Dental Anesthesia vs OMS: Thoughts?

[TravisB]

Hey folks,

Does anyone have any thoughts on deciding between these two fields? It seems there could be a lot of overlap as there is no reason why an anesthesiologist couldn't also do dentoalveolar surgery

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[Allthebags]

What makes you think that an anesthesiologist can do full bony impacted 3rds, trauma, orthognathics, etc. as well as someone who did 4-6 years of training in exactly those procedures? The only overlap is that both are well trained in anesthesia, with a dental anesthesiologist being better trained in that.

 

[TravisB]

What makes you think that an anesthesiologist can do full bony impacted 3rds, trauma, orthognathics, etc. as well as someone who did 4-6 years of training in exactly those procedures? The only overlap is that both are well trained in anesthesia, with a dental anesthesiologist being better trained in that.

dentoalveolar

 

[Ivy.ch]

Does anyone have any thoughts on deciding between these two fields?

You do not have enough exposure to either field, and need to do a lot more shadowing if you’re considering either.

 

[Bupivacaine Bear]

dentoalveolar

You won’t get any referrals for dentoalveolar surgery as a dental anesthesiologist

 

[yappy]

I can almost see the logic in it. Oms have less training in anesthetics than DA, yet deliver anesthetics frequently in their office. A DA has less training in surgery, but can do dental alveolar with their dental license.

Realistically, I would pick the specialty based on how they practice today.

 

[deleted1047421]

If you’re truly a dental anesthesiologist you won’t want to do dentalalveolar, sedating your own cases. You will be making plenty enough doing general anesthesia. Dental anesthesiologists make a ton of money already and they are very busy.
They generally have no interests maintaining a office (with the headaches and overhead that come with it) and travel office to office providing anesthesia services with busy full day schedules.

 

[deleted1047421]

I’m going to have to set the record straight.

With the specific type of anesthesia provided (intravenous deep sedation) that oral surgeons perform in the office, we provide it at the highest level. We are able to ventilate the patient and provide management for any complications that arise during intravenous deep sedation.

Now, if we are talking general endotracheal anesthesia on the pediatric population, for example, this is absolutely better performed by a dental anesthesiologist.

Again with respect to the actual type of anesthesia performed (intravenous general anesthesia) oral surgeons provide it at the highest level. Our data and literature proves that to be the case. Our century of good track record proves it.

 

[deleted1047421]

I can almost see the logic in it. Oms have less training in anesthetics than DA, yet deliver anesthetics frequently in their office. A DA has less training in surgery, but can do dental alveolar with their dental license.

Realistically, I would pick the specialty based on how they practice today.

Oral surgeons do not have less training in intravenous general anesthesia/deep sedation.
We probably have more than dental anesthesiologists when it comes to this particular type of anesthesia. Again we are mostly providing intravenous sedation in the office setting.

Don’t comment on things you have no idea what you’re talking about.

 

[dentalinthemental]

Idk how a simple question about the two careers turned into an ego-off, lol. OP— both are amazing specialities with great career outlooks. No reason why you couldn’t provide dentoalveolar surgery while also providing sedation— oral surgeons, GP’s, etc. provide it all of the time with the proper knowledge and background. Most dental anesthesiologists make a killing just providing sedation, though and have no desire to, but you absolutely could. Anyone on this thread (or otherwise) saying you can’t do both (within your own comfort level/limits of course) underestimates the training involved in a DA specialty program.

 

[stealyoface]

The two fields are fundamentally different and nothing alike other than both providers sedate patients. If you want to be a surgeon, go OMFS. If you want to do anesthesia, do Dental Anesthesiology. Dentoalveolar, despite being what most OMS do daily, is a very small part of being an oral and maxillofacial surgeon. If OMFS is what you want, no other field in dentistry will suffice

 

[OMFSLife123]

Idk how a simple question about the two careers turned into an ego-off, lol. OP— both are amazing specialities with great career outlooks. No reason why you couldn’t provide dentoalveolar surgery while also providing sedation— oral surgeons, GP’s, etc. provide it all of the time with the proper knowledge and background. Most dental anesthesiologists make a killing just providing sedation, though and have no desire to, but you absolutely could. Anyone on this thread (or otherwise) saying you can’t do both (within your own comfort level/limits of course) underestimates the training involved in a DA specialty program.

