Gems from Med School as an OMFS resident

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Couldn't agree more ^

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@bld @GimmeTheScalpel @amali

I don't have anything against OMS. It's a great specialty filled with talented people. I just like to keep things real. The OMS residents and wanna-bes on this forum spread a lot of misinformation about the practice of OMS. You guys are smoking a crack pipe.

Here is a gem from the real world: the largest OMS group in my city restrict their practice to third molar removal and implants. They will not even take a patient for sialolith treatment. After calling around I cannot find an OMS office that will manage it. I referred that patient to ENT who did. So when I hear discussions about OMS performing facial plastic surgery, instead of a fellowship trained PRS, I cannot resist commenting. I have the same hate for the "airway" dentists that steer patients away from real sleep physicians to manage OSA. Please, keep things real. Get off the pipe.
 
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I don't have anything against OMS. It's a great specialty filled with talented people. I just like keeping things real. The OMS residents and wanna-bes on this forum spread a lot of misinformation about the practice of OMS. You guys are smoking a crack pipe.

Here is a gem from the real world: the largest OMS group in my city restrict their practice to third molar removal and implants. They will not even take a patient for sialolith treatment. After calling around I cannot find an OMS office that will manage it. I referred that patient to ENT who did. So when I hear discussions about OMS performing facial plastic surgery, instead of a fellowship trained PRS, I cannot resist commenting. I have the same hate for the "airway" dentists that steer patients away from real sleep physicians to manage OSA. Please, keep things real. Get off the pipe.
This is unbelievably ignorant. One OMS group in your city only does t&t so that’s what all OMS do? We’ve been through this. It’s stupid, and this isn’t the place.

I’ll pitch in one from when I was rotating on medicine recently. A patient was admitted to our service who had a bunch of dental problems. The admitting resident introduced me as the “OFMS” student who was learning to be an orthodontist. I just smiled, but inside I was screaming.
 
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@bld @GimmeTheScalpel @amali

I don't have anything against OMS. It's a great specialty filled with talented people. I just like to keep things real. The OMS residents and wanna-bes on this forum spread a lot of misinformation about the practice of OMS. You guys are smoking a crack pipe.

Here is a gem from the real world: the largest OMS group in my city restrict their practice to third molar removal and implants. They will not even take a patient for sialolith treatment. After calling around I cannot find an OMS office that will manage it. I referred that patient to ENT who did. So when I hear discussions about OMS performing facial plastic surgery, instead of a fellowship trained PRS, I cannot resist commenting. I have the same hate for the "airway" dentists that steer patients away from real sleep physicians to manage OSA. Please, keep things real. Get off the pipe.
That is not the purpose of this specific thread. You are free to think whatever you want but please direct your comments elsewhere or make a new thread.
 
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@bld @GimmeTheScalpel @amali

I don't have anything against OMS. It's a great specialty filled with talented people. I just like to keep things real. The OMS residents and wanna-bes on this forum spread a lot of misinformation about the practice of OMS. You guys are smoking a crack pipe.

Here is a gem from the real world: the largest OMS group in my city restrict their practice to third molar removal and implants. They will not even take a patient for sialolith treatment. After calling around I cannot find an OMS office that will manage it. I referred that patient to ENT who did. So when I hear discussions about OMS performing facial plastic surgery, instead of a fellowship trained PRS, I cannot resist commenting. I have the same hate for the "airway" dentists that steer patients away from real sleep physicians to manage OSA. Please, keep things real. Get off the pipe.
There are omfs trained surgeons who do amazing facial cosmetic work. But you’ll never see a periodentist who does cosmetic surgery. Oms as a specialty opens doors for those that like surgery. Perio closes them.

“They hate us because they ain’t us”
 
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There are omfs trained surgeons who do amazing facial cosmetic work. But you’ll never see a periodentist who does cosmetic surgery. Oms as a specialty opens doors for those that like surgery. Perio closes them.

“They hate us because they ain’t us”
Residency in a nutshell. Dentistry imo is the best career out there, regardless of specialty
 
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I would never go to an OMS over a PRS for plastic surgery. I agree with the periodontist.
Do you even know what plastic surgery entails?? Are you talking about plastic surgery or cosmetic surgery they are very different man.

