OMFS is really just OS

[thewingman]

Looking at majority of “OMFS” in the local area, most of them, with exception of a few, are doing general extractions, grafting, biopsies (without even treatment, with most cases being referred to the program in town), under sedation. Aside from the couple of surgeons doing jaw and TMJ cases, majority are just doing basic oral surgery. Is this the case where you practice as well? Was all that training just a waste to do only these basic procedures?

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[Big Time Hoosier]

Was all that training just a waste to do only these basic procedures?

Should have just done perio and saved at least a year and a lot of stress. 😉

Big Hoss

 

[rotichawal]

Seems to be the case. Might be controversial, but with everyone and their mother doing t&t now, I don't see the point in doing OMFS if you have no interest in the MF procedures.

 

[bergus95]

Sedation

 

[PerioDont]

Should have just done perio and saved at least a year and a lot of stress. 😉

Big Hoss

Why hello

 

[aaaaa]

Looking at majority of “OMFS” in the local area, most of them, with exception of a few, are doing general extractions, grafting, biopsies (without even treatment, with most cases being referred to the program in town), under sedation. Aside from the couple of surgeons doing jaw and TMJ cases, majority are just doing basic oral surgery. Is this the case where you practice as well? Was all that training just a waste to do only these basic procedures?

Just curious. Why do you assume that’s all they do? Have you asked if they take trauma call or do orthognathic or tmj surgery?

 

[thewingman]

Just curious. Why do you assume that’s all they do? Have you asked if they take trauma call or do orthognathic or tmj surgery?

Hi,

I actually have asked if the have hospital privileges. About half of them don’t. Of the other half, only 3 have stated that they do non-dental cases in the OR. This is in a major metro area too.

 

[Gustavo dos Santos]

Sedation

Out of curiosity, what’s the going hourly rate for a CRNA or dental anesthesiologist?

 

[D1Bound]

Should I grab a bag of popcorn for this thread?

 

[yappy]

Looking at majority of “OMFS” in the local area, most of them, with exception of a few, are doing general extractions, grafting, biopsies (without even treatment, with most cases being referred to the program in town), under sedation. Aside from the couple of surgeons doing jaw and TMJ cases, majority are just doing basic oral surgery. Is this the case where you practice as well? Was all that training just a waste to do only these basic procedures?

Yes. This is why I decided not to enter the field.

Also, I question the therapeutic value/ benefit of surgeries like TMJ and orthognathics, except in extreme and rare circumstances.

 

[bld]

Should have just done perio and saved at least a year and a lot of stress. 😉

Big

Better yet, save a year and a lot of stress and do peds or endo. Or even better, don’t specialize at all. Best option of all, don’t do dental school!

 

[bld]

Yes. This is why I decided not to enter the field.

Also, I question the therapeutic value/ benefit of surgeries like TMJ and orthognathics, except in extreme and rare circumstances.

So, you didn't go into OS because all they do is minor procedures, or because the bigger surgeries aren't good? Getting mixed messages here. The stupid in this thread is reaching critical levels.

 

[D1Bound]

With anything I think actual experts in the subject matter should be speaking on this, which is not me but I'll slap a comment in. OMS do a lot of TnT, but I've spoken to at least one who does "full scope" in a group practice.

 

[bergus95]

everyone wants to do high paying procedures with relatively low stress. That is why T&T are the bread and butter of OMFS. You can looks at every specialty and say that there are procedures that are more commonly performed for that very reason. A heavy orthognathics/TMJ/path driven practice is usually a financial sacrifice.

 

[charlestweed]

Should have just done perio and saved at least a year and a lot of stress. 😉

Big Hoss

With the OS title, it’s easier for you to market your practice and to get more referrals from the general dentists than with the perio title. There are also more associate jobs available for OS than for perio. Therefore, I think it’s worth spending the extra year(s) in school and dealing with the extra stress during the residency training to become an OS.

 

[Phineas_Gage]

There’s a lot more need and demand for wisdom teeth and implants than there is for orthognathic surgery and broken jaws. We should all be thankful for that

 

[schmoob]

With anything I think actual experts in the subject matter should be speaking on this, which is not me but I'll slap a comment in. OMS do a lot of TnT, but I've spoken to at least one who does "full scope" in a group practice.

