lesion. In most cases we see, the causes are relatively benign and amendable to simple therapy. The important thing to remember is that the term lesion does not necessarily imply malignancy although each new lesion needs to be treated with respect and attention to detail.

Bad lesions never go away…ever.

One of the most important aspects of our job as specialists is to determine when suspicious findings, or lesions, like the example above represent more serious problems. While we can gather a great deal of insight from the questions we ask you during our interview and from the findings we see during our exam, many times the only way to truly identify a lesion is to remove a sample of it, send it to a laboratory, and have it examined and analyzed under the microscope by a pathologist (a doctor specializing in the identification of disease processes from tissue samples). This is exactly what a biopsy is: removing a small sample of tissue with the intent of conclusively identifying exactly what the abnormality represents.

Sometimes, based on the information available during our first visit, we may get the impression that your lesion isn’t something worrisome. If that’s the case, we may elect to wait a bit and re-check the area before opting to perform the biopsy. However, if there’s any inclination the problem represents something more serious, we may elect to perform the biopsy early on, so as not to delay any further necessary treatment down the road. In general, any worrisome lesion (like an oral cancer, for example) will not go away with time. As such, if the problem persists after re-evaluating the area in a week, it may be time to really consider performing the biopsy.

What can I expect from a biopsy?

For most lesions of the tongue, cheek, gums, palate, or lip the amount of tissue removed during a biopsy is very small. Oftentimes, just a few stitches after the sample is removed will suffice. In special situations, a small amount of adjacent bone may be removed when dealing with lesions around teeth, within the jaws, or the sinus. Depending on your level of anxiety and your general medical health, sedation may be an option to allow you to “sleep through” the entire procedure. For many of our patients, however, a simple biopsy can be performed successfully under local anesthesia in the office. Of course, this is a generalization, and we will always work with you to determine a plan with your best interests in mind. Sometimes, when dealing with lesions located in deeper tissues, it may be necessary to perform the procedure in the operating room to ensure 1) your maximal comfort and 2) our ability to obtain an adequate sample for diagnosis.

Growths, cysts, tumors, masses, and ulcers: what’s the difference?

Again, these are all really just descriptive terms we use to describe a little bit more about what a particular lesion looks like. Technically speaking, they just represent some of the different forms lesions may take, but really don’t describe much about the behavior of the lesion (i.e. likelihood to recur after treatment, ability to spread to other areas, the possibility of damaging adjacent teeth or nerves, etc.). From a practical standpoint, “growth,” “tumor,” and “mass” are essentially synonymous terms used to indicate the abnormality’s solid through-and-through. These things tend to feel firm to the touch, and on advanced imaging, the solid nature may not always be clearly visible. In contrast, a “cyst” is essentially the same thing except the middle is filled with fluid (think “water balloon”). With “cysts,” it’s usually important to remove not only the fluid but also the lining (the wall of the balloon), which produces the fluid center. An “ulcer” simply means there is some area of surface tissue that’s become eroded. Ulcers can occur on the skin, gums, cheek, tongue, or palate – basically, anywhere there are tissues that line the surface of the body. Because they usually occur in the outside layers of tissue, they’re often readily visible to the naked eye.

Again, the important thing to remember with all these terms is that they’re only descriptive. They can represent a wide spectrum of disease processes, some bad and some “not so bad.” The most important part is to figure out exactly what we’re dealing with first. Yes, while it’s true there’s always a possibility that any of these findings could ultimately represent underlying cancer; fortunately, in the overwhelming number of cases, that possibility is remote. Please don’t feel intimidated by the medical jargon you may encounter along the way. I’m never surprised by the number of patients who arrive on their first visit, having already scoured Google for information about the prognosis of their newly discovered “cyst” or “growth.” In most cases, without any information about the particular cyst or growth, this will often lead you astray (not to mention the unnecessary anxiety). In the end, just remember these terms don’t mean a whole lot until a final diagnosis is provided from the biopsy. As definitive experts in all aspects of oral disease, we’re committed to talking you through the process of diagnosing and treating any newly discovered lesions. Hopefully, this clarifies some of the confusion we frequently encounter during new pathology consultations. Should you ever feel confused or overwhelmed, please don’t hesitate to ask. Ultimately, it’s our job, and your right.

Stay healthy,

Dr. Lenox

Nathan D. Lenox M.D., D.M.D.

Carolina Oral & Facial Surgery

*Specializing in general oral & maxillofacial surgery and oral oncologic and reconstructive surgery.


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Contact Carolina Oral & Facial Surgery with any questions or to schedule an appointment to reclaim your smile today!

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Do You Suffer From Sleep Problems? Dr. Williams and Dr. Lenox Provide Treatment Options

July 2014

Leading the News from the American Medical Association

NHLBI: Seventy million Americans suffer from sleep problems.

USA Today (7/6, Hellmich) reported that “an estimated 70 million Americans suffer from sleep problems, such as insomnia, sleep apnea, restless leg syndrome, shift-work sleep disorder or narcolepsy, as well as sleep disturbances associated with many diseases, mental illnesses and addictions, according to the National Center on Sleep Disorders Research, part of the National Heart, Lung and Blood Institute.” Insomnia may be caused by depression, medications, anxiety, alcohol or caffeine consumption, or medical problems. The article provided sleep hygiene tips for readers troubled by an occasional bout of sleeplessness.

