Oral and maxillofacial surgery

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Oral and Maxillofacial Surgery is a recognized international training course in specialised Medicine, which requires a minimum length of formation of 5 years for a basic medical training and 4 years for a basic medical and dental training, in the European Union. In the U.S.A. and Canada, it is one of the dental specialties recognized by the American Dental Association and the Royal College of Dentists of Canada.

Contents

1 Specialty
2 Oral and Maxillofacial Surgery throughout the world
3 Oral surgery in Australia, New Zealand and the United Kingdom
4 Organizations

Specialty

The scope of this specialty is extensive and concerns the diagnosis and treatment of diseases affecting the mouth, teeth, face and neck:

Oral and dentoalveolar surgery (impacted and buried teeth, cysts …)
Praeprosthetic surgery (bone augmentation …)
Dental implants (to replace missing teeth or stabilise dentures; rehabilitation of patients having undergone surgery for tumours; to retain facial prostheses)
Orthognathic surgery (dentofacial deformities)
Temporomandibular joint disorder (TMJD)
Trauma (facial bone fractures and injuries)
Tumours (odontogenic and not odontogenic)
Reconstructive surgery
Cleft lip and palate
Congenital craniofacial deformities
Aesthetic facial surgery

Oral and Maxillofacial Surgeons (OMFS) frequently work alongside other specialists including dentists, orthodontists, restorative dentists, radiologists, pathologists, oncologists, ENT surgeons, neurosurgeons, plastic surgeons and professionals allied to medicine.

Oral and Maxillofacial Surgery throughout the world

The Oral and Maxillofacial Surgeon (OMFS) is a person with a medical (MD: 6 years) and a dental degree (DDS or DMD : 4 years) or equivalent qualifications, examples of which would be a specialist certificate in Stomatology . This training must be a University Course authenticated by a certificate.

This specialty is defined within Europe under the medical Directive 2001/19/EC (Official Journal of the European Communities L 206, 31.07.2001). It requires 5 years for a basic medical training (MD) or 4 years of further formal University training after a dual qualification in Medicine (MD) and Dentistry (DDS or DMD).

The Directive 2001/19/EC also distinguishes Oral and Maxillofacial Surgery from other evidence of formal qualifications in specialised dentistry, such as Oral Surgery , which requires a minimum length of 3 years, is limited to Oral Surgery and is reserved to the dental practitioners, who consequently are not allowed to practice Oral and Maxillofacial Surgery.

In Eastern European states that were Communist before the end of the Cold War (U.S.S.R., D.D.R., Romania, Czechoslovakia, Hungary, Poland), Oral and Maxillofacial Surgery was a specialty of Dentistry.

In the U.S.A., Oral and Maxillofacial Surgery is one of the 9 dental specialties recognized by the American Dental Association and requires 4-6 years of further formal University training after dental school (DDS or DMD). The 4-year residency programs grant a certificate of specialty training in Oral and Maxillofacial Surgery. The 6-year residency programs grant the specialty certificate in addition to a medical degree (MD). Specialists in this field are designated registrable U.S. “Board Eligible” and warrant exclusive titles.

Oral surgery in Australia, New Zealand and the United Kingdom

Oral and Maxillofacial Surgery occupies a unique position and in Australia, New Zealand and the UK is regarded as a true specialty of both medicine and dentistry combined.

Length of training and course curriculum is highly variable around the world. Traditionally training in Oral and Maxillofacial Surgery in the UK was of four years duration and was regarded as a discipline of dentistry alone. Trainees would emerge with a Fellowship in Dental Surgery from one of the Royal Colleges of Surgeons (England, Edinburgh, Glasgow, Ireland) and the entitlement to use the FDSRCS title. Training in Australia and New Zealand followed a similar pathway, with four years of clinical training but this time generally administrated through universities, earning a Master of Dental Science degree.

However in the 1980s and 1990s due to changing trends in the practice of oral and maxillofacial surgery around the world, legislative changes occurred, first in the UK and followed shortly by Australia and New Zealand, whereby in order to train in Oral and Maxillofacial Surgery, applicants needed to be dually qualified with undergraduate degrees in dentistry and medicine. This represented official recognition of the unique position Oral and Maxillofacial Surgery occupies at the interface of the "traditionally medical" and "traditionally dental" spheres of health care.

Here the UK and the Antipodes diverged somewhat. In Australia and New Zealand, training courses were adapted to provide "integrated" training in Medicine and Oral Surgery i.e. singly qualified dentists (who at that time were the overwhelming majority of trainees) would enter into a comprehensive program, the first 3 years of which were spent as a full time medical student in order to obtain the necessary prerequisite qualifications to proceed to the surgical training. Obtaining a medical degree in Australia any other way at that time took 6 years. The shortened time was a reflection of basic sciences knowledge already possessed by the trainees. Unfortunately for trainees, training time suddenly doubled to 8 years.

In the UK however, persons wishing to practice as an Oral and Maxillofacial Surgeon had to obtain a medical degree independently of any training program. Once qualified as a dentist and as a physican, the trainee could then apply for training as an Oral and Maxillofacial Surgeon. Some UK medical schools grant entry to higher years (usually year two or year three, depending on the course structure) to applicants with a dental degree. This shortens training time by a year or two.

Oral and Maxillofacial Surgeons trained in the UK (and also in Australia and New Zealand, if training requirements increase as predicted) probably spend more aggregate time in training than any other surgical specialty.

Aggregate training time:

5 years Dental degree
4-6 years Medical degree
1 year Internship
2 years minimum Basic Surgical Training (training in a wide range of surgical disciplines)
4-5 years Oral and Maxillofacial Surgery Training
1 year Fellowship (a common practice of spending a year training at overseas institutions)

Total time: 19 years training (average)

By comparison, US-trained surgeons generally spend more time as undergraduate "Pre-med" students and less time in residency training. One might therefore regard US doctors as having a more well-rounded education, but shorter clincal training.

The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing in Australia. Integrated programs are available to medical graduates allowing them to complete a dental degree in about 3-4 years in order for them to advance to surgical training.

Organizations

American Association of Oral and Maxillofacial Surgeons [link]
Directive 2001/19/EC (Official Journal of the European Communities L 206, 31.07.2001) [link]
European Association for Cranio-Maxillofacial Surgery [link]
Internacional Association of Oral and Maxillofacial Surgeons [link]
British Association of Oral and Maxillofacial Surgeons [link]
Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie [link]
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [link]
Oesterreichische Gesellschaft fuer Mund-, Kiefer- and Gesichtchirurgie [link]
Société Française de Stomatologie et Chirurgie Maxillo-Faciale [link]
Société Royale Belge de Stomatologie et de Chirurgie Maxillo-Faciale [link]
Société Souisse de Chirurgie Maxillo-Faciale [link]
Società Italiana di Chirurgia Maxillo-Facciale [link]

Dentistry

Recognized Specialties

Endodontics - Oral and Maxillofacial Pathology - Oral and Maxillofacial Radiology - Oral and Maxillofacial Surgery - Orthodontics and Dentofacial Orthopedics - Pediatric Dentistry - Periodontics - Prosthodontics - Dental public health

Unrecognized Specialties

Cosmetic Dentistry - Dental Implantology - Temporomandibular Joint Disorder - Geriatric dentistry

Other

Forensic Odontology

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