Oh, you’ve met one.

 

[aaaaa]

Oh, you’ve met one.

What’s with the snide comment from an administrator? Seems weird

If there is a large metro where almost no oms do trauma and orthognathic I’d be shocked. Maybe in the Midwest?

I’m an oms and most oms I know at least do some trauma/orthognathic/tmj. From my perspective there is a much greater need for dental extractions on sick patients, wisdom teeth and dental implants which is PART of the reason some don’t do bigger hospital cases. If your busy in your office all day and never in the hospital eventually you won’t feel comfortable doing a total joint replacement, pan facial fracture, etc. If you are in dentistry and you like doing only surgery (more than wisdom teeth and dental implants) oral surgery is a great option. If you want to be a hospital based surgeon doing crazy life saving/changing surgeries every week it’s a little more difficult to do that. There are absolutely some OMS doing life changing and life saving surgeries in the hospital every week but the route to do that is a lot harder than just going to med school to become an MD surgeon. If you're in dental school and just want to do surgery and no crowns/fillings/etc oms is a great option.

 

[Captain Underplants]

Yes. This is why I decided not to enter the field.

Also, I question the therapeutic value/ benefit of surgeries like TMJ and orthognathics, except in extreme and rare circumstances.

Basically the same, didn't date Megan Fox because she wouldn't understand my dental stories at the end of the day....

Funny to see a bunch of non-OMFS commenting about what makes a successful OMFS.

A majority of private practive OMFS wills tar toff their career taking on a bunch of trauma call, and have hospital privileges and will slowly phase it out as they start wanting to enjoy life rather than make an extra grand or ten. Sure there are some who only want to do implants and teeth, but I'd be shocked if they're still not doing sedations, basic trauma (closed reduciton in office), or some 1st stage TMJ treatment.

 

[Advance]

if an OMFS wants to limit their practice to TnT what’s the problem with that? If they have the referrals to keep busy doing it sounds like a sweet deal to me.

 

[bangity]

Shouldn't judge unless you have done the training. Even then still don't judge. When people get a little older, they want to enjoy their time with their families.

Know that I won't use the majority of my training in 10 years but the experiences (saving lives, airway call) make me appreciate things a lot more.

 

[nealofgrafton]

saw a great example of this at Guard drill today. Kid had a unilateral condylar fracture fixed by PRS. he has elastics and hybrid arch bars on. unilateral elastics on the contralateral side to the condylar fracture. he has a unilateral posterior open bite on the side of the fracture
"your dentist can 'shave' some teeth down to get your bite 'right' again"
-woof
dear all of you OMFS'ers please keep hospital privilege's and at least offer to help with some of the facial trauma.

 

[yappy]

So, you didn't go into OS because all they do is minor procedures, or because the bigger surgeries aren't good? Getting mixed messages here. The stupid in this thread is reaching critical levels.

I decided not to do OMS because it wasn't for me. I did a lot of shadowing at my DS department, took the CBSE, and did externships. My impression was that the procedures that were most critical were the removal of teeth/pus, biopsy, implant placement in the edentulous, and trauma. However, I was disappointed that the bigger OR cases were often elective and had questionable therapeutic value. I couldn't see myself performing those big cases on patients because of the risk associated with surgery, and the healing that is necessary, VS the questionable therapeutic benefit.
To contrast, I can easily see how a cardiac surgeon justifies TAVR, but the issues that most OS treat are not age related and don't involve organs like the heart. The case volume for life saving/extending surgery just isn't there in OMS unless you go the path less traveled, and less available, like a cancer academic career. To me the 4-6 years of extra training didn't justify itself. I am happy with my career decision and do a lot of tooth removal and implant placement in my general practice. This is a bigger discussion, but I think there is a movement in healthcare towards doing what you're competent in rather than what "turf" your specialty claims. That's especially true in dentistry because we're in an outpatient environment.