You do know that less than half of plastic surgeons actually do aesthetic surgery. The general public including general dentists do not know what plastic surgery is. Cosmetic surgery is a small concentration within plastic surgery and a fellowship in itself. It was only until medical school where I did a plastic surgery rotation that I saw their full scope. Also more and more omfs are becoming head neck trained where they can raise free flaps and rotational flaps which is what plastic surgery actually is - it’s reconstruction for defects, damaged areas etc. OMFS do some of the best reconstructions of the oral cavity because we are able to place implants into the fibula which is only restricted to our specialty.

On top of this, people choose to do dentoalveolar because it is the most lucrative thing you can do and they have no interest in “plastic” surgery. It does not mean the opportunity to do other things doesn’t exist. There’s tons of fellowships for the extended scope procedures.
 
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Here’s my favorite: When I was a resident, doing a medicine rotation, one of the M.D. medicine residents said to me “…so, orthodontics… That’s sort of like optometry, right?”

It will never change. You can spend all the time in the world trying, but you will never educate the medical community as to what you do, or what your dental degree means.

Having said that, I have heard neither such benign nor malignant ignorance for 25 years. In my hospital, I am the one they call with any life-threatening head and neck infections or maxillofacial fractures. They are grateful that I will come see and operate on the patient. We get paid very poorly for this, if at all, so nobody really wants to do it.

But my mom told me I would have to put up with this and do this if I got into this profession.
 
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We had some OMFS residents join us for some classes during my medical school, and now there are OMFS residents/service at my residency hospital. I don’t totally understand the full scope of when all exactly to refer to you guys despite having had some shared patients. However, some posts in this thread are ridiculous for the level of ignorance.
 
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We had some OMFS residents join us for some classes during my medical school, and now there are OMFS residents/service at my residency hospital. I don’t totally understand the full scope of when all exactly to refer to you guys despite having had some shared patients. However, some posts in this thread are ridiculous for the level of ignorance.
Trying to answer the scope question as quickly as possible:

In US, at vast majority of hospital institutions;
  • facial trauma including frontal bone fractures, all mid-face, maxilla, mandible. Soft tissue injuries to the face
  • odontogenic infections, pretty much handling it on our own wherever it's spread unless it's gotten into the mediastinum
  • dental "clearance" (usually extracting remainder of teeth) for inpatients with bacterial endocarditis, awaiting organ transplants etc etc
  • osteomyelitis/osteoradionecrosis, medication related osteonecrosis of the maxilla, mandible
  • tempromandibular joint pathology
  • benign pathology of head and neck
  • orthognathic surgery
  • initial diagnosis and local excision of head and neck cancer
  • outpatient dentoalveolar surgery (bread and butter of clinic)
At some hospital institutions
  • head and neck oncology w/reconstruction (shared with or in lieu of PRS or ENT)
  • pediatric craniofacial surgery (shared with or in lieu of PRS, NSGY)
  • cranial vault, thyroidectomy, laryngectomy type stuff (limited to certain broader scope institutions, minority of places)
  • facial cosmetic surgery (rhinos, blephs, facelelift), again limited to a smaller number of places

Private practice outpatient office setting
  • dentoalveolar surgery (dental implants, extractions) w/ or w/o IV sedation
  • management of some trauma, TMJ, benign pathology, cosmetic stuff
  • a lot of people in lieu of contributing to trauma call at a hospital will be a part of an outpatient surgery center for longer cases/inappropriate case selection for in office sedation so that they can have a separate anesthesia provider for the case. Others will have a CNRA, DA come in to their office if it's not an OR case, but something they still want a second provider for (I know this last bullet could be a contentioius point of discussion but just trying to answer your question)
At al lot of places, OMFS shares trauma with PRS and ENT. Think of the three as a venn diagaram of some sorts.

