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Should Oral Surgery Have A Place in the Undergraduate Curriculum in Dentistry?*
M ead— O ral Surgery in the Undergraduate Curriculum course, as that requires at least eleven and a half or twelve years, and he then emerges as an ultra-specialist, w orking in rather a limited field. W ould it not be possible to select well-trained dental graduates and encourage them to take one or two years in general hospital train ing, w ith some special training such as pathology or otolaryngology, and then encourage them to confine their w ork to exodontia and minor oral surgery? Again, recent graduates in medicine might take one or more years in dentistry, and complete their course w ith some spe cial training. As to the desire for uniform ity in the teaching of oral surgery for the under graduate and graduate, may I say, sub ject to correction, th at I do not know of any institution where oral surgery, as such, is being taught, and I believe that there is a good reason for this situation. If one thinks of the extraction of teeth
283
and other minor procedures as oral sur gery, we know of a number of colleges where such a course is given. I would venture to say that 99 per cent of our students will come to us w ith dental training only, and I believe that we should concentrate on teaching minor oral procedures and we should teach from the standpoint of surgical tech nic, both by lectures and by demon strations. T h e small percentage of men having both medical and dental degrees who w ill present themselves could best be trained by the general surgeon and the special surgeon, and their training be supplemented by the oral surgeon. T h e faculty should entrust the teaching of m ajor and minor oral surgery to one chief, and exodontia, while not taught by him necessarily, should come under his department. T his I believe to be the logical conclusion, if the extraction of teeth is considered surgery.
SHOULD ORAL SURGERY HAVE A PLACE IN T H E U N D ERG RA D U A TE C U R R IC U LU M IN DENTISTRY?* By STERLING V. MEAD, D.D.S., Washington, D. C. R A L surgery may be defined as “surgery of the mouth, mandible, maxillae, and adjacent structures.” I t should be divided into two separate fields: minor oral surgery and m ajor oral surgery. I t is manifestly impos sible to draw an absolute line of separ ation between these tw o fields, as many cases may involve both fields. F o r in stance, a simple fracture may be a prob
O
*R ead before the G roup C onference on O ral Surgery a t the Sixth A nnual M eeting of the A m erican A ssociation of D ental Schools, Chicago, 111., M a rch 26, 1929. Jo u r. A . D . A ., F e b ru a ry , 1030
lem of minor oral surgery; whereas, a fracture involving a bone graft w ill be come a m ajor surgical operation. T he removal of a tooth may be a minor oper ation, but m ajor surgical procedures may become necessary owing to infection, etc. M inor oral surgery should have a defi nite and im portant place in the under graduate curriculum in the dental school.
UNDERGRADUATE (M IN O R ) ORAL SURGERY W h at should be the objective? W h a t should be included in the course? W h at
284
T he Journal of the American D ental Association
should be the character and method of teaching ? W ith a proper knowledge of the prin ciples and procedures in minor oral sur gery, one can better understand pathology and diagnosis and more fully appreciate the requirements of successful operations. T h e course should include exodontia, minor oral surgery, local anesthesia and general anesthesia. Teaching should be both theoretical and practical, w ith ample clinical m ate rial available. T h e use of lantern slide lectures, moving pictures and actual demonstrations should be encouraged. Students should be required to have actual clinical experience before gradua tion. T h e student should be taught hos pital routine, sterilization and procedure. H e should receive practical demonstra tion along this line. In our present curriculum, the time is so limited that it is difficult to teach the undergraduates all the essentials of minor oral surgery. T hey are not quali fied to undertake the study of m ajor oral surgery and do not derive marked bene fit from it, and any time spent on it could more profitably be spent on minor oral surgery. A t Georgetown University, we have adopted the plan of teaching oral diag nosis and diseases of the mouth to the junior students, taking away from oral surgery such subjects as diagnosis, infec tions and stomatitis. W hen the undergraduate enters the senior year, having had training in the subjects of anatomy, histology, pathol ogy, physiology, diagnosis, etc., he is in a receptive condition to consider surgical procedure. H e is taught minor oral sur gery from both a theoretical and a prac tical standpoint. D uring the year, he is permitted to witness a few well chosen m ajor oral surgical operations for gen
eral hospital and professional training. I do not believe th at he should be re quired to be examined in m ajor oral sur gical procedures.