 

[0rgansm]

I decided not to do OMS because it wasn't for me. I did a lot of shadowing at my DS department, took the CBSE, and did externships. My impression was that the procedures that were most critical were the removal of teeth/pus, biopsy, implant placement in the edentulous, and trauma. However, I was disappointed that the bigger OR cases were often elective and had questionable therapeutic value. I couldn't see myself performing those big cases on patients because of the risk associated with surgery, and the healing that is necessary, VS the questionable therapeutic benefit.
To contrast, I can easily see how a cardiac surgeon justifies TAVR, but the issues that most OS treat are not age related and don't involve organs like the heart. The case volume for life saving/extending surgery just isn't there in OMS unless you go the path less traveled, and less available, like a cancer academic career. To me the 4-6 years of extra training didn't justify itself. I am happy with my career decision and do a lot of tooth removal and implant placement in my general practice. This is a bigger discussion, but I think there is a movement in healthcare towards doing what you're competent in rather than what "turf" your specialty claims. That's especially true in dentistry because we're in an outpatient environment. Hopefully I've cleared up the "mixed messages" and have not reached that critical "stupid" level.

Where did you extern

 

[rotichawal]

I decided not to do OMS because it wasn't for me. I did a lot of shadowing at my DS department, took the CBSE, and did externships. My impression was that the procedures that were most critical were the removal of teeth/pus, biopsy, implant placement in the edentulous, and trauma. However, I was disappointed that the bigger OR cases were often elective and had questionable therapeutic value. I couldn't see myself performing those big cases on patients because of the risk associated with surgery, and the healing that is necessary, VS the questionable therapeutic benefit.
To contrast, I can easily see how a cardiac surgeon justifies TAVR, but the issues that most OS treat are not age related and don't involve organs like the heart. The case volume for life saving/extending surgery just isn't there in OMS unless you go the path less traveled, and less available, like a cancer academic career. To me the 4-6 years of extra training didn't justify itself. I am happy with my career decision and do a lot of tooth removal and implant placement in my general practice. This is a bigger discussion, but I think there is a movement in healthcare towards doing what you're competent in rather than what "turf" your specialty claims. That's especially true in dentistry because we're in an outpatient environment.

I’m glad that you’re happy with your career choice, but if you think that elective maxillofacial cases = questionable therapeutic value, then you’re very misinformed

 

[GoDental101]

I’m glad that you’re happy with your career choice, but if you think that elective maxillofacial cases = questionable therapeutic value, then you’re very misinformed

Not exactly…there’s a huge opportunity cost associated with those surgeries and sometimes the results just don’t justify the cost, sometimes they do, but he is definitely justified in his thinking imo

 

[rotichawal]

Not exactly…there’s a huge opportunity cost associated with those surgeries and sometimes the results just don’t justify the cost, sometimes they do, but he is definitely justified in his thinking imo

It's a matter of perspective. Paresthesia is a horrible outcome for a patient going to a GP for example. Not as bad for a patient getting a huge amelo resected, or an OSA patient if MMA reduces the likelihood of him kicking it at 50 from heart disease. And to the point about case volume not being there, it most definitely is. Doing it profitably though is another matter, and a point I have no problem conceding.

 

[702]

I’m glad that you’re happy with your career choice, but if you think that elective maxillofacial cases = questionable therapeutic value, then you’re very misinformed

Completely agree. Was about to ask him questions about his ideas but don’t know where to start.

 

[Hockeytalk]

Looking at majority of “OMFS” in the local area, most of them, with exception of a few, are doing general extractions, grafting, biopsies (without even treatment, with most cases being referred to the program in town), under sedation. Aside from the couple of surgeons doing jaw and TMJ cases, majority are just doing basic oral surgery. Is this the case where you practice as well? Was all that training just a waste to do only these basic procedures?

I decided not to do OMS because it wasn't for me. I did a lot of shadowing at my DS department, took the CBSE, and did externships. My impression was that the procedures that were most critical were the removal of teeth/pus, biopsy, implant placement in the edentulous, and trauma. However, I was disappointed that the bigger OR cases were often elective and had questionable therapeutic value. I couldn't see myself performing those big cases on patients because of the risk associated with surgery, and the healing that is necessary, VS the questionable therapeutic benefit.
To contrast, I can easily see how a cardiac surgeon justifies TAVR, but the issues that most OS treat are not age related and don't involve organs like the heart. The case volume for life saving/extending surgery just isn't there in OMS unless you go the path less traveled, and less available, like a cancer academic career. To me the 4-6 years of extra training didn't justify itself. I am happy with my career decision and do a lot of tooth removal and implant placement in my general practice. This is a bigger discussion, but I think there is a movement in healthcare towards doing what you're competent in rather than what "turf" your specialty claims. That's especially true in dentistry because we're in an outpatient environment.