You're going to spend 3 years only doing anesthesia and then out of residency going to feel proficient in surgery? Doubt it.

 

[dentalinthemental]

You're going to spend 3 years only doing anesthesia and then out of residency going to feel proficient in surgery? Doubt it.

Many specialize in DA after years of being a GP, or moonlight during residency. Luckily, a career is normally 30+ years, not just day 1 out of residency. OMFS is an amazing specialty and grueling residency, but equally let’s not pretend proficiency of an oral surgeon day 1 out of school is going to have the same speed, precision, and efficiency as a seasoned oral surgeon who’s been practicing for 20 years. We as dentists are always improving, getting better, & expanding our skillset. There is always going to be an excess of patients/need for oral surgeons & dentoalveolar surgery.. It’s silly to feel threatened by other providers.

 

[yappy]

Oral surgeons do not have less training in intravenous general anesthesia/deep sedation.
We probably have more than dental anesthesiologists when it comes to this particular type of anesthesia. Again we are mostly providing intravenous sedation in the office setting.

Don’t comment on things you have no idea what you’re talking about.

You may have more experience doing it wrong, but anesthesia specialist have more knowledge and experience.
I have worked with physicians, DA, and sometimes OMS. The former two seem to always secure the airway and use more medications like nitrous and sevo to make for a more comfortable and safer experience for the patient.

Knowing your limitations is important, and your ego is going to kill someone. Most OMS I have worked that run their own sedations have not placed ET tubes or done ACLS in a long time. They’re relying on patients staying in a plane of anesthesia that they’re familiar with, while also multitasking a procedure. I respect surgeons who hire experts.

 

[deleted1047421]

It’s not my intention to derail this thread, but comments like this can’t go unanswered.

The former two seem to always secure the airway and use more medications like nitrous and sevo to make for a more comfortable and safer experience for the patient.

Whether or not a patient needs to be intubated depends on multiple factors. With the right candidate, health/airway classification, procedure, anesthesia can safely be given intravenously. MD Anesthesiologists in the hospital do this ALL the time for colonoscopies, creation of AV fistula (for HD access), podiatric surgery etc etc. MD anesthesiologists do not intubate every patient and administer inhalational anesthesia. Intravenous general anesthesia is a major part of their practice.

Also, oral surgeons don’t hesitate to bring patients to a hospital setting when the patient/case requires it. It’s common to find that many oral surgeons designate one day a week to bring patients to the operating room in a hospital for this reason. I’m one of these oral surgeons. We don’t sedate every patient in the office.

Knowing your limitations is important, and your ego is going to kill someone.

We absolutely do know our limitations which is why we don’t hesitate to utilize our hospital privileges and bring patients to the OR whenever necessary. Personally I have an OR day once a week.

Most OMS I have worked that run their own sedations have not placed ET tubes or done ACLS in a long time.

Nonsense. At a minimum of twice a month I intubate patients. Very often once a week. One of the benefits of taking call at your local hospital, and/or doing hospital cases regularly is this: you bring your patients to the OR and the anesthesiologist will always let you intubate your own patients during induction. You can practice your mask ventilation also during induction. I always recommend requesting vecuronium during induction (with the right case of course) to practice your mask ventilation for 2 minutes.
ACLS is mandatory to renew and practice regularly. I know several oral surgeons who are certified AHA ACLS instructors. It’s a state requirement to run ACLS drills with your team.

You may have more experience doing it wrong, but anesthesia specialist have more knowledge and experience.