        CDC: One in 25 adults say they’ve fallen asleep at the wheel.

AP (7/4, Stobbe) reported that according to the results of a survey released July 3 by the Centers for Disease Control and Prevention in its Morbidity and Mortality Weekly Report, “about one in 25 adults say they recently fell asleep while driving.”

CBS News (7/4) website reports that the CDC “survey of 92,000 people across 10 states and Puerto Rico” also revealed that “the biggest offenders were men aged 18 to 34.” What’s more, “according to the CDC, of the more than 33,000 fatal crashes reported annually in the US, as many as 7,500 involve drowsy drivers.”

HealthDay (7/4, Reinberg) quoted CDC epidemiologist Anne Wheaton, PhD, who explained that “most drowsy driving occurs early in the morning or late at night ‘when your body is telling you, you should be in bed.’” Wheaton advised people to “‘get enough sleep.’ In addition, don’t drink and drive, see a doctor if you have a sleep disorder, and always wear a seat belt, she said.”

How Can Dr. Williams and Dr. Lenox Assist You in Evaluating OSA?

What Is Obstructive Sleep Apnea (OSA)?

During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw. The cessation of breathing, or “apnea,” brought about by these factors initiates impulses from the brain to wake the person just enough to restart the breathing process. Sleep apnea is generally defined as the presence of more than 30 apneas during a seven-hour sleep. In severe cases, periods of not breathing may last for as long as 60 to 90 seconds and may recur up to 500 times a night.


Depending on whether your OSA is mild, moderate or severe, Dr. Williams and Dr. Lenox will select the treatment that’s best for you. This can range from behavior modification to oral appliances to an air pressure device. Surgery may be a good alternative for some patients, but it’s important to keep in mind that no surgical procedure is universally successful. Every patient has a different shaped nose and throat, so before surgery is considered the surgeons at Carolina Oral & Facial Surgery will measure the airway at several points and check for any abnormal flow of air from the nose to lungs.

Dr. Lenox has a special interest in the correction of sleep apnea disorders. He is among a small group of oral & maxillofacial surgeons across the country trained in trans-oral robotic surgery (TORS) using the DaVinci surgical robot for minimally invasive treatment of tongue-base cancer and obstructive sleep disorders.

The following surgical procedures are performed by the surgeons of Carolina Oral & Facial Surgery:

  • Uvulopalatopharyngoplasty (UPPP) This procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.
  • Hyoid Suspension The hyoid bone is located above the level of the thyroid cartilage (Adam’s apple). The procedure secures the hyoid bone to the thyroid cartilage to help stabilize this region of the airway.
  • Genioglossus Advancement (GGA) This procedure tightens the front tongue tendon, reducing the degree of tongue displacement into the throat. This operation is often performed in tandem with at least one other procedure such as UPPP or hyoid suspension.
  • Maxillomandibular Advancement (MMA) This procedure surgically moves the upper and lower jaws forward along with the soft tissues of the tongue and palate, opening the upper airway. For some patients, the MMA is the only technique that can create the necessary air passageway.
Additional  information found at AAOMS

Please call our office today, 864-458-9800 or 888-531-7393, to schedule a consultation with Dr. Lenox or Dr. Williams.





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Carolina Oral & Facial Surgery Welcomes Dr. Nathan Lenox

Dear Friends,

It still seems like only yesterday  when I completed my training and started my practice in Greenville.  However, time passes quickly and 15 years later I am excited to announce a new addition to our team.

Carolina Oral & Facial Surgery welcomes Nathan D. Lenox, MD, DMD to our practice on July 1, 2014.   Originally from the Pacific Northwest, Dr. Lenox completed his undergraduate studies at the University of Portland and earned his dental degree from Oregon Health Sciences University in Portland, Oregon. He then earned his medical degree from Louisiana State University Health Sciences Center in Shreveport, Louisiana. Following a general surgery internship, he completed his residency in oral & maxillofacial surgery at LSU Shreveport. Upon completing his residency, Dr. Lenox was selected for an additional two-year fellowship in head & neck cancer and microvascular free tissue reconstructive surgery at LSU Shreveport.

Dr. Lenox will maintain active clinical privileges at Greenville Memorial Hospital and Bon Secours St. Francis. He will offer a full scope oral surgery practice with special interest in pathology and reconstruction of post-traumatic, developmental, and tumor-related deformities of the oral-facial region. Dr. Lenox will see patients in our Easley, Greenville, and Brevard offices, as well.

Dr. Lenox shares the same compassionate patient centered care approach and mission that Carolina Oral & Facial Surgery is known for to patients, referring offices, and the community.  He will be a tremendous addition to our COFS family.   We are fortunate to have a surgeon join our practice with such a high caliber of training.

When Dr. Lenox is not treating patients, one might see him cycling through Greenville and the North Carolina mountains then unwinding with Lauren and their two beagles.