A lot of clearly misinformed opinions here.
Many ENT surgeons do not do head and neck oncology after residency. Some go into peds ENT so they can do ear tubes all day every day which is most lucrative.
Some plastic surgeons go purely into hand surgery or purely into facial cosmetics, or craniofacial. Some just do breast all day every day because its analogous to teeth and titanium for them.
Orthopedic surgeons do spine surgery in residency but many don't do it after residency.
Many family medicine residents never step foot in a hospital after residency.
Many medical residents do things in residency they will never do after graduation, nothing wrong with that.
I have seen multiple IV drug users get valve replacements all while they refuse other cares and are very likely to abuse again. Do you think these noble cardiothoracic surgeons cares? Did their PA or NP do the consult and largely tee them up for the OR so they can cut all day every day and maximize DRGs? Idk and I do wonder.


At the end of the day follow the money. Go see what a new associate makes as a GP, perio, ortho, OMFS. Look at job opportunities. Think what procedures are in demand.

elective and had questionable therapeutic value.

I am sure insurance companies would love to hear your expert opinion so they can make more money not covering procedures. I cannot wait for your publication in JOMS next month.

 

[yappy]

Not exactly…there’s a huge opportunity cost associated with those surgeries and sometimes the results just don’t justify the cost, sometimes they do, but he is definitely justified in his thinking imo

It's almost like talking to orthospine surgeons about the benefit of spinal fusions VS conservative therapy for low back pain. The data is out there, but some people practice in a way where they want to sell their "solution" to the problem. Take the OSA comment that was just made, surgery is not the preferred treatment, but don't try to convince a surgeon of that.

Many of the responses I'm getting are silly. I shared my thought process and decision making to the OP because I thought it may be beneficial to them or someone else who reads it. Surgery is cool but at the end of the day it's about helping people, and helping them make the right medical decision, even if that means no surgery. Dentistry has an off ramp before OS, unlike the medical training that @Hockeytalk was referencing. You can do implants and extractions with the right training as a GP, or as a periodontist, without having to do surgeries in residency that you'll never do again in the future. I don't think my decision to not go into OMS were based on "misinformed opinions". Ironically, it appears I have more informed opinions than many of the surgeons on here. OMS is a great specialty, but I think it's worth considering what most surgeons do day-in-day-out beyond residency.

 

[D1Bound]

A lot of clearly misinformed opinions here.
Many ENT surgeons do not do head and neck oncology after residency. Some go into peds ENT so they can do ear tubes all day every day which is most lucrative.
Some plastic surgeons go purely into hand surgery or purely into facial cosmetics, or craniofacial. Some just do breast all day every day because its analogous to teeth and titanium for them.
Orthopedic surgeons do spine surgery in residency but many don't do it after residency.
Many family medicine residents never step foot in a hospital after residency.
Many medical residents do things in residency they will never do after graduation, nothing wrong with that.
I have seen multiple IV drug users get valve replacements all while they refuse other cares and are very likely to abuse again. Do you think these noble cardiothoracic surgeons cares? Did their PA or NP do the consult and largely tee them up for the OR so they can cut all day every day and maximize DRGs? Idk and I do wonder.


At the end of the day follow the money. Go see what a new associate makes as a GP, perio, ortho, OMFS. Look at job opportunities. Think what procedures are in demand.


I am sure insurance companies would love to hear your expert opinion so they can make more money not covering procedures. I cannot wait for your publication in JOMS next month.

Your last statements are what draws me in. Job opportunity and demand? People tell me Oral surgery NEVER loses, thus peaking my interest.

 

[rotichawal]

Ironically, it appears I have more informed opinions than many of the surgeons on here.

Textbook Dunning-Kruger my man.

 

[gryffindor]

Just curious. Why do you assume that’s all they do? Have you asked if they take trauma call or do orthognathic or tmj surgery?

