- Email: [email protected]
What Is in a Name? Oral and Maxillofacial Surgeon Versus Oral Surgeon
OTHER
What Is in a Name? Oral and Maxillofacial Surgeon Versus Oral Surgeon Andre V. Guerrero, DDS, MD,* Alessandra Altamirano,y Eric Brown,z Christina J. Shin, DDS,x Katayoun Tajik, DDS,k Emily Fu,{ Jeffrey Dean, DDS, MD,# and Alan Herford, DDS, MD** Purpose:
In 1975, the American Society of Oral Surgeons officially changed its name to the American Association of Oral and Maxillofacial Surgeons. This change was intended to address the specialty’s expanding surgical scope. However, today, many health care professionals continue to use the term oral surgeon. This study was undertaken to determine if students’ perception of the oral and maxillofacial surgeon’s (OMS) surgical scope would change when oral and maxillofacial surgeon was used instead of oral surgeon.
Material and Methods:
This cross-sectional study surveyed undergraduate and dental students’ choice of specialist to treat 21 different conditions. The independent variable was the specialty term (oral and maxillofacial surgeon vs oral surgeon). The dependent variables were specialists chosen for the procedure (ear, nose, and throat surgeon; plastic surgeon; OMS or oral surgeon; periodontist; other). The test of proportions (z test) with the Yates correction was performed for data analysis.
Results:
Of the 280 senior dental students who were surveyed, 258 surveys were included in the study. Dental students’ perception of the OMS’s surgical scope increased significantly from 51% to 55% when oral and maxillofacial surgeon was used instead of oral surgeon. Of the 530 undergraduate upper division science students who were surveyed, 488 surveys were included in the study. Undergraduate upper division science students’ perception of the OMS’s surgical scope increased significantly from 23% to 31% when oral and maxillofacial surgeon was used as an option instead of oral surgeon.
Conclusion:
The use of oral and maxillofacial surgeon increased students’ perception of the OMS’s surgical scope. This study also suggested that students were not fully aware of the magnitude of the OMS’s scope of practice. The current dichotomy and inconsistent use of the specialty’s official term adds to the confusion and to misunderstanding. Therefore, OMSs should universally refer to themselves as oral and maxillofacial surgeons and help educate others of their scope. Ó 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg -:1-11, 2013 these patients.1 Instead of being surgically reconstructed, deformed faces were covered by masks.1 To address this demand, the American Society of Oral Surgeons and Exodontists was established in 1921.1 This name was used until 1946, when it was
During World War I, the large number of destructive facial wounds led to an increased demand for facial surgeons.1 At that time, the specialties of plastic surgery and oral and maxillofacial surgery did not exist and very few general surgeons were prepared to treat *Resident, Department of Oral and Maxillofacial Surgery, Loma
#Professor and Program Director, Department of Oral and
Linda University, Loma Linda, CA.
Maxillofacial Surgery, Loma Linda University, Loma Linda, CA.
yPost-baccalaureate Student, University of California Berkeley,
**Professor and Chairman, Department of Oral and Maxillofacial
Berkeley, California.
Surgery, Loma Linda University, Loma Linda, CA.
zDental Student, University of California San Francisco,
Address correspondence and reprint requests to Dr Guerrero:
San Francisco, CA.
11092 Anderson St., Room 3306, Loma Linda, CA 92350; e-mail:
xResident, Department of Dentistry, Boston Children’s Hospital,
[email protected]
Boston, Massachusetts. kResident, Department of Pediatric Dentistry, Jacobi Medical
Ó 2013 American Association of Oral and Maxillofacial Surgeons
Center, New York, New York.
http://dx.doi.org/10.1016/j.joms.2013.04.018
0278-2391/13/00420-5$36.00/0
{Masters Student, Department of Medical Science, Mississippi College, Clinton, Mississippi.
1
2 replaced by the American Society of Oral Surgeons.1 In 1975, the name was changed to the American Association of Oral and Maxillofacial Surgeons.1 Each name change was intended to more accurately represent oral and maxillofacial surgeons’ (OMSs’) scope of practice. Unfortunately, the term oral and maxillofacial surgeon is not universally used by dentists, medical practitioners, or OMSs. Oftentimes, these providers forego the maxillofacial part of the name and simply use oral surgeon. Other times, OMSs replace maxillofacial with ancillary names, such as facial, jaw, cosmetic, or implant.2 This inconsistency in the name of the specialty creates confusion and misunderstanding. In 2002, Laskin et al3 reported that other medical specialties such as nephrology and hepatology also have difficulty with the public’s perception of their scope. In their study, Laskin et al3 arrived at the conclusion that ‘‘the name alone can never be completely descriptive.’’ Although their conclusion is true, the name of a specialty is the most important ‘‘ambassador’’ of its scope of practice, and it is imperative to compare the use of oral and maxillofacial surgeon with oral surgeon to better determine the adequate ‘‘ambassador.’’ Currently, no research has investigated this issue. Previous scope-of-practice studies have used populations, including dental students, medical students, dentists, physicians, and the public.3-8 Although some of these studies surveyed dental students, they did not specifically survey fourth-year dental students.4-6 Furthermore, only Hunter et al4 surveyed American dental students and that study was performed in 1996. In the present study, the authors surveyed fourth-year dental students (seniors) within 6 months of graduating from dental school. At that point, most students have completed most of their didactic and clinical oral and maxillofacial surgical education. It is imperative to survey senior dental students to assess the current state of the oral and maxillofacial surgical curriculum in American dental schools. Furthermore, none of the previous scope-ofpractice studies surveyed ‘‘undergraduate upper division science students.’’ Undergraduate science students are more likely to pursue careers within the health field. Ensuring that they understand the OMS’s surgical scope of practice may provide multiple benefits: 1) it may attract them to pursue dentistry as a career in the hope of becoming an OMS; 2) if they pursue other health fields, they might refer more patients to OMSs in appreciation of the OMS’s scope; and 3) it may attract more students willing to pursue an academic career. Therefore, it is imperative to investigate students’ understanding of the OMS’s scope and how their perception changes when oral and maxillofacial surgeon is used instead of oral surgeon.
ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
The purpose of this study was to determine if students’ perception of an OMS’s scope of practice would change when using the term oral and maxillofacial surgeon instead of oral surgeon. The authors hypothesized that using oral and maxillofacial surgeon would provide a significant advantage over oral surgeon. The specific objectives of the study were to determine if 1) the use of oral and maxillofacial surgeon would provide a significant advantage over oral surgeon, 2) senior dental students were fully aware of an OMS’s scope of practice, and 3) undergraduate upper division science students (potential applicants to dental school) were aware of an OMS’s scope of practice.
Material and Methods STUDY DESIGN
This study was declared exempt from review by the local institutional review board. The authors used a methodology similar to that used in several surveys performed in the United States4 (1996), Great Britain5 (2005), Brazil6 (2008), and France7 (2011). A questionnaire was designed to determine if using oral and maxillofacial surgeon instead of oral surgeon would alter undergraduate and dental students’ perception of the scope of practice. To address the research purpose, the authors designed a cross-sectional study to survey undergraduate upper division science students (predoctoral students) and dental students. Undergraduate upper division science students at the University of California–Los Angeles, University of California–Riverton, and California State University–Fullerton were surveyed during a mandatory upper division science class from January through February 2012. Senior dental students within 6 months of graduation from the University of California–San Francisco, Loma Linda University, and New York University schools of dentistry were surveyed during a mandatory dental class from January through February 2012. For inclusion, students had to be present in class on the day of the survey. Senior dental students were surveyed during a mandatory class. Undergraduate upper division science students were surveyed during a mandatory class. Students were excluded if they were not present on the day of the survey. Surveys were excluded if fewer than 50% of survey questions were answered. Individual questions were excluded if more than 1 answer was given for the question. VARIABLES
The independent variable was the specialty name (oral and maxillofacial surgeon vs oral surgeon).