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COFS Recognizes Oral Cancer Awareness Month

Early Detection Saves Lives

In honor of Oral Cancer Awareness Month, Carolina Oral and Facial Surgery, P.A. will be offering free oral cancer screenings on April 22, 2014 in our Easley office and April 24, 2014 in our Greenville office. Oral cancer is not a rare disease. Approximately 43,250 people will be diagnosed with oral cancer every year in the US. It kills one person every hour of every day, and over 115 new individuals will be diagnosed with it each day. The good news is that it can often be found early in its development, through a simple, painless, and quick screening.

Who should get screened?

Every adult. Oral cancer can often be caught early, even as a pre-cancer. With early detection, survival rates are high and the side effects are from treatment are at their lowest. Like other screenings you engage in such as cervical, skin, prostate, colon and breast examinations, oral cancer screenings are an effective means of finding cancer at its early, highly curable stages. Make them part of your annual health check-ups.

What are the risk factors?

There are two distinct pathways by which most people come to oral cancer. One is through the use of tobacco and alcohol, a long term historic problem and cause, and the other is through exposure to the HPV16 virus (human papilloma virus version 16), which is now the leading cause of oral cancers in the US, and the same one, which is responsible for the vast majority of cervical cancers in women. The quickest growing segment of the oral cancer population are young, healthy, non-smokers due to the connection to this virus.

Early Indicators:

Red and/or white discolorations of the soft tissues of the mouth.

Any sore which does not heal within 14 days.

Hoarseness which lasts for a prolonged period of time.

Advanced Indicators:

A sensation that something is stuck in you throat.

Numbness in the oral region.

Difficulty in moving the jaw or tongue.

Difficulty in swallowing.

Ear pain which occurs on one side only.

A sore under a denture, which even after adjustment of the denture, still does not heal.

A lump or thickening which develops in the mouth or on the neck.

An oral cancer screening should be conducted every year, so take advantage of this free offer and get screened today. Call (864)458-9800 to make an appointment for your complimentary screening. If you can make either of these dates, please let our office know and we will schedule your visit before the end of April.

For more information about oral cancer, please log onto The Oral Cancer Foundation’s official website at

Dr. Bart D. Williams III


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April is National Facial Protection Month: 5 Points for Wearing a Mouth Guard During Sports

Dear Parents,

April is National Facial Protection month.  I have treated many sports injuries over the years that could have been avoided if a mouthguard had been worn.  I hope you will take to heart the 5 points for wearing a mouthguard below.  Enjoy your spring and summer sports! 

Dr. Williams

Wearing a Mouth Guard During Sports

It’s easy for people to not realize what they have until it’s gone. Imagine what it would be like if your child were missing a front tooth from facial trauma? They would probably be a bit embarrassed smiling and talking, and not to mention eating would feel pretty abnormal as well. The good news is that taking preventative measures to protect their smile can diminish the chances of having a toothless smile.

Wearing a mouth guard when playing sports decreases the risk of injuries to the mouth or jaw. Some sports players don’t like to wear mouth guards because of the inconvenience of their appearance while wearing one, but more injuries can happen when not wearing a mouth guard that can affect your appearance in a much more inconvenient way. I know this is a discussion I have with all three of my children.  Here are five reasons why you should always protect your pearly whites when participating in any contact sports or collision sports where unexpected contact can happen:

1. Protection Against Tooth Fractures

Mouth guards protect your teeth from chipping and breaking. Even though tooth fractures can usually be saved, why go through the risk when wearing a mouth guard can save you all the trouble.

2. Protection Against Tooth Replacement

Wearing a mouth guard is cushion for your teeth, so if a ball hits your face your teeth don’t receive a crushing force. However, if a ball hits your mouth without a mouth guard, it can result in completely breaking or ruining your tooth, leaving you with a toothless smile and an emergency call to my office. Having a gap in your smile due to an accident that could have been prevented isn’t worth it.

3. Protection Against Soft Tissue Injuries

Some contact sports involve quick impacts that could leave you biting through your tongue or lips! A mouth guard can prevent soft tissue injuries by creating a soft resistance from teeth contacting your lips and tongue.

4. Protection Against Concussions

According to the American Dental Association, mouth guards could help reduce the severity and incidence concussions. A properly fitted mouth guard decreases the likelihood of sustaining concussive injury because the padding between the mandible and the maxilla can lessen the force of the mandible pushing up on the skull near the brain, which causes a concussion.

5. Protection Against Jaw Fractures

Wearing a protective mouth guard protects you from jaw fractures. Impact to the neck or jaw could result in serious injury, but with the protection of a mouth guard during an impact, it reduces the likelihood of jaw dislodgement or neck trauma.

The Academy of General Dentistry estimates that mouth guards prevent more than 200,000 injuries each year! Using a mouth guard won’t only help prevent you from dental and jaw injuries but can also prevent damage to braces or other orthodontic work. If you’re ready to take the step to save your smile when playing sports, contact my office, Carolina Oral & Facial Surgery, at 864-458-9800 for more information about mouth guard protection.

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