Oral and maxillofacial surgery

Regulations

In several countries oral and maxillofacial surgery is a speciality recognized by a professional association, as is the case with the Dental Council of India, American Dental Association, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Dentists of Canada, Royal Australasian College of Dental Surgeons and the Brazilian Federal Council of Odontology (CFO).

In other countries oral and maxillofacial surgery as a specialty exists but under different forms as the work is sometimes performed by a single or dual qualified specialist depending on each country's regulations and training opportunities available.

Summary

An oral and maxillofacial surgeon is a regional specialist surgeon treating the entire craniomaxillofacial complex: anatomical area of the mouth, jaws, face, skull, as well as associated structures.

Depending upon the jurisdiction, maxillofacial surgeons may require training in dentistry, surgery, and general medicine; training and qualification in medicine may be undertaken optionally even if not required.

Oral and maxillofacial surgery is widely recognized as one of the specialties of dentistry. In many countries however, maxillofacial surgery is a medical specialty requiring both medical and dental degrees, culminating in an appropriate qualification (e.g. Fellow of the Royal College of Surgeons, FRCS, in the UK). All oral and maxillofacial surgeons however must obtain a university degree in dentistry before beginning residency training in oral and maxillofacial surgery. In the United States Oral and Maxillofacial Residency programs are either 4 years or 6 years in duration. Programs that grant the MD degree are 6 years in duration.

They also may choose to undergo further training in a 1 or 2 year subspecialty Oral and Maxillofacial Surgery Fellowship Training in the following areas:

The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing in a few EU countries. However, the public funds spent for 14 years of training are of a major concern for governments. Integrated programs are becoming more available to medical graduates allowing them to complete the dental degree requirement in about 3 years in order for them to advance to subsequently complete Oral and Maxillofacial surgical training.

Surgical procedures

Treatments may be performed on the craniomaxillofacial complex: mouth, jaws, face, neck, skull, and include:

Anesthesia Training

In the United States, Oral and Maxillofacial Surgeons are required to undergo five months of intensive general anesthesia training. An additional month of pediatric anesthesia training is also required.

The American Society of Anesthesiologists published a Statement on the Anesthesia Care Team which specifies qualified anesthesia personnel and practitioners as anesthesiologists,anesthesiology fellows, anesthesiology residents, oral surgery residents, anesthesiologist assistants, and nurse anesthetists.

Laser applications in OMS

Lasers were first introduced to OMS in the mid 1980s starting with the CO₂ laser. The CO₂ (carbon dioxide) laser remains the gold standard for the soft tissue surgery because of the ease of simultaneous photo-thermal ablation and coagulation (and small blood capillary hemostasis). The CO₂ laser is used in oral and dental surgery for virtually all soft-tissue procedures, such as gingivecomies, vestibuloplasties, frenectomies and operculectomies. The CO₂ laser's 10,600 nm wavelength is also safe around implants as it is reflected by titanium, and thus has been gaining popularity in the field of periodontology. It may be effective in treating peri-implantitis.

In the UK and most of Europe

Oral & Maxillofacial (OMF) Surgeons specialise in the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck.

OMF surgery is unique in requiring a dual qualification in medicine and dentistry, and is often seen as the bridge between medicine and dentistry, treating conditions that require expertise from both backgrounds such as head and neck cancers, salivary gland diseases, facial disproportion, facial pain, temporomandibular joint disorders, impacted teeth, cysts and tumours of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections.

Many OMF surgeons focus on one of these areas to develop a sub-specialist interest within the scope of the wider specialty.

In Australia, New Zealand, North America

Oral and maxillofacial surgery is one of the nine dental specialties recognized by the American Dental Association, Royal College of Dentists of Canada, the Royal Australasian College of Dental Surgeons. Oral and maxillofacial surgery requires 4–6 years of further formal university training after dental school (DDS, BDent, DMD or BDS). In the United States, four-year residency programs grant a certificate of specialty training in oral and maxillofacial surgery. Six-year residency programs grant the specialty certificate in addition to a degree such as a medical degree (MD, DO, MBBS, MBChB etc.), or research degree (MS, MSc, MPhil, MDS, MSD, MDSc, DClinDent, DSc, DMSc, or PhD). Both 4 and 6 year graduates are designated US "Board Eligible," those that earn "Certification" are Diplomats'. Approximately 50% of the training programs in the US and 66% of Canadian training programs, are "dual-degree".

The typical training program for an oral and maxillofacial surgeon is:

In addition, graduates of oral and maxillofacial surgery training programs can pursue fellowships, typically 1 – 2 years in length, in the following areas:

In Hong Kong

In Hong Kong a master's programme and an advanced diploma programme is offered by the Faculty of Dentistry of The University of Hong Kong. Oral and maxillofacial surgery department are available at public hospitals managed by the Hospital Authority.