Of all the oral health providers, oral and maxillofacial surgery (OMFS) is the dental specialty most closely linked to our medical colleagues. However, compared to other head and neck surgeons, oral and maxillofacial surgeons are trained in general dentistry prior to entering the specialty. This training positions them with specific dental knowledge not found in other general surgery or surgical specialties. Experience with the intricacies of the masticatory system, including the anatomy of the dentition and all of the complexities of occlusion and the envelope of motion, allow a more complete approach to treatment planning, and the restoration or replacement of these structures. This in-depth knowledge of the teeth and jaws, as well as the muscles of mastication, the temporomandibular joint, and craniofacial development, makes the oral and maxillofacial surgeon exclusively qualified to treat these conditions among all other health care providers and surgeons. Following trauma—the loss of hard and soft tissues from destructive disease or malformations from craniofacial developmental disorders—oral and maxillofacial surgeons are uniquely qualified to assemble a team of specialists across disciplines to definitively treat and facilitate the restoration and repair of oral and craniofacial structures and to reestablish masticatory, respiratory, and visual function in the case of trauma reconstruction. Enabling patients to return to a healthy state of function, comfort, and esthetics also enhances their quality of life. Teeth or their replacements are an integral predictable part of this reconstruction. Without the leadership and expertise of the oral and maxillofacial surgeon in collaboration with restorative and maxillofacial prosthodontists and other dental specialists, few trauma or cancer patients would be able to achieve optimum esthetics and function.
Scope of Training
The specialty goes far beyond that of general dentistry and most other dental specialties in the scope of training. In addition to having a more lengthy residency than any other specialty, the minimum of 4 years in a residency includes higher levels of “the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and aesthetic aspects of the hard and soft tissues of the oral and maxillofacial region” (quote from the OMFS website). Part of the intensive hospital-based training includes competency in admission history and physicals, general anesthesia, facial plastic surgery, emergency room training in general trauma, orthognathic surgery, and cancer therapy, including knowledge of postsurgical chemotherapy and radiation therapy. The residency is closely tied to many of the medical and surgical residencies, including training in anesthesia, general surgery, ear-nose-throat (ENT), medicine, hematology, emergency medicine, and many more. The hospital-based residencies provide valuable training ground for the future practice of oral and maxillofacial surgery, but the hospital and the medical system also benefit greatly from the presence of such surgeons, faculty, and residents who bring unique expertise to the health care team by their in-depth knowledge of the oral and maxillofacial structures and function that no other specialists provide, including plastic surgeons or otolaryngologists. Team approaches to complex cases are often needed, and, when OMFS is included, they provide expertise that will enhance the overall treatment planning and reconstruction of a difficult trauma, developmental defect, or cancer case.
In the past two decades, the field of OMFS has gone through extensive change. One important factor is the development of the dual certification (MD/OMS) that has enhanced the presence of the specialty in the hospital setting and further strengthened the field among the medical specialties. Although not essential, this training path has facilitated research in many areas, including growth and development, dental implants, regenerative medicine, and advancements in maxillofacial reconstruction. The dual certification programs further advanced fellowship training in head and neck oncology, reconstruction, craniofacial syndromes, and facial plastic surgery, among others. This recent expansion of scope is rapidly changing the future of this specialty, which will undoubtedly further strengthen the stance of oral and maxillofacial surgeons in the dental and medical arena.
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