When I was early in my practice, there was a month where 3 local OMS stopped by with business cards and food. I asked each of them if they did orthognathic or took certain less desirable insurances. The answers were exactly the same - "No we don't do orthognathic surgery and we only accept the better paying PPOs." It took me like 5 or 6 years to finally make reliable connections of where I could send my patients for orthognathic surgery. I really only have a choice of 2 surgeons/groups in my area and we have almost 4 million people here. And basically both of those groups are connected to the OMS residency programs. I think there might be 2 other offices/groups but I haven't gone searching anymore since I found these two.

 

[bld]

Take the OSA comment that was just made, surgery is not the preferred treatment, but don't try to convince a surgeon of that.

Not first line treatment no, but in patients refractory to other methods, surgical or otherwise, MMA is extremely effective. No surgeon will think their solution is first line, but when it is indicated it is life saving. There's protocol and sequence with clinical judgement that goes into deciding when surgery is needed, and no good surgeon makes that decision lightly.

the bigger OR cases were often elective and had questionable therapeutic value

You've made this point a few times. What do you mean questionable therapeutic value? If you mean they don't save someone's life, then I suppose I agree that some OMS surgeries aren't life saving. But that's a poor measure of outcome for therapeutic value. The vast majority of patients who have undergone orthognathic surgery are very satisfied with the surgery and would say that it dramatically improved their quality of life. That seems like a pretty good outcome that is worth the training. If we talk about TMJ surgery, that can have a massive impact on a patient's quality of life. Giving somebody the ability to eat food they love is a great service.

I decided not to do OMS because it wasn't for me.

This is the correct answer. You didn't want to do OMS, and that's fine. I have a problem with you saying that what OMS does isn't beneficial. I think core OMS is a great service to patients and can back it up with both data and anecdote. And I know many private practice Oral Surgeons will essentially lose money on these bigger cases to do them precisely because they are a huge service to the patient.

Ironically, it appears I have more informed opinions than many of the surgeons on here.

Nope.

 

[Don'tSleep]

It's almost like talking to orthospine surgeons about the benefit of spinal fusions VS conservative therapy for low back pain. The data is out there, but some people practice in a way where they want to sell their "solution" to the problem. Take the OSA comment that was just made, surgery is not the preferred treatment, but don't try to convince a surgeon of that.

Many of the responses I'm getting are silly. I shared my thought process and decision making to the OP because I thought it may be beneficial to them or someone else who reads it. Surgery is cool but at the end of the day it's about helping people, and helping them make the right medical decision, even if that means no surgery. Dentistry has an off ramp before OS, unlike the medical training that @Hockeytalk was referencing. You can do implants and extractions with the right training as a GP, or as a periodontist, without having to do surgeries in residency that you'll never do again in the future. I don't think my decision to not go into OMS were based on "misinformed opinions". Ironically, it appears I have more informed opinions than many of the surgeons on here. OMS is a great specialty, but I think it's worth considering what most surgeons do day-in-day-out beyond residency.

I was hesitant to respond at first, but this is getting pretty ridiculous. This is a perfect example of the Dunning-Kruger effect. There are numerous high level peer reviewed publications directly contradicting Yappy's statements. It is perfectly fine if you didn't personally like the procedures, but to say that they are essentially without justification is absurd. Please do your own research. Just to get you started, off the top of my head, here are some world renowned sources about the things you stated were of "questionable therapeutic value" from non-OMFS. I can think of a lot of OMFS literature as well, but I'd hate to be accused of bias. Where I went to dental school, the OMFS faculty constantly impressed upon us that one of the most important jobs of a surgeon is to know when not to cut. If you had a different experience, that is unfortunate.

- William Proffit (orthodontist) - if you read his work and still question orthognathic surgery, I give up.
- Anything from Stanford Sleep Center Protocol for OSA treatment.

edit: Just saw rotichawal's previous post. Glad to know I wasn't the only one thinking that 🤣

 

[AfterEffects]

Is there a possibility that Yappy is uninformed because we as OMFS professionals are not doing a good job informing our dental peers and the general public?
I can't tell you how many of my dental school classmates don't even know what orthognathic surgery is. Or on an even more basic level, the literature supporting the prophylactic removal of 3rds.