That’s a false comment that all oral surgeons are doing anesthesia wrong.
I’m literally speechless.
We’ve had nothing but an exceptional track record with great results spending a century. There has been numerous data and literature outlining our safety and efficacy.
Your comments are inflammatory and false. You also have zero understanding of anesthesia.

 

[deleted1047421]

Hey folks,

Does anyone have any thoughts on deciding between these two fields? It seems there could be a lot of overlap as there is no reason why an anesthesiologist couldn't also do dentoalveolar surgery

To answer your original question I think both are great fields.

If I couldn’t get into omfs, I most certainly would have applied for dental anesthesia.

I don’t know a single dental anesthesiologist which owns a practice and does traditional dentistry. They are way too busy killing it financially traveling office to office exclusively providing anesthesia services. Furthermore anesthesia is very easy on the body. You’re not hurting yourself. Many anesthesiologists joke with me and tell me the ABCs of anesthesia are : airway, billing card.

It also wouldn’t make financial sense to try to emulate oral surgeons. Omfs bill insurances on a specialty fee schedule. As a dental anesthesiologist you would probably still be billing under a general dentist fee schedule. The risk and liability wouldn’t be worth what you are getting paid. Lastly performing third molar surgery has a lot of risks such as oral antral fistula formation, retrieval of dislodged third molars from the sinus, dislodgment of third molars into the infratemporal fossa, dislodgement of root tips into the siblingual space. Post operative complications also include deep space infections, osteomyelitis, nerve injuries, uncontrollable bleeding. Unless you’ve done an omfs residency, you will never be able to manage these issues.

 

[jqrsDental]

It’s not my intention to derail this thread, but comments like this can’t go unanswered.

Whether or not a patient needs to be intubated depends on multiple factors. With the right candidate, health/airway classification, procedure, anesthesia can safely be given intravenously. MD Anesthesiologists in the hospital do this ALL the time for colonoscopies, creation of AV fistula (for HD access), podiatric surgery etc etc. MD anesthesiologists do not intubate every patient and administer inhalational anesthesia. Intravenous general anesthesia is a major part of their practice.

Also, oral surgeons don’t hesitate to bring patients to a hospital setting when the patient/case requires it. It’s common to find that many oral surgeons designate one day a week to bring patients to the operating room in a hospital for this reason. I’m one of these oral surgeons. We don’t sedate every patient in the office.


We absolutely do know our limitations which is why we don’t hesitate to utilize our hospital privileges and bring patients to the OR whenever necessary. Personally I have an OR day once a week.



Nonsense. At a minimum of twice a month I intubate patients. Very often once a week. One of the benefits of taking call at your local hospital, and/or doing hospital cases regularly is this: you bring your patients to the OR and the anesthesiologist will always let you intubate your own patients during induction. You can practice your mask ventilation also during induction. I always recommend requesting vecuronium during induction (with the right case of course) to practice your mask ventilation for 2 minutes.
ACLS is mandatory to renew and practice regularly. I know several oral surgeons who are certified AHA ACLS instructors. It’s a state requirement to run ACLS drills with your team.


That’s a false comment that all oral surgeons are doing anesthesia wrong.
I’m literally speechless.
We’ve had nothing but an exceptional track record with great results spending a century. There has been numerous data and literature outlining our safety and efficacy.
Your comments are inflammatory and false. You also have zero understanding of anesthesia.

I think yappy wanted to do omfs at one point but didnt have the scores. Not a big issue but it’s where he comes from. Like me comparing perio to omfs, we all got a chip on the shoulder.

 

[TravisB]

To answer your original question I think both are great fields.

If I couldn’t get into omfs, I most certainly would have applied for dental anesthesia.

I don’t know a single dental anesthesiologist which owns a practice and does traditional dentistry. They are way too busy killing it financially traveling office to office exclusively providing anesthesia services. Furthermore anesthesia is very easy on the body. You’re not hurting yourself. Many anesthesiologists joke with me and tell me the ABCs of anesthesia are : airway, billing card.

