Doctor Doctor Pull Me A Tooth

October 2, 2012 2:09 PM

Do Oral/Maxillofacial Surgeons require medical degrees (Relevant undergraduate + med school + residency) like, for lack of a better term, "real" surgeons?

Wiki lists oral/maxillofacial surgery as a subspecialty of dentistry. If I recall correctly, my wisdom tooth surgery involved the oral surgeon performing the general anaesthetic as well. Is this something that is qualified by being an oral surgeon or were they more likely an MD/anaesthesiologist as well? I'm wondering about regulations in Canada specifically but details on the situation in the US would be interesting as well.

posted by tehloki to grab bag (6 answers total)

Yes.
posted by tylerkaraszewski at 2:13 PM on October 2, 2012 [1 favorite]

If I recall correctly, my wisdom tooth surgery involved the oral surgeon performing the general anaesthetic as well. Is this something that is qualified by being an oral surgeon

I know one oral surgeon in DC who has both a DDS and an MD, but your typical oral surgeon just has a degree from dental school and did a fellowship subspecializing and is qualified to take out your wisdom teeth while giving you general anaesthetic.

Physicians will generally go ballistic at the idea of putting someone under general anaesthetic without the presence of an anaesthesiologist, but oral surgeon dentists have been doing it for decades.
posted by deanc at 2:17 PM on October 2, 2012 [1 favorite]

I used to work in an oral surgery office (in the US). There were two surgeons; one had a DDS (from military service, FWIW) and the other was a DMD. Both gave "twilight" anesthesia. I think the head nurse was a NP as well.
posted by supercres at 2:38 PM on October 2, 2012

Though I should add: twilight anesthesia was used for almost all extractions. It's not full general anesthesia in the most common sense: the patient isn't on a ventilator, like they would be for most surgeries, and can follow simple instructions; they just don't remember the experience, and don't feel the pain. The "full" general level of anesthesia does require an anesthesiologist (and breathing tube, and much more monitoring).

The surgeons in the clinic I worked in would go across the street to the local hospital to perform surgeries under general anesthesia in cases where twilight wouldn't do the trick: older patients, mentally disabled patients, some children, and other difficult patients. (It's possible to "fight" the twilight anesthesia, making surgery impossible. Usually an anxiety reaction.) Maxillofacial surgery (broken jaws, etc) would also be under general, and we wouldn't do them in the clinic. Like I said, there would be dedicated anesthesiologists doing those.
posted by supercres at 2:45 PM on October 2, 2012

In Canada Oral/Maxillofacial Surgeons are dentists, for example here are the entry requirements for the Oral/Maxillofacial Surgeons at the Schulich School of Medicine here in London:

Graduate of a CDAC Accredited Dental School (in Canada or the U.S.)
Canadian citizen or landed immigrant
Eligible for licensure in dentistry in the province of Ontario
NDEB certification www.ndeb.ca/

On the physician side of things, plastic surgery is the closest comparable specialty. For example at McMaster PGY-4 residents complete an oral and maxillofacial surgery rotation.
posted by Harpocrates at 3:26 PM on October 2, 2012

Yes, as far as I know, the OMFS residents at a large university medical center in the US take a year or so (can't remember exactly) out of their residency (clinical) training to take the pathophysiology/pathology block of courses at the university's medical school. These courses allow them to take, and pass, Step 1 of the USMLE licensing exam before continuing on with the rest of their residency. I am not sure by what mechanism they obtain their MD medical degree through the university, but after you pass the USMLE steps and do a residency, you are eligible for licensure as a physician.

Also, OMFS residents do rotations in general surgery at the hospital. As far as I know, OMFS is not your run-of-the-mill, community dentist.
posted by scalespace at 7:48 PM on October 2, 2012