A negative (one of the very few in my opinoin) of OMFS is that the training quality, depth, and breadth can be so variable from institution to instiution when it comes to things outside our normal bread and butter. For obvious reasons this can be an issue, but it also helps taint our perception among medical colleagues because there are so few of us and so many of them. If MDs train somewhere where the OMFS residents aren't held to the same expectation as the other residents who are on the service the OMFS is currently rotating with, it's easy to view them as incompetent or not well trained. Whereas at instiutions where OMFS is included and held accountable (and this usually comes with more collegial respect between attendings), patient care and interdepartment communication is better, and the MD grows up to remember "yeah those OMFS people were hard core they knew their stuff"

Apologies for any typos
 
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Trying to answer the scope question as quickly as possible:

In US, at vast majority of hospital institutions;
  • facial trauma including frontal bone fractures, all mid-face, maxilla, mandible. Soft tissue injuries to the face
  • odontogenic infections, pretty much handling it on our own wherever it's spread unless it's gotten into the mediastinum
  • dental "clearance" (usually extracting remainder of teeth) for inpatients with bacterial endocarditis, awaiting organ transplants etc etc
  • osteomyelitis/osteoradionecrosis, medication related osteonecrosis of the maxilla, mandible
  • tempromandibular joint pathology
  • benign pathology of head and neck
  • orthognathic surgery
  • initial diagnosis and local excision of head and neck cancer
  • outpatient dentoalveolar surgery (bread and butter of clinic)
At some hospital institutions
  • head and neck oncology w/reconstruction (shared with or in lieu of PRS or ENT)
  • pediatric craniofacial surgery (shared with or in lieu of PRS, NSGY)
  • cranial vault, thyroidectomy, laryngectomy type stuff (limited to certain broader scope institutions, minority of places)
  • facial cosmetic surgery (rhinos, blephs, facelelift), again limited to a smaller number of places

Private practice outpatient office setting
  • dentoalveolar surgery (dental implants, extractions) w/ or w/o IV sedation
  • management of some trauma, TMJ, benign pathology, cosmetic stuff
  • a lot of people in lieu of contributing to trauma call at a hospital will be a part of an outpatient surgery center for longer cases/inappropriate case selection for in office sedation so that they can have a separate anesthesia provider for the case. Others will have a CNRA, DA come in to their office if it's not an OR case, but something they still want a second provider for (I know this last bullet could be a contentioius point of discussion but just trying to answer your question)
At al lot of places, OMFS shares trauma with PRS and ENT. Think of the three as a venn diagaram of some sorts.

A negative (one of the very few in my opinoin) of OMFS is that the training quality, depth, and breadth can be so variable from institution to instiution when it comes to things outside our normal bread and butter. For obvious reasons this can be an issue, but it also helps taint our perception among medical colleagues because there are so few of us and so many of them. If MDs train somewhere where the OMFS residents aren't held to the same expectation as the other residents who are on the service the OMFS is currently rotating with, it's easy to view them as incompetent or not well trained. Whereas at instiutions where OMFS is included and held accountable (and this usually comes with more collegial respect between attendings), patient care and interdepartment communication is better, and the MD grows up to remember "yeah those OMFS people were hard core they knew their stuff"

Apologies for any typos
The military is heavy on facial cosmetics
 
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Here’s my favorite: When I was a resident, doing a medicine rotation, one of the M.D. medicine residents said to me “…so, orthodontics… That’s sort of like optometry, right?”

It will never change. You can spend all the time in the world trying, but you will never educate the medical community as to what you do, or what your dental degree means.

Having said that, I have heard neither such benign nor malignant ignorance for 25 years. In my hospital, I am the one they call with any life-threatening head and neck infections or maxillofacial fractures. They are grateful that I will come see and operate on the patient. We get paid very poorly for this, if at all, so nobody really wants to do it.

But my mom told me I would have to put up with this and do this if I got into this profession.
These are the things we need in the community.

I had a patient with an mandibular odontogenic infection. I placed him on antibiotics and told him to come back in 3 days. He returned and the edema was significantly larger, and it had moved inferiority and medially with severe trismus. I was immediately worried about a deep space infection or Ludwig’s Angina. I called a number of my local OMFS and they were all “too busy.” As you mentioned, it pays poorly. So I sent him immediately to the closest academic OMFS program which has a good reputation. I wrote a very detailed referral and the patient was seen immediately with lots of attention, he didn’t just sit around in the ER. He ended being admitted for 4 days and required both intraoral and extraoral drainage, as well as IV abx. I am a general dentist so this care was well beyond my scope because I am not trained to manage this sort of situation.
Anyway he got better and I received feedback from the program that it was a great case for the residents. The program director himself was involved because they were monitoring his airway. Most importantly the patient didn’t die and was happy I sent him to the program to be treated.
 