GRADUATE TEACHING In the graduate teaching of oral sur gery w hat should be the requirements for admission to such course of instruc tion ? Should instruction be given un der the dental or the medical faculty? Any one possessing the M .D . or the D .D .S. degree from a recognized college should be admitted to the course on major oral surgery. Some suitable degree should be given at the successful completion of the course. W hile it is reasonable to believe that to possess both an M .D . and a D .D .S. degree shows higher education and train ing, and is to be desired, it is not thought necessary, and w ith our present exten sive courses in both schools, to obtain both degrees is an economic hardship. T h e course should be of long enough duration and of such a character as to train men so well in oral surgical pro cedures that they w ill be accepted by both the medical and the dental profes sion, and recognized as having the proper training. Hospital training should be a definite requirement.
MAJOR ORAL SURGERY W e believe that m ajor oral surgery should be taught in the dental school by the dental faculty. T here should be the proper cooperation with the different de partm ents of the medical school. T h e maxillary sinus, for instance, should be considered from the standpoint of the rhinologist and the oral surgeon. D if ferent conditions w ill have a bearing upon the teaching personnel.
DEGREE As to whether oral surgery is a part of medicine or dentistry, and the degree
M ead— Oral Surgery in the Undergruduate Curriculum necessary to practice this specialty, I agree w ith H arrison, who states, “ I am not acquainted w ith the medical schools which adequately teach the pathology and surgery of the m outh.” O ral surgery is taught in all dental colleges and all state boards examine candidates on the subject. A license to practice dentistry, therefore, carries w ith it the legal right to practice oral surgery. It is not the medical or dental degree that qualifies one for the practice of oral surgery, but a broad and general funda m ental knowledge of the principles of diagnosis, surgical pathology and experi ence and judgm ent, and oral surgical procedures. Every dentist should become qualified to recognize pathologic processes in the mouth, but he should attem pt treatm ent of only those cases which he is fully qualified to manage successfully. Any one practicing m ajor oral surgery should have the ability and experience necessary to handle conditions in the m outh successfully even though compli cated by extension to other parts. H e should know when and whom to call for consultation and advice. I t w ill be just as unreasonable to be lieve that the general dental practitioner can be prevented from practicing oral surgery as it is to think that a physician can be prevented from practicing su r gery or doing the work of any special ist. In the rural districts, this would be a more difficult m atter to control. I t would be desirable if a plan could be evolved whereby any one who uses the term “oral surgeon” or professes to spe cialize in this field would be required to pass a special examination for this pur pose. W h en he uses the term “ oral surgeon” or “oral surgery” or professes to specialize in this field, he assumes the
285
responsibilities and liabilities of those qualified in this work.
UNIFORM COURSE Is it desirable to endeavor to make the undergraduate and graduate teach ing of oral surgery more nearly uniform in the schools of the country? I t would be of great importance and assistance to the dental schools if the American Asso ciation of D ental Schools could recom mend a course of study for minor oral surgery and major oral surgery. T h e fol lowing are tentative outlines of these courses, which we submit for your con sideration. A t the present time, there is a wide difference of opinion as to the proper course of oral surgery in the dental school. In some schools, for instance, general anesthesia is not properly taught, the opinion being th at it should not be used by the dental surgeon. I t must be remembered that general anesthesia has been brought to the present useful ness through general improvement by the dentist. I t would be of great benefit if a stand ardized course in oral surgery could be outlined so that each school would know w hat would be required of an under graduate, as a plan of this kind cannot be followed if the state boards are not in accord w ith it.
MINOR ORAL SURGERY E xam ination of the mouth. R ecording results of exam ination. A natom y of the m outh. Choice of anesthesia. G e n era l anesthesia. Local anesthesia. P re o p e ra tiv e p re p ara tio n . Surgical technic and hospitalization. B andages, sutures and dressings. Inflam m ation a n d infection. Special infections. Exodontia. W ounds.