 

[D1Bound]

Is there a possibility that Yappy is uninformed because we as OMFS professionals are not doing a good job informing our dental peers and the general public?
I can't tell you how many of my dental school classmates don't even know what orthognathic surgery is. Or on an even more basic level, the literature supporting the prophylactic removal of 3rds.

I was hesitant to respond at first, but this is getting pretty ridiculous. This is a perfect example of the Dunning-Kruger effect. There are numerous high level peer reviewed publications directly contradicting Yappy's statements. It is perfectly fine if you didn't personally like the procedures, but to say that they are essentially without justification is absurd. Please do your own research. Just to get you started, off the top of my head, here are some world renowned sources about the things you stated were of "questionable therapeutic value" from non-OMFS. I can think of a lot of OMFS literature as well, but I'd hate to be accused of bias. Where I went to dental school, the OMFS faculty constantly impressed upon us that one of the most important jobs of a surgeon is to know when not to cut. If you had a different experience, that is unfortunate.

- William Proffit (orthodontist) - if you read his work and still question orthognathic surgery, I give up.
- Anything from Stanford Sleep Center Protocol for OSA treatment.

edit: Just saw rotichawal's previous post. Glad to know I wasn't the only one thinking that 🤣

Okay I've been holding back but I think it is time to pull out the popcorn

 

[Rambunctious]

What’s with the snide comment from an administrator? Seems weird

If there is a large metro where almost no oms do trauma and orthognathic I’d be shocked. Maybe in the Midwest?

I’m an oms and most oms I know at least do some trauma/orthognathic/tmj. From my perspective there is a much greater need for dental extractions on sick patients, wisdom teeth and dental implants which is PART of the reason some don’t do bigger hospital cases. If your busy in your office all day and never in the hospital eventually you won’t feel comfortable doing a total joint replacement, pan facial fracture, etc. If you are in dentistry and you like doing only surgery (more than wisdom teeth and dental implants) oral surgery is a great option. If you want to be a hospital based surgeon doing crazy life saving/changing surgeries every week it’s a little more difficult to do that. There are absolutely some OMS doing life changing and life saving surgeries in the hospital every week but the route to do that is a lot harder than just going to med school to become an MD surgeon. If you're in dental school and just want to do surgery and no crowns/fillings/etc oms is a great option.

why they allowed this person to be an administrator is beyond me. a lot of snide, rude, opinionated comments

 

[yappy]

@bld and @Don'tSleep thank you for your thoughtful replies. Everyone benefits from more experienced people such as yourself commenting. My assessment of these larger surgeries, like orthognathics is subjective. I'm not saying the techniques are not sound, or that your patients have bad results (although I see relapse is relatively common). I'm glad to hear that your patients are satisfied with their decision to get surgery. My issue with OS was that I did not feel comfortable exposing patients to the surgical, anesthesia, and perioperative risks associated with the elective surgeries in the specialty. That is what I meant by questionable therapeutic benefit. The risk:benefit just didn't make sense to me. We're both in agreement that OS is not the field for me. The cases that got me excited about the specialty, and why I really considered it, were space infections and trauma. But at my externships most of the OR experience was made up of orthognathic surgery while I was there. Turns out you really cannot build a career of those things. After a lot of soul searching I realized that it's a great specialty for someone but not a good fit for me.

Edit: I’m not misinformed. There is no need to insult me by saying I'm stupid, don’t know anything about surgery, or focus too much on teeth. I've read Peterson, most of Fonseca and did a few externships.

 

[GimmeTheScalpel]

Yes. This is why I decided not to enter the field.

Also, I question the therapeutic value/ benefit of surgeries like TMJ and orthognathics, except in extreme and rare circumstances.

You don’t think TMD should be treated surgically or that jaw surgery should be performed for malocclusion or sleep apnea? Best to just not say some stuff.

 

[Eli Manning]

I totally agree with some of the above comments. What you will run across with general dentists is that they do not know what they do not know. Yappy simply does not know anything about OMS or surgery in general for that matter. This person states they do not understand the value of these surgeries; however, any OMS can tell you that the benefits are profound.
I also question whether Yappy has even crossed paths with a patient who would benefit from these surgeries and I would suspect that Yappy has many times. But because of Yappy's limited education in the realm of surgery, they are unable to identify who these patients are. And this is unfortunate bc these patients could have been properly referred for needs that Yappy is simply unable to identify.
Which is the case with a lot of general dentists. They may see a patient who has a severe class III skeletal malocclusion but without the proper education they are unable to notice it bc they are too focused on the teeth and not the overall occlusion, how it might be corrected, and who the proper specialists are to refer to.

