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Reestablishing our dental base
J Oral MaxillofacSurg 50:1151,1992
Reestablishing Our Dental Base Traditionally, oral and maxillofacial surgery has been a specialty of dentistry. Even in the beginning, when those who practiced oral and maxillofacial surgery had only a medical degree or were dually qualified, they were closely aligned with dental schools. This tradition has continued to the present. Although we now spend much more time in hospitals, and physicians make up a part of our referral pattern, our main bases are still dental schools and dental departments, and our main source of patients is still the dentist. Yet, now we see inroads being made into these historical areas of support by other dental specialties and special clinical interest groups. To some extent this is related to the misconception that oral and maxillofacial surgery is gradually deserting dentistry. Even though our Association has constantly maintained that dentistry is our home, and we intend to keep it that way, this perception still exists. However, there may be an even more fundamental and realistic problem-our relationship with the dental students. They represent the referring dentists of the future, and yet we often tend to overlook this valuable asset. It would certainly be easier and better if they were to develop a proper appreciation for oral and maxillofacial surgery and the oral and maxillofacial surgeon during their formative years than for us to try to change their perception at a later date. If we are to preserve our proper position in the dental community, we need to become more aware of the fact that some of our current actions could easily give dental students a wrong impression of where our interests really lie. It is unfortunate that to students the oral and maxillofacial surgeon often appears to be an elitist. This perception occurs because of the attitude of some oral and maxillofacial surgeons that it is demeaning to teach dental students. It is easy to find faculty who want to participate in the residency program, but getting them to spend a reasonable amount of time in the dental school clinic is not as simple. Even when such tasks are fulfilled, they are often done half-heartedly, and other responsibilities take precedent when there is a conflict. The same attitudes are frequently seen in the part-time faculty, who also prefer the challenge of working with residents rather than dental students. The dental student also is influenced by our attitude toward dentoalveolar surgery. Although we like to associate ourselves with the major aspects of oral and
maxillofacial surgery, we need to realize that the basis of our clinical practice, in most instances, is still dentoalveolar surgery, and this is also the basis for most of our referrals. It may not have been necessary to worry about this attitude in the past, but with increasing competition from other dental specialties and special clinical interest groups, the dentoalveolar surgery base could easily be eroded, and with it may go the referral of major cases, for which outside competition also is developing. It is unrealistic to assume that dentists will necessarily consider an oral and maxillofacial surgeon for treatment of patients with conditions such as oral lesions or facial deformities when they do not constantly have us in mind for other things. When our presentations to dental students place more emphasis on maxillofacial than oral surgery, when the basic lectures and clinical teaching are often relegated to the residents, and when students see us and our residents stress hospital procedures over those done in the clinic, it is easy to see how these practices could be interpreted as disinterest in the dental aspects of our specialty, and this perception may be carried over into practice referral patterns. This apparent lack of interest also is reinforced for the students when they see our relationships with other members of the faculty. Whereas there is constant interaction between the generalists and other specialists, both in the student clinics and in the faculty practice, the oral and maxillofacial surgeons tend to remain more isolated, playing only a minor role in the overall treatment planning and delivery process, and spending more time practicing in the hospital than in the school. The students, therefore, develop a closer working relationship with the other specialties, and this also carries over into their future practice habits and referral patterns. Even though it is appropriate for our specialty to continually strive to expand its scope, it is equally as important to maintain our historic dental base. There is no better place for this to begin than in the dental school. We need to make every effort to graduate dental practitioners who not only know who we are and what we do, but who also feel that we are an integral part of the dental family. It is not enough, however, just to say these things. Our actions need to reinforce our words. DANIEL M. LAWN
1151
Reestablishing Our Dental Base Traditionally, oral and maxillofacial surgery has been a specialty of dentistry. Even in the beginning, when those who practiced oral and maxillofacial surgery had only a medical degree or were dually qualified, they were closely aligned with dental schools. This tradition has continued to the present. Although we now spend much more time in hospitals, and physicians make up a part of our referral pattern, our main bases are still dental schools and dental departments, and our main source of patients is still the dentist. Yet, now we see inroads being made into these historical areas of support by other dental specialties and special clinical interest groups. To some extent this is related to the misconception that oral and maxillofacial surgery is gradually deserting dentistry. Even though our Association has constantly maintained that dentistry is our home, and we intend to keep it that way, this perception still exists. However, there may be an even more fundamental and realistic problem-our relationship with the dental students. They represent the referring dentists of the future, and yet we often tend to overlook this valuable asset. It would certainly be easier and better if they were to develop a proper appreciation for oral and maxillofacial surgery and the oral and maxillofacial surgeon during their formative years than for us to try to change their perception at a later date. If we are to preserve our proper position in the dental community, we need to become more aware of the fact that some of our current actions could easily give dental students a wrong impression of where our interests really lie. It is unfortunate that to students the oral and maxillofacial surgeon often appears to be an elitist. This perception occurs because of the attitude of some oral and maxillofacial surgeons that it is demeaning to teach dental students. It is easy to find faculty who want to participate in the residency program, but getting them to spend a reasonable amount of time in the dental school clinic is not as simple. Even when such tasks are fulfilled, they are often done half-heartedly, and other responsibilities take precedent when there is a conflict. The same attitudes are frequently seen in the part-time faculty, who also prefer the challenge of working with residents rather than dental students. The dental student also is influenced by our attitude toward dentoalveolar surgery. Although we like to associate ourselves with the major aspects of oral and
maxillofacial surgery, we need to realize that the basis of our clinical practice, in most instances, is still dentoalveolar surgery, and this is also the basis for most of our referrals. It may not have been necessary to worry about this attitude in the past, but with increasing competition from other dental specialties and special clinical interest groups, the dentoalveolar surgery base could easily be eroded, and with it may go the referral of major cases, for which outside competition also is developing. It is unrealistic to assume that dentists will necessarily consider an oral and maxillofacial surgeon for treatment of patients with conditions such as oral lesions or facial deformities when they do not constantly have us in mind for other things. When our presentations to dental students place more emphasis on maxillofacial than oral surgery, when the basic lectures and clinical teaching are often relegated to the residents, and when students see us and our residents stress hospital procedures over those done in the clinic, it is easy to see how these practices could be interpreted as disinterest in the dental aspects of our specialty, and this perception may be carried over into practice referral patterns. This apparent lack of interest also is reinforced for the students when they see our relationships with other members of the faculty. Whereas there is constant interaction between the generalists and other specialists, both in the student clinics and in the faculty practice, the oral and maxillofacial surgeons tend to remain more isolated, playing only a minor role in the overall treatment planning and delivery process, and spending more time practicing in the hospital than in the school. The students, therefore, develop a closer working relationship with the other specialties, and this also carries over into their future practice habits and referral patterns. Even though it is appropriate for our specialty to continually strive to expand its scope, it is equally as important to maintain our historic dental base. There is no better place for this to begin than in the dental school. We need to make every effort to graduate dental practitioners who not only know who we are and what we do, but who also feel that we are an integral part of the dental family. It is not enough, however, just to say these things. Our actions need to reinforce our words. DANIEL M. LAWN
1151