286
The Journal of the American D ental Association
P e riap ica l diseases. P e rio d o n ta l diseases. Apicoectom y. A lveolectom y. R eplantation. F ra c tu re of m axilla. F ra c tu re of m andible. In ju rie s of teeth and alv e o lar process. D iseases of m axillary bones. T em p o ro m an d ib u la r joint. D iseases of sa liv a ry glands, stones, etc. D iseases of m ax illary sinus. D iseases of lymph glands. H em orrhage. S urgical a n d psychic shock ; its causes, p re vention and treatm ent. A ccidents. F oreign bodies. C u ttin g frenum and m uscular atta ch ments. O p e rativ e accidents. R esidual infection. T u m o rs, cysts. Physiotherapy.
M AJOR ORAL SURGERY Physical exam ination— anatom ic considera tion. D iagnosis of diseases of the mouth. Inflam m ations and infections. P re p a ra tio n of the hands, o perative field, instrum ents a n d dressings.
H em orrhage, shock and allied com plica tions. .W o u n d s and in ju rie s of the soft p a rts. In ju rie s of the teeth and a lv e o lar process. F ractures. C left p alate. C left lip. O b tu rato rs, artifical velum s and speech train in g . R e p air of acquired defects in the lips, cheeks and p alate. T re a tm e n t of deform aties a n d m alrela tions of the jaw s. D iseases of the tem p o ro m an d ib u lar jo in t— lim ited m ovem ent of the jaw . E xodontia. Infections of the teeth, p e rid e n ta l tissues a n d m ax illa ry bones. Septic infections of the floor of the mouth a n d neck. D iseases of the m ax illa ry sinus. In ju rie s and diseases of the lip. Affections of the sa liv a ry glands and their ducts. In ju rie s and diseases of the tongue. D iseases of the nerves. T u m o rs. Cysts. Local anesthesia. G e n era l anesthesia. Physiotherapy.
SHOULD ORAL SURGERY H A V E A PLACE IN TH E U N D ER G RA D U A TE C U R R IC U LU M IN DENTISTRY*? By CHALMERS J. LYONS, D.D.S., Ann Arbor, Mich. H O U L D oral surgery have a place in the undergraduate curriculum in dentistry ? O u r answer to this ques tion w ill be emphatically “yes.” If this subject has no place in the dental curri culum, oral surgery as such w ill not be
S
*R ead before the g roup conference on O ral S urgery a t the Sixth A nnual M eeting of the A m erican A ssociation of D ental Schools, C hi cago, 111., M a rch 26, 1929. Jo u r. A . D . A ., F e b ru a ry , foyo
taught. M ore than sixty years ago, the great Garrison originated the term “oral surgery,” w ith the idea in mind of link ing it up in some way w ith medicine. T h ree score years have now passed, and today finds medicine only slightly inter ested in this subject. In fact, oral surgery is now recognized in but few medical schools of this country, and in these schools it is taught in a very limited and
283
and other minor procedures as oral sur gery, we know of a number of colleges where such a course is given. I would venture to say that 99 per cent of our students will come to us w ith dental training only, and I believe that we should concentrate on teaching minor oral procedures and we should teach from the standpoint of surgical tech nic, both by lectures and by demon strations. T h e small percentage of men having both medical and dental degrees who w ill present themselves could best be trained by the general surgeon and the special surgeon, and their training be supplemented by the oral surgeon. T h e faculty should entrust the teaching of m ajor and minor oral surgery to one chief, and exodontia, while not taught by him necessarily, should come under his department. T his I believe to be the logical conclusion, if the extraction of teeth is considered surgery.
SHOULD ORAL SURGERY HAVE A PLACE IN T H E U N D ERG RA D U A TE C U R R IC U LU M IN DENTISTRY?* By STERLING V. MEAD, D.D.S., Washington, D. C. R A L surgery may be defined as “surgery of the mouth, mandible, maxillae, and adjacent structures.” I t should be divided into two separate fields: minor oral surgery and m ajor oral surgery. I t is manifestly impos sible to draw an absolute line of separ ation between these tw o fields, as many cases may involve both fields. F o r in stance, a simple fracture may be a prob
O
*R ead before the G roup C onference on O ral Surgery a t the Sixth A nnual M eeting of the A m erican A ssociation of D ental Schools, Chicago, 111., M a rch 26, 1929. Jo u r. A . D . A ., F e b ru a ry , 1030
lem of minor oral surgery; whereas, a fracture involving a bone graft w ill be come a m ajor surgical operation. T he removal of a tooth may be a minor oper ation, but m ajor surgical procedures may become necessary owing to infection, etc. M inor oral surgery should have a defi nite and im portant place in the under graduate curriculum in the dental school.
