Oral and maxillofacial surgery

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Oral and Maxillofacial Surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is a recognized international dental specialty, 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 9 dental specialties recognized by the American Dental Association and the Royal College of Dentists of Canada.

Contents 1 Area of Specialty 2 United States and Canada 3 Europe, UK and Australia/New Zealand 3.1 France, Italy, Austria 3.2 Spain 3.3 Belgium, Germany, Ireland, Luxembourg, Finland, United Kingdom 3.3.1 Changes in length of training and course curriculum 3.4 India 4 Organizations 5 See also

[edit] Area of Specialty

Oral and maxillofacial surgeons are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. They are also trained to administer anesthesia, and provide care in an office setting.[1] The scope of this specialty is extensive and concerns the diagnosis and treatment of diseases affecting the oral (mouth) and maxillofacial (face and neck) regions, including the following:

1. Oral and Dentoalveolar Surgery (removal of impacted and buried teeth, cysts, etc.)
2. Preprosthetic Surgery (bone augmentation)
3. Dental implant surgery and associated bone grafting (to replace missing teeth or stabilise dentures; rehabilitation of patients having undergone surgery for tumours; to retain facial prostheses)
4. Orthognathic surgery (dentofacial deformities)
5. Facial trauma surgery (facial bone fractures and injuries)
6. Surgery of Odontogenic and non-odontogenic Tumors
7. Reconstructive surgery
8. Cleft lip and palate surgery
9. Congenital craniofacial deformities
10. Facial plastic surgery (rhinoplasty, rhytidectomy, blepharoplasty, facial implants, etc.)
11. Temporomandibular joint disorder (TMJD)
12. Head and Neck Oncology

Oral and Maxillofacial Surgeons (OMFS) frequently work alongside other specialists including dentists, orthodontists, prosthodontists, radiologists, pathologists, oncologists, ENT surgeons, neurosurgeons, plastic surgeons and professionals allied to medicine (British Association of Oral and Maxillofacial Surgeons [2]).

Oral and Maxillofacial Surgery is often found at the bridge of dentistry and medicine, and, as such, is recognized as a medical specialty in most countries, a dental specialty in others. Most countries require dual-certification in both dentistry (DDS, DMD, or BDS) and medicine (MD, MBBS, MBBCh, or equivalent) to practice Oral and Maxillofacial Surgery.

[edit] United States and Canada

In the U.S.A. and Canada, Oral and Maxillofacial Surgery is one of the 9 dental specialties recognized by the American Dental Association and Canadian Dental Association. Oral and Maxillofacial Surgery requires 4-6 years of further formal University training after dental school (DDS or DMD). 4-year residency programs grant a certificate of specialty training in Oral and Maxillofacial Surgery. 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. Approximately 50% of the training programs in the U.S., but only 1/5 of Canadian training programs, are dual-degree leading to dual certification in Oral and Maxillofacial Surgery and medicine (MD).

The typical training program for a North American Oral and Maxillofacial Surgeon is:

• 4 Years Undergraduate Study (BA, BS, or equivalent)
• 4 Years Dental Study (DMD or DDS)
• 4 - 6 Years Residency Training (6 Year training includes MD Degree)
• Total Length after Secondary School: 12 - 14 Years

In addition, graduates of Oral and Maxillofacial Surgery training programs can pursue advanced fellowships, typically 1 - 2 years in length, training in the following areas:

• Craniofacial/Pediatric Maxillofacial Surgery (cleft lip and palate repair, surgery for craniosynostoses, etc.)
• Head and Neck Surgical Oncology (ablative survery for cancer and microvascular reconstructive surgery)
• Facial Cosmetic Surgery (facelift, rhinoplasty, etc.)
• Maxillofacial Trauma Surgery (soft tissue and skeletal injuries to the face and neck)

[edit] Europe, UK and Australia/New Zealand

The Oral and Maxillofacial Surgeon (OMFS) is a person with a medical (MD: 6 years) and a dental degree (DDS or DMD : 5 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, including the United Kingdom, 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 training program for an E.C. Oral and Maxillofacial Surgeon is:

[edit] France, Italy, Austria

• 6 Years Graduate Medical Study (including MD Degree)
• Certificate accompanying qualification: certificate of experience in Medicine
• 5 Years of formal qualification in specialised medicine for Maxillofacial Surgery
• 2 Years of Maxillofacial surgery fellowship
• Total Length: 13 Years^{[citation needed]}

[edit] Spain

• 6 Years Graduate Medical Study (including MD Degree)
• MIR exam to enter the fellowship in Oral & Maxillofacial Surgery in a public hospital.
• 5 Years of formal qualification in specialised medicine for Maxillofacial Surgery
• Total Length: 11 Years^{[citation needed]}

[edit] Belgium, Germany, Ireland, Luxembourg, Finland, United Kingdom

• 6 Years Graduate Medical Study (including MD Degree)
• Certificate accompanying qualification: certificate of experience in Medicine
• 3 (to 5) Years Graduate Dental Study (DMD, DDS, B. Dent. Sc. or BDS)
• Certificate accompanying qualification: certificate of experience in Dentistry
• 4 Years of formal qualification in specialised medicine for Maxillofacial Surgery
• Total Length: 13 (to 15) Years^{[citation needed]}

Belgium, Germany, Ireland, Luxembourg, Finland and the United Kingdom grant entry to higher years (usually year two or year three, depending on the course structure) to applicants with a medical or a dental degree. This shortens training time by a year or two.

Spain and Italy do not grant any shortening of training time for both degrees and specialty.Oral surgery is not recognised as a dental specialty in Spain.

The European 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.

Switzerland grants shortening of training time for Medicine and Dentistry. A formal qualification in Medicine (MD: 6 years) grants entry to the 3rd year of Dentistry (DDS or DMD: 3 years), while Dentistry (DDS or DMD: 5 years) to the 3rd year of Medicine (MD: 4 years). In Switzerland Oral and Maxillofacial Surgery requires 3 years of formal qualification in specialised Medicine.

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.

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

[edit] Changes in length of training and course curriculum

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 physician, 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)^{[citation needed]}

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 clinical 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.

[edit] India

Oral & Maxillofacial Surgery (OMFS) in India is a post-graduate degree in Dentistry. The prospective surgeon has to take an examination to enter an undergraduate program in dentistry. This course is usually four years long. Upon completion of the program, the student has to do a one-year internship in a dental college to get the BDS (Bachelor in Dental Surgery). In order to specialize in OMFS, the student has to take another examination to enter a 3-year MDS (Masters in Dental Surgery) program. During this period the student does a residency in general medicine, anaesthesia, general surgery, and neurosurgery. A dissertation has to submitted as part of the master's degree, and is followed by a theory exam and practical surgery exam. The degree is conferred after he is found eligible by the examiners.

There are about 3500 Oral and maxillofacial surgeons in India.^{[citation needed]}

[edit] Organizations

• Association of Oral and Maxillofacial Surgeons of India [3]
• American Association of Oral and Maxillofacial Surgeons [4]
• American Board of Oral and Maxillofacial Surgery [5]
• American College of Surgeons [6]
• The Royal College of Surgeons of England
• Faculty of Dental Surgery of The Royal College of Surgeons of England
• Directive 2001/19/EC (Official Journal of the European Communities L 206, 31.07.2001) [7]
• European Association for Cranio-Maxillofacial Surgery [8]
• Internacional Association of Oral and Maxillofacial Surgeons [9]
• British Association of Oral and Maxillofacial Surgeons [10]
• Clinica de Cirujia Maxilofacial - Clinimax [11]
• Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie [12]
• Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [13]
• Oesterreichische Gesellschaft fuer Mund-, Kiefer- and Gesichtchirurgie [14]
• Sociedad Española de Cirugía Oral y Maxilofacial

[15]

• Société Française de Stomatologie et Chirurgie Maxillo-Faciale [16]
• Société Royale Belge de Stomatologie et de Chirurgie Maxillo-Faciale [17]
• Société Souisse de Chirurgie Maxillo-Faciale [18]
• Società Italiana di Chirurgia Maxillo-Facciale [19]
• Australian and New Zealand Association of Oral and Maxillofacial Surgeons [20]

[edit] See also

• Distraction osteogenesis
• Oral and maxillofacial surgeon

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