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The dependent variables were the specialists chosen for the procedure (ear, nose, and throat surgeon; plastic surgeon; OMS or oral surgeon; periodontist; other).
oral surgeon for each treatment condition. Excel (Microsoft, Redmond, WA) was used to create the graphs.
Results DATA COLLECTION METHODS
Undergraduate students taking upper division science courses at the University of California–Los Angeles, University of California–Riverside, and California State University–Fullerton were given surveys at the beginning of the class and these were collected at the end of the class. The surveys were passed out by undergraduate upper division science students who coauthored this study. Senior dental students at the University of California–San Francisco, Loma Linda University, and New York University with less than 6 months until graduation were given surveys at the beginning of the class and these were collected at the end of the class. The surveys were passed out by a volunteer dental student. No incentives or compensation were given to complete the survey. Students passing out the survey did not disclose their affiliation to oral and maxillofacial surgery to the students being surveyed. Surveys were created with only 1 variation: half described the specialist as an oral surgeon and the other half described the specialist as an oral and maxillofacial surgeon. The 2 different surveys were printed and distributed in class in a double-blinded and alternating fashion so that each student would have a different survey from the student sitting nearby. The instructions on the survey read, ‘‘Which surgeon would you expect to treat you for the following conditions? (Choose only 1 surgeon for each condition).’’ Specialists listed were ear, nose, and throat surgeon; plastic surgeon; oral surgeon or oral and maxillofacial surgeon, periodontist; and other for those not listed. Twenty-one different conditions or treatments were divided into 1 of 4 categories: trauma, pathology, reconstructive surgery, and cosmetic surgery. The conditions or treatments listed were cut on the face, fracture of the lower jaw, fracture of the upper jaw, fracture of the cheekbone, cancer in the mouth, temporomandibular joint dysfunction, cancer of the tongue, mole or lump on the face, removal of the salivary gland, swelling around the eye, swelling on the face, swelling on the neck, sleep apnea surgery, sinus surgery, child with cleft lip, child with cleft palate, difficulty breathing in the nose, dental implantation, cosmetic surgery of the nose, appearance of the face, and appearance of the jaw. DATA ANALYSES
The test of proportions (z test) with the Yates correction was performed in Sigma Plot 11.0 (SYSTAT Software, Inc, Erkrath Germany) to compare students’ perceptions of oral and maxillofacial surgeon with
Two hundred eighty senior dental students were randomized and surveyed. One hundred forty students received a survey that had oral and maxillofacial surgeon as an option. The other 140 students received a survey that had oral surgeon as an option. Of the oral and maxillofacial surgeon surveys, 130 met the inclusion criteria. Of the oral surgeon surveys, 128 met the inclusion criteria (Fig 1). Five hundred thirty undergraduate upper division science students were randomized and surveyed. Two hundred sixty-five received a survey that had oral and maxillofacial surgeon as an option. The other 265 received a survey that had oral surgeon as an option. Of the oral and maxillofacial surgeon surveys, 242 met the inclusion criteria. Of the oral surgeon surveys, 246 met the inclusion criteria (Fig 2). TOTAL
When oral and maxillofacial surgeon was an option, senior dental students chose it 55% of the time. When oral surgeon was an option, it was chosen 51% of the time. The difference was statistically significant (P = .004; Tables 1 to 3, Fig 3). When oral and maxillofacial surgeon was an option, undergraduate upper division science students chose it 31% of the time. When oral surgeon was an option, it was chosen 23% of the time. The difference was statistically significant (P < .001; Tables 3 to 5, Fig 4). TRAUMA
Oral and maxillofacial surgeon was chosen 74% of the time by senior dental students to treat traumatic conditions. Oral surgeon was chosen 69% of the time by senior dental students. The difference was not statistically significant (Fig 3). Oral and maxillofacial surgeon was chosen 54% of the time by undergraduate upper division science students to treat traumatic conditions. Oral surgeon was chosen 35% of the time by undergraduate science students. The difference was statistically significant (P < .001; Fig 4). PATHOLOGY
Oral and maxillofacial surgeon was chosen 61% of the time by senior dental students to treat pathologic conditions. Oral surgeon was chosen 58% of the time by senior dental students. The difference was not statistically significant (Fig 3). Oral and maxillofacial surgeon was chosen 31% of the time by undergraduate upper division science
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ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
FIGURE 1. Senior dental student survey inclusion flowchart. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
FIGURE 2. Undergraduate upper division science student survey inclusion flowchart. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
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Table 1. RESPONSES OF SENIOR DENTAL STUDENTS TO ORAL AND MAXILLOFACIAL SURGEON
Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total (n)
Ear, Nose, and Throat Surgeon (%)
Plastic Surgeon (%)
Oral and Maxillofacial Surgeon (%)
Periodontist (%)
Other (%)
2 0 1 0
80 2 1 10
10 98 98 90
0 0 0 0
7 0 0 0
126 127 127 123
12 0 7 7 10 18 16 41
0 0 1 51 1 18 16 3
79 73 83 25 85 44 55 46
0 0 0 0 0 0 0 0
9 27 9 17 4 21 14 9
122 124 123 122 122 125 122 123
55 35 2 6 80 0
0 2 24 13 6 1
32 57 72 80 13 39
0 6 0 0 0 56
13 0 2 2 2 4
123 122 121 118 123 119
2 1 0
92 89 47
6 10 51 55 (1,410)
0 0 1
0 0 2
126 126 122 2,586
Total Responses (n)
Abbreviation: TMJ, temporomandibular joint. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
students to treat pathologic conditions. Oral surgeon was chosen 24% of the time by undergraduate science students. The difference was statistically significant (P < .001; Fig 4). RECONSTRUCTIVE SURGERY
Oral and maxillofacial surgeon was chosen 48% of the time by senior dental students to perform reconstructive surgery. Oral surgeon was chosen 45% of the time by senior dental students. The difference was not statistically significant (Fig 3). Oral and maxillofacial surgeon was chosen 26% of the time by undergraduate upper division science students to perform reconstructive surgery. Oral surgeon was chosen 24% of the time by undergraduate science students. The difference was not statistically significant (Fig 4). COSMETIC SURGERY
Oral and maxillofacial surgeon was chosen 22% of the time by senior dental students to perform cosmetic
surgery. Oral surgeon was chosen 18% of the time by senior dental students. The difference was not statistically significant (Fig 3). Oral and maxillofacial surgeon was chosen 10% of the time by undergraduate upper division science students to perform cosmetic surgery. Oral surgeon was chosen 5% of the time by undergraduate science students. The difference was statistically significant (P < .001; Fig 4). INDIVIDUAL CONDITIONS
Oral and maxillofacial surgeon was chosen 44% of the time by senior dental students to treat eye swelling. Oral surgeon was chosen 30% of the time by senior dental students. The difference was statistically significant (P < .001; Table 3). The use of oral and maxillofacial surgeon significantly increased undergraduate upper division science students’ selection of the specialty for the following categories: cut on the face, fracture of the lower jaw, fracture of the upper jaw, fracture of
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ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
Table 2. RESPONSES OF SENIOR DENTAL STUDENTS TO ORAL SURGEON
Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total (n)
Ear, Nose, and Throat Surgeon (%)
Plastic Surgeon (%)
Oral Surgeon (%)
Periodontist (%)
Other (%)
2 0 0 1
81 5 4 15
8 93 94 82
0 0 0 0
9 2 2 2
122 126 125 125
9 0 6 4 8 17 9 40
3 1 3 47 0 21 23 9
77 75 79 24 87 30 52 39
0 0 0 0 2 0 1 1
11 24 11 25 3 33 15 11
127 125 125 126 121 125 123 122
49 41 3 5 81 1
2 3 27 15 4 2
29 47 65 77 10 41
1 7 2 0 1 53
20 3 2 3 5 4
122 120 124 122 124 116
6 1 0
90 94 50
0 0 0
1 1 2
125 122 122 2,589
3 4 48 51 (1,314)
Total Responses (n)
Abbreviation: TMJ, temporomandibular joint. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
the cheekbone, mole or lump on the face, swelling around the eye, swelling on the face, swelling in the neck, sinus surgery, and appearance of the face (P < .001; Table 3).