It also wouldn’t make financial sense to try to emulate oral surgeons. Omfs bill insurances on a specialty fee schedule. As a dental anesthesiologist you would probably still be billing under a general dentist fee schedule. The risk and liability wouldn’t be worth what you are getting paid. Lastly performing third molar surgery has a lot of risks such as oral antral fistula formation, retrieval of dislodged third molars from the sinus, dislodgment of third molars into the infratemporal fossa, dislodgement of root tips into the siblingual space. Post operative complications also include deep space infections, osteomyelitis, nerve injuries, uncontrollable bleeding. Unless you’ve done an omfs residency, you will never be able to manage these issues.

What type of salary have you seen DA's make?

 

[stealyoface]

What type of salary have you seen DA's make?

I don’t know numbers but I’ve also heard they make a killing

 

[yappy]

It’s not my intention to derail this thread, but comments like this can’t go unanswered.

Whether or not a patient needs to be intubated depends on multiple factors. With the right candidate, health/airway classification, procedure, anesthesia can safely be given intravenously. MD Anesthesiologists in the hospital do this ALL the time for colonoscopies, creation of AV fistula (for HD access), podiatric surgery etc etc. MD anesthesiologists do not intubate every patient and administer inhalational anesthesia. Intravenous general anesthesia is a major part of their practice.

Also, oral surgeons don’t hesitate to bring patients to a hospital setting when the patient/case requires it. It’s common to find that many oral surgeons designate one day a week to bring patients to the operating room in a hospital for this reason. I’m one of these oral surgeons. We don’t sedate every patient in the office.


We absolutely do know our limitations which is why we don’t hesitate to utilize our hospital privileges and bring patients to the OR whenever necessary. Personally I have an OR day once a week.



Nonsense. At a minimum of twice a month I intubate patients. Very often once a week. One of the benefits of taking call at your local hospital, and/or doing hospital cases regularly is this: you bring your patients to the OR and the anesthesiologist will always let you intubate your own patients during induction. You can practice your mask ventilation also during induction. I always recommend requesting vecuronium during induction (with the right case of course) to practice your mask ventilation for 2 minutes.
ACLS is mandatory to renew and practice regularly. I know several oral surgeons who are certified AHA ACLS instructors. It’s a state requirement to run ACLS drills with your team.


That’s a false comment that all oral surgeons are doing anesthesia wrong.
I’m literally speechless.
We’ve had nothing but an exceptional track record with great results spending a century. There has been numerous data and literature outlining our safety and efficacy.
Your comments are inflammatory and false. You also have zero understanding of anesthesia.

My observation is that most oms don’t retain hospital privileges. An ACLS cert is a necessary two day course, but it doesn’t mean anything if you don’t frequently use it like anesthesia does. Doing a few tubes a month on curated patients does not make an expert. The anesthesiologist is there to take over if necessary. It’s pretty much an admission that physicians and DA are more trained in delivering anesthetics and handling complications.
I think you’re being “inflammatory and false” by claiming parody of training with anesthesiologists and DA. It’s a completely unreasonable position to take.

 

[O.M.F.S.]

My observation is that most oms don’t retain hospital privileges. An ACLS cert is a necessary two day course, but it doesn’t mean anything if you don’t frequently use it like anesthesia does. Doing a few tubes a month on curated patients does not make an expert. The anesthesiologist is there to take over if necessary. It’s pretty much an admission that physicians and DA are more trained in delivering anesthetics and handling complications.
I think you’re being “inflammatory and false” by claiming parody of training with anesthesiologists and DA. It’s a completely unreasonable position to take.

You do not have the education, training, or credentials to make statements about OMFS, Dental Anesthesiology, or any other specialties. Stick to GP threads.