UNDERGRADUATE (M IN O R ) ORAL SURGERY W h at should be the objective? W h a t should be included in the course? W h at
284
T he Journal of the American D ental Association
should be the character and method of teaching ? W ith a proper knowledge of the prin ciples and procedures in minor oral sur gery, one can better understand pathology and diagnosis and more fully appreciate the requirements of successful operations. T h e course should include exodontia, minor oral surgery, local anesthesia and general anesthesia. Teaching should be both theoretical and practical, w ith ample clinical m ate rial available. T h e use of lantern slide lectures, moving pictures and actual demonstrations should be encouraged. Students should be required to have actual clinical experience before gradua tion. T h e student should be taught hos pital routine, sterilization and procedure. H e should receive practical demonstra tion along this line. In our present curriculum, the time is so limited that it is difficult to teach the undergraduates all the essentials of minor oral surgery. T hey are not quali fied to undertake the study of m ajor oral surgery and do not derive marked bene fit from it, and any time spent on it could more profitably be spent on minor oral surgery. A t Georgetown University, we have adopted the plan of teaching oral diag nosis and diseases of the mouth to the junior students, taking away from oral surgery such subjects as diagnosis, infec tions and stomatitis. W hen the undergraduate enters the senior year, having had training in the subjects of anatomy, histology, pathol ogy, physiology, diagnosis, etc., he is in a receptive condition to consider surgical procedure. H e is taught minor oral sur gery from both a theoretical and a prac tical standpoint. D uring the year, he is permitted to witness a few well chosen m ajor oral surgical operations for gen
eral hospital and professional training. I do not believe th at he should be re quired to be examined in m ajor oral sur gical procedures.
GRADUATE TEACHING In the graduate teaching of oral sur gery w hat should be the requirements for admission to such course of instruc tion ? Should instruction be given un der the dental or the medical faculty? Any one possessing the M .D . or the D .D .S. degree from a recognized college should be admitted to the course on major oral surgery. Some suitable degree should be given at the successful completion of the course. W hile it is reasonable to believe that to possess both an M .D . and a D .D .S. degree shows higher education and train ing, and is to be desired, it is not thought necessary, and w ith our present exten sive courses in both schools, to obtain both degrees is an economic hardship. T h e course should be of long enough duration and of such a character as to train men so well in oral surgical pro cedures that they w ill be accepted by both the medical and the dental profes sion, and recognized as having the proper training. Hospital training should be a definite requirement.
MAJOR ORAL SURGERY W e believe that m ajor oral surgery should be taught in the dental school by the dental faculty. T here should be the proper cooperation with the different de partm ents of the medical school. T h e maxillary sinus, for instance, should be considered from the standpoint of the rhinologist and the oral surgeon. D if ferent conditions w ill have a bearing upon the teaching personnel.
DEGREE As to whether oral surgery is a part of medicine or dentistry, and the degree
M ead— Oral Surgery in the Undergruduate Curriculum necessary to practice this specialty, I agree w ith H arrison, who states, “ I am not acquainted w ith the medical schools which adequately teach the pathology and surgery of the m outh.” O ral surgery is taught in all dental colleges and all state boards examine candidates on the subject. A license to practice dentistry, therefore, carries w ith it the legal right to practice oral surgery. It is not the medical or dental degree that qualifies one for the practice of oral surgery, but a broad and general funda m ental knowledge of the principles of diagnosis, surgical pathology and experi ence and judgm ent, and oral surgical procedures. Every dentist should become qualified to recognize pathologic processes in the mouth, but he should attem pt treatm ent of only those cases which he is fully qualified to manage successfully. Any one practicing m ajor oral surgery should have the ability and experience necessary to handle conditions in the m outh successfully even though compli cated by extension to other parts. H e should know when and whom to call for consultation and advice. I t w ill be just as unreasonable to be lieve that the general dental practitioner can be prevented from practicing oral surgery as it is to think that a physician can be prevented from practicing su r gery or doing the work of any special ist. In the rural districts, this would be a more difficult m atter to control. I t would be desirable if a plan could be evolved whereby any one who uses the term “oral surgeon” or professes to spe cialize in this field would be required to pass a special examination for this pur pose. W h en he uses the term “ oral surgeon” or “oral surgery” or professes to specialize in this field, he assumes the
285
responsibilities and liabilities of those qualified in this work.