Discussion In 1975, the official name of this specialty was changed from oral surgery to oral and maxillofacial surgery.1 Since then, no studies have directly compared how the use of either term affects people’s perceptions of an OMS’s surgical scope. The purpose of this study was to determine if students’ perception of an OMS’s scope of practice would change when using oral and maxillofacial surgeon instead of oral surgeon. The authors hypothesized that using oral and maxillofacial surgeon would provide a significant advantage over oral surgeon. The specific objectives of the study were to determine if 1) the use of oral and maxillofacial surgeon would provide a significant advantage over oral surgeon, 2) senior dental students were fully aware of an OMS’s scope of practice, and 3) undergraduate upper division science stu-
dents (potential applicants to dental school) were aware of an OMS’s scope of practice. The authors found that although oral and maxillofacial surgeon is not completely descriptive of an OMS’s scope of practice, it does have a statistically significant advantage over oral surgeon in the senior dental student population and the undergraduate upper division science student population. The authors also found that dental students and undergraduate students were not fully aware of an OMS’s scope of practice. UNDERGRADUATE UPPER DIVISION SCIENCE STUDENTS
There have been no previously published data on undergraduate students’ understanding of an OMS’s scope of practice. Likewise, no one has studied the difference in using oral and maxillofacial surgeon instead of oral surgeon on students’ understanding of an OMS’s scope. Whether oral surgeon or oral and maxillofacial surgeon was used, the present study suggested that undergraduate upper division
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Table 3. COMPARISON OF RESPONSES FROM SENIOR DENTAL STUDENTS AND UNDERGRADUATE UPPER DIVISION SCIENCE STUDENTS WHEN USING ORAL AND MAXILLOFACIAL SURGEON VERSUS ORAL SURGEON
Senior Dental Students Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total
Undergraduate Science Students
Oral and Maxillofacial Surgeon (%)
Oral Surgeon (%)
Oral and Maxillofacial Surgeon (%)
Oral Surgeon (%)
10 98 98 90
8 93 94 82
20* 71* 71* 54*
7 50 52 30
79 73 83 25 85 44* 55 46
77 75 79 24 87 30 52 39
45 41 41 11* 49 17* 29* 18*
44 32 38 4 52 5 10 7
32 57 72 80 13 39
29 47 65 77 10 41
11 9* 38 43 3 53
8 4 32 39 3 59
6 10 51 55*
3 4 48 51
4 7* 17 31*
2 1 12 23
Abbreviation: TMJ, temporomandibular joint. * Indicates a significantly higher response rate compared with oral surgeon (P < .001). Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
science students had a poor understanding of an OMS’s wide surgical scope. When referred to as an oral surgeon, the specialist was selected only 23% of the time. There was a statistically significant increase to 31% when oral and maxillofacial surgeon was used. Although using oral and maxillofacial surgeon in this survey yielded a statistically significant increase in the overall perception of the OMS’s scope of practice, it is unknown if this translates to clinical significance. The survey showed that using oral and maxillofacial surgeon significantly increased undergraduate science students’ perception of the OMS’s scope in treating trauma, pathology, and cosmetics (Fig 4). Using oral and maxillofacial surgeon also significantly increased undergraduate upper division science students’ selection of the specialty for the following categories: cut on the face, fracture of the lower jaw, fracture of the upper jaw, fracture of the cheekbone, mole or
lump on the face, swelling around the eye, swelling on the face, swelling in the neck, sinus surgery, and appearance of the face. Surprisingly, periodontists were selected in relatively large proportions to treat cancer in the mouth (23%), temporomandibular joint dysfunction (17%), cancer of the tongue (15%), and swelling around the eye (10%). These large proportions might be attributed to students’ general lack of knowledge of the periodontal specialty and incorrect guessing. These findings suggest that it is beneficial for OMSs to refer to themselves as oral and maxillofacial surgeons. Because undergraduate upper division science students are more likely to pursue health careers, ensuring that they understand an OMS’s surgical scope of practice may provide multiple benefits: 1) it may attract them to pursue a career in dentistry in the hope of becoming an OMS; 2) if they pursue other health fields, they might refer more patients to OMSs in appreciation of the OMS’s scope; and 3) it may attract
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ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
FIGURE 3. Senior dental students’ perspective of scope when using oral and maxillofacial surgeon or oral surgeon. *Significantly higher response rate compared with oral surgeon (P < .001). Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
Table 4. RESPONSES OF UNDERGRADUATE UPPER DIVISION SCIENCE STUDENTS TO ORAL AND MAXILLOFACIAL SURGEON
Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total (n)
Ear, Nose, and Throat Surgeon (%)
Plastic Surgeon (%)
Oral and Maxillofacial Surgeon (%)
Periodontist (%)
Other (%)
2 1 1 1
46 11 10 28
20 71 71 54
1 4 5 1
31 13 13 16
231 238 238 236
17 8 26 2 35 9 8 29
0 4 1 56 6 20 20 14
45 41 41 11 49 17 29 18
23 17 15 5 4 10 6 5
15 31 16 26 7 44 37 34
235 218 228 229 235 235 238 238
40 66 5 6 80 2
14 16 50 40 12 5
11 9 38 43 3 53
8 1 3 4 0 32
27 8 4 7 4 7
228 237 235 230 235 223
13 1 4
82 91 77
0 0 0
0 0 1
237 239 238 4,901
Abbreviation: TMJ, temporomandibular joint.
4 7 17 31 (1,519)
Total Responses (n)
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Table 5. RESPONSES OF UNDERGRADUATE UPPER DIVISION SCIENCE STUDENTS TO ORAL SURGEON
Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total (n)
Ear, Nose, and Throat Surgeon (%)
Plastic Surgeon (%)
Oral Surgeon (%)
Periodontist (%)
Other (%)
2 5 4 4
68 15 14 34
7 50 52 30
2 12 11 9
21 19 19 24
233 242 242 237
16 14 21 3 24 15 15 39
2 7 5 61 9 24 33 17
44 32 38 4 52 5 10 7
22 16 17 6 4 7 5 4
16 31 19 26 11 50 37 33
244 225 238 241 244 238 241 242
37 65 9 10 83 3
12 20 52 41 11 5
8 4 32 39 3 59
7 2 4 6 0 29
37 9 3 4 3 5
237 243 242 241 236 238
13 1 1
84 97 82
0 0 2
0 0 3
243 245 244 5,036
2 1 12 23 (1,178)
Total Responses (n)
Abbreviation: TMJ, temporomandibular joint. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
FIGURE 4. Undergraduate upper division science students’ perspective of scope when using oral and maxillofacial surgeon or oral surgeon. *Significantly higher response rate compared with oral surgeon (P < .001). Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
10 more students willing to pursue an academic career. Sarraf et al9 recently published evidence that only 9% of oral and maxillofacial surgical graduates enter academics each year. This rate is lower than comparable fields in medicine.9 Despite the lack of evidence, one explanation for this is that oral and maxillofacial surgical programs select residents from a pool of applicants who choose a career in dentistry in part for its favorable lifestyle. To address this issue, oral and maxillofacial surgery needs to attract a pool of applicants who want to pursue an academic lifestyle. Promoting oral and maxillofacial surgery to undergraduate premedical and predental groups may convince those interested in an academic surgical career to pursue dentistry instead of medicine. The primary author of this report has given several oral and maxillofacial surgical scopeof-practice presentations, with great success in educating prehealth students. SENIOR DENTAL STUDENTS
There have been no previously published data on senior dental students’ (#6 months of graduating) awareness of an OMS’s scope of practice. Likewise, no one has studied the effects of using oral and maxillofacial surgeon instead of oral surgeon on students’ perception of an OMS’s scope. Whether oral surgeon or oral and maxillofacial surgeon was used, this study suggested that senior dental students had a mediocre awareness of an OMS’s wide surgical scope. When referred to as oral surgeon, the specialist was selected only 51% of the time. There was a statistically significant increase to 55% when oral and maxillofacial surgeon was used. Although using oral and maxillofacial surgeon in this survey yielded a statistically significant increase in the overall perception of an OMS’s scope of practice, it is unknown if it translates to clinical significance. The surveys were completed in January and February, when most senior dental students were within 6 months of graduating and had completed their oral and maxillofacial surgical education in dental school. The fact that senior dental students selected oral and maxillofacial surgeon more frequently than oral surgeon suggests that there may be a subconscious or psychological component to the term that ‘‘reminds’’ them of an OMS’s surgical scope. Nevertheless, a 55% response rate for dental students is inadequate. It potentially means that 45% of patients will be referred to other specialists. If senior dental students have a mediocre understanding of an OMS’s scope, it becomes exceedingly difficult to gain public recognition, gain referrals for procedures, and campaign for improved reimbursement of procedures. Therefore, it is imperative that OMSs review the current educational model to better educate dental students about oral and maxillofacial surgery.
ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
Increasing the variety of surgical cases that dental students are required to observe, as during medical school surgical rotations, is an option to address this issue. The survey showed that senior dental students were well aware of an OMS’s expertise in treating facial fractures. They selected oral and maxillofacial surgeons 98% of the time for lower jaw fractures, 98% of the time for upper jaw fractures, and 90% of the time for cheek bone fractures. Surprisingly, for cut on the face, OMSs were selected only 10% of the time. Plastic surgeons were selected 80% of the time to treat a cut on the face. Also perplexing is that senior dental students selected oral and maxillofacial surgeon only 39% of the time to place dental implants. Periodontists were selected 56% of the time. These findings suggest that OMSs need to improve dental students’ exposure to the specialty so that they appreciate the wide surgical scope and expertise of OMSs. Further studies should be performed to determine if there is a correlation between the amount of time that dental students spend with OMSs and periodontists and the number and type of patients whom they refer for placement of dental implants. OTHER STUDIES
The last scope-of-practice study that surveyed American dental students was performed by Hunter et al4 in 1996. The present response rates for the individual conditions or treatments were higher than in the study by Hunter et al for every condition except fracture of the lower jaw, cleft palate, implantation, and appearance of the jaw. There are some variables in the study by Hunter et al that differ from the present study that may explain the difference. First, it is unclear exactly how many years of dental education the students in the study by Hunter et al had received; if students with less than 3.5 years of dental education were included in their survey, it could explain their decreased perception of an OMS’s scope. Second, it is unclear whether they used oral surgeon or oral and maxillofacial surgeon; the use of the former term might explain their decreased perception of an OMS’s scope. Third, since 1996, an OMS’s scope of practice has broadened; this would explain the increased perception of an OMS’s scope in the present study. Fourth, the study by Hunter et al included different dental schools than in the present study. STRENGTHS AND WEAKNESSES
The strength of this study is that it was a doubleblinded randomized survey of students’ perception of an OMS’s scope. One significant caveat, however, is that the students surveyed attended 3 dental schools and 3 undergraduate colleges. This limited selection
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of schools may not be representative of the entire student population. In the United States, some dental schools have affiliated oral and maxillofacial surgical programs, whereas others do not. The 3 dental schools that were surveyed have an affiliated oral and maxillofacial surgical program; however, the amount of exposure to oral and maxillofacial surgery at these schools was not surveyed. This study also did not collect information on student age, gender, education, chosen career, or prior professional experiences. Although these variables may influence the results of a study, there is no reason to believe that there was a skewed representation of a variable in any of the student populations. Moreover, although there was statistical significance in this study, it is not possible to assume clinical significance. In the United States, OMSs are trained to treat all conditions relating to the oral and maxillofacial complex, including dentoalveolar deformities, maxillofacial deformities, cleft and craniofacial deformities, facial trauma, temporomandibular joint surgery, tumors, head and neck cancer, facial reconstructive surgery, and facial cosmetic surgery. Unfortunately, most students and many health care providers, including dentists, are unaware of the extent of an OMS’s scope.3-8 This issue may be addressed by urging the American Association of Oral and Maxillofacial Surgeons to increase marketing and establish a strong relationship with the media for publicity. For example, plastic surgeons have successfully promoted themselves in the media and it is part of the reason that the term plastic surgery is ubiquitous in society. Unfortunately, methods of increasing public awareness are costly. To aggravate the situation, dentists, medical practitioners, and OMSs do not use oral and maxillofacial surgeon universally. Instead, many health care providers readily use oral surgeon. This inconsistency in the name of the specialty creates confusion and misunderstanding. Although it may be easier to enunciate the less complex name, it inaccurately represents the OMSs’ field. In fact, the term oral surgeon is often used by some medical specialists to denigrate the specialty. The present study showed that using the term oral and maxillofacial surgeon increased students’ perception of an OMS’s scope. Although the clinical
significance of this study may be open to debate, universally using oral and maxillofacial surgeon might help decrease confusion and increase awareness of the OMS’s broad scope of practice. In an editorial in the Journal of Oral and Maxillofacial Surgery in October 2011, Dodson stated that ‘‘becoming the loudest voice in a media-strained marketplace is the greatest race of our time. And the key is: simplify the message.’’10 The editorial was directed at manuscript titles11; however, the quotation is also relevant in naming specialties. Perhaps changing oral and maxillofacial surgeon to an easier to enunciate oral and facial surgeon, as suggested by Ameerally et al,8 would improve people’s perception of the OMS’s surgical scope. Future studies investigating this question are warranted before such a drastic change. Until then, OMSs should unify and refer to themselves as oral and maxillofacial surgeons.
References 1. Deranian HM: The transformation of the American Association of Oral Surgeons into the American Association of Oral and Plastic Surgeons. J Hist Dent 56:79, 2008 2. Hupp J: Oral facial jaw mouth cosmetic implant surgeons— What’s in a name? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:1, 2009 3. Laskin DM, Ellis JA, Best AM: Public recognition of specialty designations. J Oral Maxillofac Surg 60:1182, 2002 4. Hunter MJ, Rubeiz T, Rose L: Recognition of the scope of oral and maxillofacial surgery by the public and health care professionals. J Oral Maxillofac Surg 54:1227, 1996 5. Ifeacho SN, Malhi GK, James G: Perception by the public and medical profession of oral and maxillofacial surgery—Has it changed after 10 years? Br J Oral Maxillofac Surg 43:289, 2005 6. Rocha NS, Filho JRL, Silva EDO, et al: Perception of oral maxillofacial surgery by health-care professionals. Int J Oral Maxillofac Surg 37:41, 2008 7. Herlin C, Goudot P, Jammet P, et al: Oral and maxillofacial surgery: What are the French specificities? J Oral Maxillofac Surg 69:1525, 2011 8. Ameerally P, Fordyce AM, Martin IC: So you think they know what we do? The public and professional perception of oral and maxillofacial surgery. Br J Oral Maxillofac Surg 32:141, 1994 9. Sarraf AA, Abubaker O, Laskin DM, et al: Characteristics of oral and maxillofacial surgery residencies that result in graduating residents entering academic positions. J Oral Maxillofac Surg 69:2271, 2011 10. Dodson T: Beware the idle title. J Oral Maxillofac Surg 69:2481, 2011 11. Dodson T: A guide for preparing a patient-oriented research manuscript. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:307, 2007
What Is in a Name? Oral and Maxillofacial Surgeon Versus Oral Surgeon Andre V. Guerrero, DDS, MD,* Alessandra Altamirano,y Eric Brown,z Christina J. Shin, DDS,x Katayoun Tajik, DDS,k Emily Fu,{ Jeffrey Dean, DDS, MD,# and Alan Herford, DDS, MD** Purpose:
In 1975, the American Society of Oral Surgeons officially changed its name to the American Association of Oral and Maxillofacial Surgeons. This change was intended to address the specialty’s expanding surgical scope. However, today, many health care professionals continue to use the term oral surgeon. This study was undertaken to determine if students’ perception of the oral and maxillofacial surgeon’s (OMS) surgical scope would change when oral and maxillofacial surgeon was used instead of oral surgeon.