 

[yappy]

You do not have the education, training, or credentials to make statements about OMFS, Dental Anesthesiology, or any other specialties. Stick to GP threads.

Where am I wrong?

 

[O.M.F.S.]

You are wrong because you did not receive education, training, or have credentials to make statements about OMFS, Dental Anesthesiology, or any other specialties. Your statements based solely on observations are not facts and do not mean anything. You are more than welcome to comment about pre-dental or GP threads because you have the education, training, and credentials.

 

[Ivy.ch]

My observation is that most oms don’t retain hospital privileges. An ACLS cert is a necessary two day course, but it doesn’t mean anything if you don’t frequently use it like anesthesia does. Doing a few tubes a month on curated patients does not make an expert. The anesthesiologist is there to take over if necessary. It’s pretty much an admission that physicians and DA are more trained in delivering anesthetics and handling complications.
I think you’re being “inflammatory and false” by claiming parody of training with anesthesiologists and DA. It’s a completely unreasonable position to take.

OMS are experts in open airway IV anesthesia management for surgeries within the mouth and surrounding structures on ÅSA 1 and 2 patients. We are prepared for intubation and emergency airway and anesthesia complications if they arise. Who do you think trains us? Anesthesiologists. We know our limitations - patient selection is something we constantly stress in training. None of us are trying show off to anesthesiology.

Working with anesthesia for our bread and butter would be a nightmare. Working with an open airway without a tube, working in an environment with blood and secretions in the mouth, performing procedures that constantly vary in level of stimulation, and not having direct access to the mouth and nose.

Dental anesthesiologists are absolutely experts in what they do. We’re experts in what we do.

I stand by my original comment on this post: The two fields are very very different, so if someone is debating between the two, I think they need to do a lot more shadowing. They both are great. Just very different.

 

[Hockeytalk]

Where am I wrong?

 

[yappy]

View attachment 379578

DK doesn’t apply to me in this conversation. It’s the opposite. I respect anesthesia which is why I use an experienced anesthesiologist to provide anesthetics to my patients. My position is that licensed professionals with the most training in anesthesia are the experts. DK is not being an anesthesiologist or DA and claiming to have equal expertise, in any method.

This is my last comment on this thread, Ive derailed enough. Sorry OP.

 

[Allsmiles!]

DK doesn’t apply to me in this conversation. It’s actually the opposite. I respect anesthesia which is why I use an experienced anesthesiologist to provide anesthetics to my patients. My position is that licensed professionals with the most training in anesthesia are the experts. DK is not being an anesthesiologist or DA and claiming to have equal expertise.

This is my last comment on this thread, Ive derailed enough. Sorry OP. My humble recommendation is to watch an OMS in private practice run a sedation and then watch an anesthesiologist.

Yappy…your post before this one should have been your last comment. You are still trying to make some sort of point which makes no sense and has nothing to do with OP’s original question.

Your final advice was to say, “watch an OMS in private practice run sedation and then watch an anesthesiologist” for what, to see who does sedation better??? That has nothing to do with OP’s question…it’s very obvious that you are upset about something.

@TravisB I think Ivy.ch’s advice was spot on…these two specialties are so, so very different from one another…not even close…do some research and shadow as much as you can and you will gravitate toward one of them…they are both great specialties.

Yappy…”watch an OMS in private practice run sedation and then watch an anesthesiologist” good job on editing your post and removing the above quote 😏

 

[ThirdMolarz]

Hey folks,

Does anyone have any thoughts on deciding between these two fields? It seems there could be a lot of overlap as there is no reason why an anesthesiologist couldn't also do dentoalveolar surgery

Do you enjoy surgery? What’s your experience so far with either

 

[TravisB]

Do you enjoy surgery? What’s your experience so far with either

I've done a fair bit of third molar extractions, alveoloplasties, no implants. I've seen several orthognathic cases. I don't think I would like operating for 6 hours on an orthognathic case. I just like learning in general though and I think it would be great to learn more about the TMJ, esthetics, etc. A big reason I like OMS is because of the anesthesia.