UNIFORM COURSE Is it desirable to endeavor to make the undergraduate and graduate teach ing of oral surgery more nearly uniform in the schools of the country? I t would be of great importance and assistance to the dental schools if the American Asso ciation of D ental Schools could recom mend a course of study for minor oral surgery and major oral surgery. T h e fol lowing are tentative outlines of these courses, which we submit for your con sideration. A t the present time, there is a wide difference of opinion as to the proper course of oral surgery in the dental school. In some schools, for instance, general anesthesia is not properly taught, the opinion being th at it should not be used by the dental surgeon. I t must be remembered that general anesthesia has been brought to the present useful ness through general improvement by the dentist. I t would be of great benefit if a stand ardized course in oral surgery could be outlined so that each school would know w hat would be required of an under graduate, as a plan of this kind cannot be followed if the state boards are not in accord w ith it.
MINOR ORAL SURGERY E xam ination of the mouth. R ecording results of exam ination. A natom y of the m outh. Choice of anesthesia. G e n era l anesthesia. Local anesthesia. P re o p e ra tiv e p re p ara tio n . Surgical technic and hospitalization. B andages, sutures and dressings. Inflam m ation a n d infection. Special infections. Exodontia. W ounds.
286
The Journal of the American D ental Association
P e riap ica l diseases. P e rio d o n ta l diseases. Apicoectom y. A lveolectom y. R eplantation. F ra c tu re of m axilla. F ra c tu re of m andible. In ju rie s of teeth and alv e o lar process. D iseases of m axillary bones. T em p o ro m an d ib u la r joint. D iseases of sa liv a ry glands, stones, etc. D iseases of m ax illary sinus. D iseases of lymph glands. H em orrhage. S urgical a n d psychic shock ; its causes, p re vention and treatm ent. A ccidents. F oreign bodies. C u ttin g frenum and m uscular atta ch ments. O p e rativ e accidents. R esidual infection. T u m o rs, cysts. Physiotherapy.
M AJOR ORAL SURGERY Physical exam ination— anatom ic considera tion. D iagnosis of diseases of the mouth. Inflam m ations and infections. P re p a ra tio n of the hands, o perative field, instrum ents a n d dressings.
H em orrhage, shock and allied com plica tions. .W o u n d s and in ju rie s of the soft p a rts. In ju rie s of the teeth and a lv e o lar process. F ractures. C left p alate. C left lip. O b tu rato rs, artifical velum s and speech train in g . R e p air of acquired defects in the lips, cheeks and p alate. T re a tm e n t of deform aties a n d m alrela tions of the jaw s. D iseases of the tem p o ro m an d ib u lar jo in t— lim ited m ovem ent of the jaw . E xodontia. Infections of the teeth, p e rid e n ta l tissues a n d m ax illa ry bones. Septic infections of the floor of the mouth a n d neck. D iseases of the m ax illa ry sinus. In ju rie s and diseases of the lip. Affections of the sa liv a ry glands and their ducts. In ju rie s and diseases of the tongue. D iseases of the nerves. T u m o rs. Cysts. Local anesthesia. G e n era l anesthesia. Physiotherapy.
SHOULD ORAL SURGERY H A V E A PLACE IN TH E U N D ER G RA D U A TE C U R R IC U LU M IN DENTISTRY*? By CHALMERS J. LYONS, D.D.S., Ann Arbor, Mich. H O U L D oral surgery have a place in the undergraduate curriculum in dentistry ? O u r answer to this ques tion w ill be emphatically “yes.” If this subject has no place in the dental curri culum, oral surgery as such w ill not be
S
*R ead before the g roup conference on O ral S urgery a t the Sixth A nnual M eeting of the A m erican A ssociation of D ental Schools, C hi cago, 111., M a rch 26, 1929. Jo u r. A . D . A ., F e b ru a ry , foyo
taught. M ore than sixty years ago, the great Garrison originated the term “oral surgery,” w ith the idea in mind of link ing it up in some way w ith medicine. T h ree score years have now passed, and today finds medicine only slightly inter ested in this subject. In fact, oral surgery is now recognized in but few medical schools of this country, and in these schools it is taught in a very limited and