Material and Methods:
This cross-sectional study surveyed undergraduate and dental students’ choice of specialist to treat 21 different conditions. The independent variable was the specialty term (oral and maxillofacial surgeon vs oral surgeon). The dependent variables were specialists chosen for the procedure (ear, nose, and throat surgeon; plastic surgeon; OMS or oral surgeon; periodontist; other). The test of proportions (z test) with the Yates correction was performed for data analysis.
Results:
Of the 280 senior dental students who were surveyed, 258 surveys were included in the study. Dental students’ perception of the OMS’s surgical scope increased significantly from 51% to 55% when oral and maxillofacial surgeon was used instead of oral surgeon. Of the 530 undergraduate upper division science students who were surveyed, 488 surveys were included in the study. Undergraduate upper division science students’ perception of the OMS’s surgical scope increased significantly from 23% to 31% when oral and maxillofacial surgeon was used as an option instead of oral surgeon.
Conclusion:
The use of oral and maxillofacial surgeon increased students’ perception of the OMS’s surgical scope. This study also suggested that students were not fully aware of the magnitude of the OMS’s scope of practice. The current dichotomy and inconsistent use of the specialty’s official term adds to the confusion and to misunderstanding. Therefore, OMSs should universally refer to themselves as oral and maxillofacial surgeons and help educate others of their scope. Ó 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg -:1-11, 2013 these patients.1 Instead of being surgically reconstructed, deformed faces were covered by masks.1 To address this demand, the American Society of Oral Surgeons and Exodontists was established in 1921.1 This name was used until 1946, when it was
During World War I, the large number of destructive facial wounds led to an increased demand for facial surgeons.1 At that time, the specialties of plastic surgery and oral and maxillofacial surgery did not exist and very few general surgeons were prepared to treat *Resident, Department of Oral and Maxillofacial Surgery, Loma
#Professor and Program Director, Department of Oral and
Linda University, Loma Linda, CA.
Maxillofacial Surgery, Loma Linda University, Loma Linda, CA.
yPost-baccalaureate Student, University of California Berkeley,
**Professor and Chairman, Department of Oral and Maxillofacial
Berkeley, California.
Surgery, Loma Linda University, Loma Linda, CA.
zDental Student, University of California San Francisco,
Address correspondence and reprint requests to Dr Guerrero:
San Francisco, CA.
11092 Anderson St., Room 3306, Loma Linda, CA 92350; e-mail:
xResident, Department of Dentistry, Boston Children’s Hospital,
[email protected]
Boston, Massachusetts. kResident, Department of Pediatric Dentistry, Jacobi Medical
Ó 2013 American Association of Oral and Maxillofacial Surgeons
Center, New York, New York.
http://dx.doi.org/10.1016/j.joms.2013.04.018
0278-2391/13/00420-5$36.00/0
{Masters Student, Department of Medical Science, Mississippi College, Clinton, Mississippi.
1
2 replaced by the American Society of Oral Surgeons.1 In 1975, the name was changed to the American Association of Oral and Maxillofacial Surgeons.1 Each name change was intended to more accurately represent oral and maxillofacial surgeons’ (OMSs’) scope of practice. Unfortunately, the term oral and maxillofacial surgeon is not universally used by dentists, medical practitioners, or OMSs. Oftentimes, these providers forego the maxillofacial part of the name and simply use oral surgeon. Other times, OMSs replace maxillofacial with ancillary names, such as facial, jaw, cosmetic, or implant.2 This inconsistency in the name of the specialty creates confusion and misunderstanding. In 2002, Laskin et al3 reported that other medical specialties such as nephrology and hepatology also have difficulty with the public’s perception of their scope. In their study, Laskin et al3 arrived at the conclusion that ‘‘the name alone can never be completely descriptive.’’ Although their conclusion is true, the name of a specialty is the most important ‘‘ambassador’’ of its scope of practice, and it is imperative to compare the use of oral and maxillofacial surgeon with oral surgeon to better determine the adequate ‘‘ambassador.’’ Currently, no research has investigated this issue. Previous scope-of-practice studies have used populations, including dental students, medical students, dentists, physicians, and the public.3-8 Although some of these studies surveyed dental students, they did not specifically survey fourth-year dental students.4-6 Furthermore, only Hunter et al4 surveyed American dental students and that study was performed in 1996. In the present study, the authors surveyed fourth-year dental students (seniors) within 6 months of graduating from dental school. At that point, most students have completed most of their didactic and clinical oral and maxillofacial surgical education. It is imperative to survey senior dental students to assess the current state of the oral and maxillofacial surgical curriculum in American dental schools. Furthermore, none of the previous scope-ofpractice studies surveyed ‘‘undergraduate upper division science students.’’ Undergraduate science students are more likely to pursue careers within the health field. Ensuring that they understand the OMS’s surgical scope of practice may provide multiple benefits: 1) it may attract them to pursue dentistry as a career in the hope of becoming an OMS; 2) if they pursue other health fields, they might refer more patients to OMSs in appreciation of the OMS’s scope; and 3) it may attract more students willing to pursue an academic career. Therefore, it is imperative to investigate students’ understanding of the OMS’s scope and how their perception changes when oral and maxillofacial surgeon is used instead of oral surgeon.
ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
The purpose of this study was to determine if students’ perception of an OMS’s scope of practice would change when using the term oral and maxillofacial surgeon instead of oral surgeon. The authors hypothesized that using oral and maxillofacial surgeon would provide a significant advantage over oral surgeon. The specific objectives of the study were to determine if 1) the use of oral and maxillofacial surgeon would provide a significant advantage over oral surgeon, 2) senior dental students were fully aware of an OMS’s scope of practice, and 3) undergraduate upper division science students (potential applicants to dental school) were aware of an OMS’s scope of practice.
Material and Methods STUDY DESIGN
This study was declared exempt from review by the local institutional review board. The authors used a methodology similar to that used in several surveys performed in the United States4 (1996), Great Britain5 (2005), Brazil6 (2008), and France7 (2011). A questionnaire was designed to determine if using oral and maxillofacial surgeon instead of oral surgeon would alter undergraduate and dental students’ perception of the scope of practice. To address the research purpose, the authors designed a cross-sectional study to survey undergraduate upper division science students (predoctoral students) and dental students. Undergraduate upper division science students at the University of California–Los Angeles, University of California–Riverton, and California State University–Fullerton were surveyed during a mandatory upper division science class from January through February 2012. Senior dental students within 6 months of graduation from the University of California–San Francisco, Loma Linda University, and New York University schools of dentistry were surveyed during a mandatory dental class from January through February 2012. For inclusion, students had to be present in class on the day of the survey. Senior dental students were surveyed during a mandatory class. Undergraduate upper division science students were surveyed during a mandatory class. Students were excluded if they were not present on the day of the survey. Surveys were excluded if fewer than 50% of survey questions were answered. Individual questions were excluded if more than 1 answer was given for the question. VARIABLES
The independent variable was the specialty name (oral and maxillofacial surgeon vs oral surgeon).
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The dependent variables were the specialists chosen for the procedure (ear, nose, and throat surgeon; plastic surgeon; OMS or oral surgeon; periodontist; other).
oral surgeon for each treatment condition. Excel (Microsoft, Redmond, WA) was used to create the graphs.