 

[Bupivacaine Bear]

I've done a fair bit of third molar extractions, alveoloplasties, no implants. I've seen several orthognathic cases. I don't think I would like operating for 6 hours on an orthognathic case. I just like learning in general though and I think it would be great to learn more about the TMJ, esthetics, etc. A big reason I like OMS is because of the anesthesia.

Anesthesia is very competitive. It’s very much a who you know type of thing for getting into residency from what I’ve heard. there are just so few spots and programs and popularity has increased quite a bit since it became an officially recognized specialty.

Find the 2024 anesthesia match/interview thread and reach out to some of the people who had interviews. Ask about the process. Try to find a local DA and shadow if your school doesn’t have a program

 

[Allthebags]

I've done a fair bit of third molar extractions, alveoloplasties, no implants. I've seen several orthognathic cases. I don't think I would like operating for 6 hours on an orthognathic case. I just like learning in general though and I think it would be great to learn more about the TMJ, esthetics, etc. A big reason I like OMS is because of the anesthesia.

Putting all the yapping in this thread aside, your takeaway here should be that the two fields have some crossover but are vastly different in daily practice. Ultimately you need to decide if you like surgery or anesthesia more. As an anesthesiologist, I can absolutely guarantee you will not get referrals for typical OS procedures. That being said, there's nothing stopping you as a DA from doing the same surgeries any GP can do; you just can't bill at the specialist level for those procedures, nor can you market yourself as an OS.

 

[TravisB]

Putting all the yapping in this thread aside, your takeaway here should be that the two fields have some crossover but are vastly different in daily practice. Ultimately you need to decide if you like surgery or anesthesia more. As an anesthesiologist, I can absolutely guarantee you will not get referrals for typical OS procedures. That being said, there's nothing stopping you as a DA from doing the same surgeries any GP can do; you just can't bill at the specialist level for those procedures, nor can you market yourself as an OS.

What is stopping an OS from joining an anesthesia group and offering only anesthesia? Let's say they broke their hand and can't operate

 

[deleted1047421]

What is stopping an OS from joining an anesthesia group and offering only anesthesia? Let's say they broke their hand and can't operate

I’m not totally sure on this but, fairly certain our liability malpractice coverage, only applies to anesthesia in relation to omfs where we are sedating our own patients. Plus it wouldn’t make financial sense to do this. That would be a dumb move.

That being said I do have a number of friends who act as the second provider anesthetist when they are under the same roof. I’ve even heard of those who go all out and do inhalational with patients intubated, with two oral surgeons in the room.

 

[DMD12345]

I’m not totally sure on this but, fairly certain our liability malpractice coverage, only applies to anesthesia in relation to omfs where we are sedating our own patients. Plus it wouldn’t make financial sense to do this. That would be a dumb move.

That being said I do have a number of friends who act as the second provider anesthetist when they are under the same roof. I’ve even heard of those who go all out and do inhalational with patients intubated, with two oral surgeons in the room.

Woah cool to the two os thing. But so let’s say your sister who’s a general dentist has a day where a DA comes to their office and does I.V. sedation but they call in sick last minute, and you have the day off and are a begrudgingly good brother. So you wouldn’t be able to come over and run the I.V.s for her?

 

[deleted1047421]

Woah cool to the two os thing. But so let’s say your sister who’s a general dentist has a day where a DA comes to their office and does I.V. sedation but they call in sick last minute, and you have the day off and are a begrudgingly good brother. So you wouldn’t be able to come over and run the I.V.s for her?

No I wouldn’t do it.
None of my colleagues would do it.

A lot of us have done it once for a general dentist and we’d never do it again.

 

[dentalinthemental]

No I wouldn’t do it.
None of my colleagues would do it.

A lot of us have done it once for a general dentist and we’d never do it again.

Is it just because of liability?