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These are the things we need in the community.

I had a patient with an mandibular odontogenic infection. I placed him on antibiotics and told him to come back in 3 days. He returned and the edema was significantly larger, and it had moved inferiority and medially with severe trismus. I was immediately worried about a deep space infection or Ludwig’s Angina. I called a number of my local OMFS and they were all “too busy.” As you mentioned, it pays poorly. So I sent him immediately to the closest academic OMFS program which has a good reputation. I wrote a very detailed referral and the patient was seen immediately with lots of attention, he didn’t just sit around in the ER. He ended being admitted for 4 days and required both intraoral and extraoral drainage, as well as IV abx. I am a general dentist so this care was well beyond my scope because I am not trained to manage this sort of situation.
Anyway he got better and I received feedback from the program that it was a great case for the residents. The program director himself was involved because they were monitoring his airway. Most importantly the patient didn’t die and was happy I sent him to the program to be treated.
My friend, you saved his life.

Actually, it is an honor to treat these patients. Call is not punishment.

And I forgot to say that the patients and their families are grateful.

So, it doesn’t bother me anymore if certain people, even the physicians, look down on dentistry.
 
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These are the things we need in the community.

I had a patient with an mandibular odontogenic infection. I placed him on antibiotics and told him to come back in 3 days. He returned and the edema was significantly larger, and it had moved inferiority and medially with severe trismus. I was immediately worried about a deep space infection or Ludwig’s Angina. I called a number of my local OMFS and they were all “too busy.” As you mentioned, it pays poorly. So I sent him immediately to the closest academic OMFS program which has a good reputation. I wrote a very detailed referral and the patient was seen immediately with lots of attention, he didn’t just sit around in the ER. He ended being admitted for 4 days and required both intraoral and extraoral drainage, as well as IV abx. I am a general dentist so this care was well beyond my scope because I am not trained to manage this sort of situation.
Anyway he got better and I received feedback from the program that it was a great case for the residents. The program director himself was involved because they were monitoring his airway. Most importantly the patient didn’t die and was happy I sent him to the program to be treated.
if you were to look back at the case would you have referred him day 1 instead of rx and wait?
 
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if you were to look back at the case would you have referred him day 1 instead of rx and wait?
I would’ve handled this case the same. If his swelling was more advanced on day 1 when I saw him then yes, immediate referral. As we all know every case is different. Based on the location of the infxn and the symptoms, I didn’t think it was something that needed referral right away. I don’t have the case in front of me but I think I did more than just amox. I believe I may have rx’d a medrol dose pack as well.

Anyway I didn’t want to alarm the patient and didn’t think it needed to be referred immediately. I applied first line tx with very close monitoring, which is why I had him come back in 3 days and not 1 week.

After speaking with his treating doctors, they all agreed on my handling of the case. They said they would have rx’d the same thing and had him come back in 3 days. Not one person said I should have sent him in right away.
 
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I have seen thousands of patients who had this exact initial, primary care management, and their swelling diminished between when they saw their dentist and when they saw me.

Your seeing them back in three days was excellent judgment.

And the fact that you were persistent in finding a referral shows great leadership.

I take back every negative thing I’ve ever said about you.

This person is alive and well right now because of your leadership.
 
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Back to topic, when I was an OMS resident, one of the medical residents said to me “orthodontics, that’s like optometry, right?”

And, in the most professional fashion that I could muster, I said “No, to be an orthodontist, you have to go to four years of dental school followed by 2 to 3 years of a residency. And it is extremely competitive to get into that training. You have to be at the top of your class. Orthodontists are the smartest people in dentistry….just ask them.”
 
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Back to topic, when I was an OMS resident, one of the medical residents said to me “orthodontics, that’s like optometry, right?”

And, in the most professional fashion that I could muster, I said “No, to be an orthodontist, you have to go to four years of dental school followed by 2 to 3 years of a residency. And it is extremely competitive to get into that training. You have to be at the top of your class. Orthodontists are the smartest people in dentistry….just ask them.”

I read optometry and thought Ophthalmology which is kinda like orthodontics, very good work life balance

But yeah definitely not optometry
 
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