Results DATA COLLECTION METHODS
Undergraduate students taking upper division science courses at the University of California–Los Angeles, University of California–Riverside, and California State University–Fullerton were given surveys at the beginning of the class and these were collected at the end of the class. The surveys were passed out by undergraduate upper division science students who coauthored this study. Senior dental students at the University of California–San Francisco, Loma Linda University, and New York University with less than 6 months until graduation were given surveys at the beginning of the class and these were collected at the end of the class. The surveys were passed out by a volunteer dental student. No incentives or compensation were given to complete the survey. Students passing out the survey did not disclose their affiliation to oral and maxillofacial surgery to the students being surveyed. Surveys were created with only 1 variation: half described the specialist as an oral surgeon and the other half described the specialist as an oral and maxillofacial surgeon. The 2 different surveys were printed and distributed in class in a double-blinded and alternating fashion so that each student would have a different survey from the student sitting nearby. The instructions on the survey read, ‘‘Which surgeon would you expect to treat you for the following conditions? (Choose only 1 surgeon for each condition).’’ Specialists listed were ear, nose, and throat surgeon; plastic surgeon; oral surgeon or oral and maxillofacial surgeon, periodontist; and other for those not listed. Twenty-one different conditions or treatments were divided into 1 of 4 categories: trauma, pathology, reconstructive surgery, and cosmetic surgery. The conditions or treatments listed were cut on the face, fracture of the lower jaw, fracture of the upper jaw, fracture of the cheekbone, cancer in the mouth, temporomandibular joint dysfunction, cancer of the tongue, mole or lump on the face, removal of the salivary gland, swelling around the eye, swelling on the face, swelling on the neck, sleep apnea surgery, sinus surgery, child with cleft lip, child with cleft palate, difficulty breathing in the nose, dental implantation, cosmetic surgery of the nose, appearance of the face, and appearance of the jaw. DATA ANALYSES
The test of proportions (z test) with the Yates correction was performed in Sigma Plot 11.0 (SYSTAT Software, Inc, Erkrath Germany) to compare students’ perceptions of oral and maxillofacial surgeon with
Two hundred eighty senior dental students were randomized and surveyed. One hundred forty students received a survey that had oral and maxillofacial surgeon as an option. The other 140 students received a survey that had oral surgeon as an option. Of the oral and maxillofacial surgeon surveys, 130 met the inclusion criteria. Of the oral surgeon surveys, 128 met the inclusion criteria (Fig 1). Five hundred thirty undergraduate upper division science students were randomized and surveyed. Two hundred sixty-five received a survey that had oral and maxillofacial surgeon as an option. The other 265 received a survey that had oral surgeon as an option. Of the oral and maxillofacial surgeon surveys, 242 met the inclusion criteria. Of the oral surgeon surveys, 246 met the inclusion criteria (Fig 2). TOTAL
When oral and maxillofacial surgeon was an option, senior dental students chose it 55% of the time. When oral surgeon was an option, it was chosen 51% of the time. The difference was statistically significant (P = .004; Tables 1 to 3, Fig 3). When oral and maxillofacial surgeon was an option, undergraduate upper division science students chose it 31% of the time. When oral surgeon was an option, it was chosen 23% of the time. The difference was statistically significant (P < .001; Tables 3 to 5, Fig 4). TRAUMA
Oral and maxillofacial surgeon was chosen 74% of the time by senior dental students to treat traumatic conditions. Oral surgeon was chosen 69% of the time by senior dental students. The difference was not statistically significant (Fig 3). Oral and maxillofacial surgeon was chosen 54% of the time by undergraduate upper division science students to treat traumatic conditions. Oral surgeon was chosen 35% of the time by undergraduate science students. The difference was statistically significant (P < .001; Fig 4). PATHOLOGY
Oral and maxillofacial surgeon was chosen 61% of the time by senior dental students to treat pathologic conditions. Oral surgeon was chosen 58% of the time by senior dental students. The difference was not statistically significant (Fig 3). Oral and maxillofacial surgeon was chosen 31% of the time by undergraduate upper division science
4
ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
FIGURE 1. Senior dental student survey inclusion flowchart. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
FIGURE 2. Undergraduate upper division science student survey inclusion flowchart. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
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Table 1. RESPONSES OF SENIOR DENTAL STUDENTS TO ORAL AND MAXILLOFACIAL SURGEON
Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total (n)
Ear, Nose, and Throat Surgeon (%)
Plastic Surgeon (%)
Oral and Maxillofacial Surgeon (%)
Periodontist (%)
Other (%)
2 0 1 0
80 2 1 10
10 98 98 90
0 0 0 0
7 0 0 0
126 127 127 123
12 0 7 7 10 18 16 41
0 0 1 51 1 18 16 3
79 73 83 25 85 44 55 46
0 0 0 0 0 0 0 0
9 27 9 17 4 21 14 9
122 124 123 122 122 125 122 123
55 35 2 6 80 0
0 2 24 13 6 1
32 57 72 80 13 39
0 6 0 0 0 56
13 0 2 2 2 4
123 122 121 118 123 119
2 1 0
92 89 47
6 10 51 55 (1,410)
0 0 1
0 0 2
126 126 122 2,586
Total Responses (n)
Abbreviation: TMJ, temporomandibular joint. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
students to treat pathologic conditions. Oral surgeon was chosen 24% of the time by undergraduate science students. The difference was statistically significant (P < .001; Fig 4). RECONSTRUCTIVE SURGERY
Oral and maxillofacial surgeon was chosen 48% of the time by senior dental students to perform reconstructive surgery. Oral surgeon was chosen 45% of the time by senior dental students. The difference was not statistically significant (Fig 3). Oral and maxillofacial surgeon was chosen 26% of the time by undergraduate upper division science students to perform reconstructive surgery. Oral surgeon was chosen 24% of the time by undergraduate science students. The difference was not statistically significant (Fig 4). COSMETIC SURGERY
Oral and maxillofacial surgeon was chosen 22% of the time by senior dental students to perform cosmetic
surgery. Oral surgeon was chosen 18% of the time by senior dental students. The difference was not statistically significant (Fig 3). Oral and maxillofacial surgeon was chosen 10% of the time by undergraduate upper division science students to perform cosmetic surgery. Oral surgeon was chosen 5% of the time by undergraduate science students. The difference was statistically significant (P < .001; Fig 4). INDIVIDUAL CONDITIONS
Oral and maxillofacial surgeon was chosen 44% of the time by senior dental students to treat eye swelling. Oral surgeon was chosen 30% of the time by senior dental students. The difference was statistically significant (P < .001; Table 3). The use of oral and maxillofacial surgeon significantly increased undergraduate upper division science students’ selection of the specialty for the following categories: cut on the face, fracture of the lower jaw, fracture of the upper jaw, fracture of
6
ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
Table 2. RESPONSES OF SENIOR DENTAL STUDENTS TO ORAL SURGEON
Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total (n)
Ear, Nose, and Throat Surgeon (%)
Plastic Surgeon (%)
Oral Surgeon (%)
Periodontist (%)
Other (%)
2 0 0 1
81 5 4 15
8 93 94 82
0 0 0 0
9 2 2 2
122 126 125 125
9 0 6 4 8 17 9 40
3 1 3 47 0 21 23 9
77 75 79 24 87 30 52 39
0 0 0 0 2 0 1 1
11 24 11 25 3 33 15 11
127 125 125 126 121 125 123 122
49 41 3 5 81 1
2 3 27 15 4 2
29 47 65 77 10 41
1 7 2 0 1 53
20 3 2 3 5 4
122 120 124 122 124 116
6 1 0
90 94 50
0 0 0
1 1 2
125 122 122 2,589
3 4 48 51 (1,314)
Total Responses (n)
Abbreviation: TMJ, temporomandibular joint. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
the cheekbone, mole or lump on the face, swelling around the eye, swelling on the face, swelling in the neck, sinus surgery, and appearance of the face (P < .001; Table 3).
Discussion In 1975, the official name of this specialty was changed from oral surgery to oral and maxillofacial surgery.1 Since then, no studies have directly compared how the use of either term affects people’s perceptions of an OMS’s surgical scope. The purpose of this study was to determine if students’ perception of an OMS’s scope of practice would change when using oral and maxillofacial surgeon instead of oral surgeon. The authors hypothesized that using oral and maxillofacial surgeon would provide a significant advantage over oral surgeon. The specific objectives of the study were to determine if 1) the use of oral and maxillofacial surgeon would provide a significant advantage over oral surgeon, 2) senior dental students were fully aware of an OMS’s scope of practice, and 3) undergraduate upper division science stu-
dents (potential applicants to dental school) were aware of an OMS’s scope of practice. The authors found that although oral and maxillofacial surgeon is not completely descriptive of an OMS’s scope of practice, it does have a statistically significant advantage over oral surgeon in the senior dental student population and the undergraduate upper division science student population. The authors also found that dental students and undergraduate students were not fully aware of an OMS’s scope of practice. UNDERGRADUATE UPPER DIVISION SCIENCE STUDENTS
There have been no previously published data on undergraduate students’ understanding of an OMS’s scope of practice. Likewise, no one has studied the difference in using oral and maxillofacial surgeon instead of oral surgeon on students’ understanding of an OMS’s scope. Whether oral surgeon or oral and maxillofacial surgeon was used, the present study suggested that undergraduate upper division
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Table 3. COMPARISON OF RESPONSES FROM SENIOR DENTAL STUDENTS AND UNDERGRADUATE UPPER DIVISION SCIENCE STUDENTS WHEN USING ORAL AND MAXILLOFACIAL SURGEON VERSUS ORAL SURGEON
Senior Dental Students Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total
Undergraduate Science Students
Oral and Maxillofacial Surgeon (%)
Oral Surgeon (%)
Oral and Maxillofacial Surgeon (%)
Oral Surgeon (%)
10 98 98 90
8 93 94 82
20* 71* 71* 54*
7 50 52 30
79 73 83 25 85 44* 55 46
77 75 79 24 87 30 52 39
45 41 41 11* 49 17* 29* 18*
44 32 38 4 52 5 10 7
32 57 72 80 13 39
29 47 65 77 10 41
11 9* 38 43 3 53
8 4 32 39 3 59
6 10 51 55*
3 4 48 51
4 7* 17 31*
2 1 12 23
Abbreviation: TMJ, temporomandibular joint. * Indicates a significantly higher response rate compared with oral surgeon (P < .001). Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
science students had a poor understanding of an OMS’s wide surgical scope. When referred to as an oral surgeon, the specialist was selected only 23% of the time. There was a statistically significant increase to 31% when oral and maxillofacial surgeon was used. Although using oral and maxillofacial surgeon in this survey yielded a statistically significant increase in the overall perception of the OMS’s scope of practice, it is unknown if this translates to clinical significance. The survey showed that using oral and maxillofacial surgeon significantly increased undergraduate science students’ perception of the OMS’s scope in treating trauma, pathology, and cosmetics (Fig 4). Using oral and maxillofacial surgeon also significantly increased undergraduate upper division science students’ selection of the specialty for the following categories: cut on the face, fracture of the lower jaw, fracture of the upper jaw, fracture of the cheekbone, mole or
lump on the face, swelling around the eye, swelling on the face, swelling in the neck, sinus surgery, and appearance of the face. Surprisingly, periodontists were selected in relatively large proportions to treat cancer in the mouth (23%), temporomandibular joint dysfunction (17%), cancer of the tongue (15%), and swelling around the eye (10%). These large proportions might be attributed to students’ general lack of knowledge of the periodontal specialty and incorrect guessing. These findings suggest that it is beneficial for OMSs to refer to themselves as oral and maxillofacial surgeons. Because undergraduate upper division science students are more likely to pursue health careers, ensuring that they understand an OMS’s surgical scope of practice may provide multiple benefits: 1) it may attract them to pursue a career in dentistry in the hope of becoming an OMS; 2) if they pursue other health fields, they might refer more patients to OMSs in appreciation of the OMS’s scope; and 3) it may attract
8
ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
FIGURE 3. Senior dental students’ perspective of scope when using oral and maxillofacial surgeon or oral surgeon. *Significantly higher response rate compared with oral surgeon (P < .001). Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
Table 4. RESPONSES OF UNDERGRADUATE UPPER DIVISION SCIENCE STUDENTS TO ORAL AND MAXILLOFACIAL SURGEON
Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total (n)
Ear, Nose, and Throat Surgeon (%)
Plastic Surgeon (%)
Oral and Maxillofacial Surgeon (%)
Periodontist (%)
Other (%)
2 1 1 1
46 11 10 28
20 71 71 54
1 4 5 1
31 13 13 16
231 238 238 236
17 8 26 2 35 9 8 29
0 4 1 56 6 20 20 14
45 41 41 11 49 17 29 18
23 17 15 5 4 10 6 5
15 31 16 26 7 44 37 34
235 218 228 229 235 235 238 238
40 66 5 6 80 2
14 16 50 40 12 5
11 9 38 43 3 53
8 1 3 4 0 32
27 8 4 7 4 7
228 237 235 230 235 223
13 1 4
82 91 77
0 0 0
0 0 1
237 239 238 4,901
Abbreviation: TMJ, temporomandibular joint.
4 7 17 31 (1,519)
Total Responses (n)
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GUERRERO ET AL
Table 5. RESPONSES OF UNDERGRADUATE UPPER DIVISION SCIENCE STUDENTS TO ORAL SURGEON
Which Surgeon Would You Expect to Treat You? Trauma Cut on face Fracture of lower jaw Fracture of upper jaw Fracture of cheekbone Pathology Cancer in mouth TMJ dysfunction Cancer of tongue Mole or lump on face Removal of salivary gland Swelling around eye Swelling on face Swelling on neck Reconstructive surgery Sleep apnea surgery Sinus surgery Child with cleft lip Child with cleft palate Difficulty breathing in nose Dental implants Cosmetic surgery Cosmetic surgery of nose Appearance of face Appearance of jaw Total (n)
Ear, Nose, and Throat Surgeon (%)
Plastic Surgeon (%)
Oral Surgeon (%)
Periodontist (%)
Other (%)
2 5 4 4
68 15 14 34
7 50 52 30
2 12 11 9
21 19 19 24
233 242 242 237
16 14 21 3 24 15 15 39
2 7 5 61 9 24 33 17
44 32 38 4 52 5 10 7
22 16 17 6 4 7 5 4
16 31 19 26 11 50 37 33
244 225 238 241 244 238 241 242
37 65 9 10 83 3
12 20 52 41 11 5
8 4 32 39 3 59
7 2 4 6 0 29
37 9 3 4 3 5
237 243 242 241 236 238
13 1 1
84 97 82
0 0 2
0 0 3
243 245 244 5,036
2 1 12 23 (1,178)
Total Responses (n)
Abbreviation: TMJ, temporomandibular joint. Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
FIGURE 4. Undergraduate upper division science students’ perspective of scope when using oral and maxillofacial surgeon or oral surgeon. *Significantly higher response rate compared with oral surgeon (P < .001). Guerrero et al. Oral and Maxillofacial Versus Oral Surgeon. J Oral Maxillofac Surg 2013.
10 more students willing to pursue an academic career. Sarraf et al9 recently published evidence that only 9% of oral and maxillofacial surgical graduates enter academics each year. This rate is lower than comparable fields in medicine.9 Despite the lack of evidence, one explanation for this is that oral and maxillofacial surgical programs select residents from a pool of applicants who choose a career in dentistry in part for its favorable lifestyle. To address this issue, oral and maxillofacial surgery needs to attract a pool of applicants who want to pursue an academic lifestyle. Promoting oral and maxillofacial surgery to undergraduate premedical and predental groups may convince those interested in an academic surgical career to pursue dentistry instead of medicine. The primary author of this report has given several oral and maxillofacial surgical scopeof-practice presentations, with great success in educating prehealth students. SENIOR DENTAL STUDENTS
There have been no previously published data on senior dental students’ (#6 months of graduating) awareness of an OMS’s scope of practice. Likewise, no one has studied the effects of using oral and maxillofacial surgeon instead of oral surgeon on students’ perception of an OMS’s scope. Whether oral surgeon or oral and maxillofacial surgeon was used, this study suggested that senior dental students had a mediocre awareness of an OMS’s wide surgical scope. When referred to as oral surgeon, the specialist was selected only 51% of the time. There was a statistically significant increase to 55% when oral and maxillofacial surgeon was used. Although using oral and maxillofacial surgeon in this survey yielded a statistically significant increase in the overall perception of an OMS’s scope of practice, it is unknown if it translates to clinical significance. The surveys were completed in January and February, when most senior dental students were within 6 months of graduating and had completed their oral and maxillofacial surgical education in dental school. The fact that senior dental students selected oral and maxillofacial surgeon more frequently than oral surgeon suggests that there may be a subconscious or psychological component to the term that ‘‘reminds’’ them of an OMS’s surgical scope. Nevertheless, a 55% response rate for dental students is inadequate. It potentially means that 45% of patients will be referred to other specialists. If senior dental students have a mediocre understanding of an OMS’s scope, it becomes exceedingly difficult to gain public recognition, gain referrals for procedures, and campaign for improved reimbursement of procedures. Therefore, it is imperative that OMSs review the current educational model to better educate dental students about oral and maxillofacial surgery.
ORAL AND MAXILLOFACIAL VERSUS ORAL SURGEON
Increasing the variety of surgical cases that dental students are required to observe, as during medical school surgical rotations, is an option to address this issue. The survey showed that senior dental students were well aware of an OMS’s expertise in treating facial fractures. They selected oral and maxillofacial surgeons 98% of the time for lower jaw fractures, 98% of the time for upper jaw fractures, and 90% of the time for cheek bone fractures. Surprisingly, for cut on the face, OMSs were selected only 10% of the time. Plastic surgeons were selected 80% of the time to treat a cut on the face. Also perplexing is that senior dental students selected oral and maxillofacial surgeon only 39% of the time to place dental implants. Periodontists were selected 56% of the time. These findings suggest that OMSs need to improve dental students’ exposure to the specialty so that they appreciate the wide surgical scope and expertise of OMSs. Further studies should be performed to determine if there is a correlation between the amount of time that dental students spend with OMSs and periodontists and the number and type of patients whom they refer for placement of dental implants. OTHER STUDIES
The last scope-of-practice study that surveyed American dental students was performed by Hunter et al4 in 1996. The present response rates for the individual conditions or treatments were higher than in the study by Hunter et al for every condition except fracture of the lower jaw, cleft palate, implantation, and appearance of the jaw. There are some variables in the study by Hunter et al that differ from the present study that may explain the difference. First, it is unclear exactly how many years of dental education the students in the study by Hunter et al had received; if students with less than 3.5 years of dental education were included in their survey, it could explain their decreased perception of an OMS’s scope. Second, it is unclear whether they used oral surgeon or oral and maxillofacial surgeon; the use of the former term might explain their decreased perception of an OMS’s scope. Third, since 1996, an OMS’s scope of practice has broadened; this would explain the increased perception of an OMS’s scope in the present study. Fourth, the study by Hunter et al included different dental schools than in the present study. STRENGTHS AND WEAKNESSES
The strength of this study is that it was a doubleblinded randomized survey of students’ perception of an OMS’s scope. One significant caveat, however, is that the students surveyed attended 3 dental schools and 3 undergraduate colleges. This limited selection
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of schools may not be representative of the entire student population. In the United States, some dental schools have affiliated oral and maxillofacial surgical programs, whereas others do not. The 3 dental schools that were surveyed have an affiliated oral and maxillofacial surgical program; however, the amount of exposure to oral and maxillofacial surgery at these schools was not surveyed. This study also did not collect information on student age, gender, education, chosen career, or prior professional experiences. Although these variables may influence the results of a study, there is no reason to believe that there was a skewed representation of a variable in any of the student populations. Moreover, although there was statistical significance in this study, it is not possible to assume clinical significance. In the United States, OMSs are trained to treat all conditions relating to the oral and maxillofacial complex, including dentoalveolar deformities, maxillofacial deformities, cleft and craniofacial deformities, facial trauma, temporomandibular joint surgery, tumors, head and neck cancer, facial reconstructive surgery, and facial cosmetic surgery. Unfortunately, most students and many health care providers, including dentists, are unaware of the extent of an OMS’s scope.3-8 This issue may be addressed by urging the American Association of Oral and Maxillofacial Surgeons to increase marketing and establish a strong relationship with the media for publicity. For example, plastic surgeons have successfully promoted themselves in the media and it is part of the reason that the term plastic surgery is ubiquitous in society. Unfortunately, methods of increasing public awareness are costly. To aggravate the situation, dentists, medical practitioners, and OMSs do not use oral and maxillofacial surgeon universally. Instead, many health care providers readily use oral surgeon. This inconsistency in the name of the specialty creates confusion and misunderstanding. Although it may be easier to enunciate the less complex name, it inaccurately represents the OMSs’ field. In fact, the term oral surgeon is often used by some medical specialists to denigrate the specialty. The present study showed that using the term oral and maxillofacial surgeon increased students’ perception of an OMS’s scope. Although the clinical
significance of this study may be open to debate, universally using oral and maxillofacial surgeon might help decrease confusion and increase awareness of the OMS’s broad scope of practice. In an editorial in the Journal of Oral and Maxillofacial Surgery in October 2011, Dodson stated that ‘‘becoming the loudest voice in a media-strained marketplace is the greatest race of our time. And the key is: simplify the message.’’10 The editorial was directed at manuscript titles11; however, the quotation is also relevant in naming specialties. Perhaps changing oral and maxillofacial surgeon to an easier to enunciate oral and facial surgeon, as suggested by Ameerally et al,8 would improve people’s perception of the OMS’s surgical scope. Future studies investigating this question are warranted before such a drastic change. Until then, OMSs should unify and refer to themselves as oral and maxillofacial surgeons.
References 1. Deranian HM: The transformation of the American Association of Oral Surgeons into the American Association of Oral and Plastic Surgeons. J Hist Dent 56:79, 2008 2. Hupp J: Oral facial jaw mouth cosmetic implant surgeons— What’s in a name? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:1, 2009 3. Laskin DM, Ellis JA, Best AM: Public recognition of specialty designations. J Oral Maxillofac Surg 60:1182, 2002 4. Hunter MJ, Rubeiz T, Rose L: Recognition of the scope of oral and maxillofacial surgery by the public and health care professionals. J Oral Maxillofac Surg 54:1227, 1996 5. Ifeacho SN, Malhi GK, James G: Perception by the public and medical profession of oral and maxillofacial surgery—Has it changed after 10 years? Br J Oral Maxillofac Surg 43:289, 2005 6. Rocha NS, Filho JRL, Silva EDO, et al: Perception of oral maxillofacial surgery by health-care professionals. Int J Oral Maxillofac Surg 37:41, 2008 7. Herlin C, Goudot P, Jammet P, et al: Oral and maxillofacial surgery: What are the French specificities? J Oral Maxillofac Surg 69:1525, 2011 8. Ameerally P, Fordyce AM, Martin IC: So you think they know what we do? The public and professional perception of oral and maxillofacial surgery. Br J Oral Maxillofac Surg 32:141, 1994 9. Sarraf AA, Abubaker O, Laskin DM, et al: Characteristics of oral and maxillofacial surgery residencies that result in graduating residents entering academic positions. J Oral Maxillofac Surg 69:2271, 2011 10. Dodson T: Beware the idle title. J Oral Maxillofac Surg 69:2481, 2011 11. Dodson T: A guide for preparing a patient-oriented research manuscript. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:307, 2007