 

[Big Time Hoosier]

Yeah, but can an OMFS do a pulp and crown on a 4-year-old with only minimal nitrous sedation? Didn't think so.

Closing thread.

Big Hoss

 

[Big Time Hoosier]

Closing thread.

One day I shall have the power. One day...

Big Hoss

 

[2TH MVR]

There will always be a difference in opinions from those in the academic environment vs. those in real life. Of course .... orthognathic surgery has therapeutic value. But in MY world ... what I see is many variables associated with this highly complex procedure making it ....... less popular. Some of these variables are mostly associated with lack of proper compensation for both the orthodontist and OMFS. Insurance companies dictating whether they will cover a single jaw, double jaw or multi-piece jaw surgeries thereby severely affecting the occlusal outcome post-surgery. IMO successful orthognathic surgery requires BOTH ortho and OMFS to work together. I've had situations where my patient requires orthognathic surgery. Was referred to my practice for the pre-surgical ortho .... then .... against my wishes .... chose an OMFS on their insurance plan that I had no history with. I've ALWAYS worked with one OMFS who does many surgeries. I've seen his work and he is the only OMFS I wanted my patients to see. Every patient that used a different surgeon .... had a less than ideal outcome which led to me spending additional time trying to correct the malocclusion post surgery.

I am a big fan of dentofacial orthopedics. A majority of skeletal issues can be improved if treated at the right age. Right or wrong .... my emphasis when I see a young growing patient with a skeletal disharmony is what can I do to eliminate the need for future orthognathic surgery. Isn't that common sense? Surgery is expensive for families. Invasive. The other issue is that growing child will have to endure their entire childhood life living with a skeletal malocclusion waiting for complete growth in order to do surgery. Of course ... there are those patients that will always need the surgery.

I work for a DSO now. We do NO ortho related orthognathic cases. NONE. Not my decision, but Corps. I'm glad though.

One of my best friends is an OMFS. I referred everything to him. A number of years ago .... he told me that he no longer wanted to treat my orthognathic surgery cases. He told me there were just too many headaches associated with orthognathics.

 

[ShortShortsDad]

God damn there is a lot of ignorance here.

As a military OMS I’ve had multiple people join the military for the sole reason of getting orthognathic surgery. Poor kids with legitimate deformities willing to spend a year getting shot at overseas to get fixed. It’s humbling to be able to serve them and literally change their lives.

Once I leave for private practice I probably won’t be able to do the fully custom no-expense-spared cases but I’ll still try to serve the community when my ortho asks.

 

[deleted1047421]

God damn there is a lot of ignorance here.

As a military OMS I’ve had multiple people join the military for the sole reason of getting orthognathic surgery. Poor kids with legitimate deformities willing to spend a year getting shot at overseas to get fixed. It’s humbling to be able to serve them and literally change their lives.

Once I leave for private practice I probably won’t be able to do the fully custom no-expense-spared cases but I’ll still try to serve the community when my ortho asks.

Well said.

Orthognathic surgery has a major benefit for patients, period.
The ability to provide an immediate functional and cosmetic improvement to a patient is one of the most rewarding feelings and sense of accomplishment a surgeon can have.
With a severe facial skeletal deformity with significant skeletal jaw discrepancy, corrective treatment will be unsuccessful with orthodontics alone. Corrective jaw surgery will absolutely be needed.

For those orthodontists who have had mixed results with orthognathic surgery, perhaps they have not worked with an experienced surgeon who uses medical modeling (virtual surgical planning). The advancements in treatment planning will allow both surgeon and orthodontist to presurgically plan to correct a facial asymmetry, not just the occlusion. The results are highly predictable and successful. Also with a more experienced and well trained surgeon, the better the surgical outcomes and ability to achieve an optimal immediate post op occlusion (for example more comfortable performing a multi piece Le fort).

I’ve met many patients who were initial good candidates for orthognathic surgery (class 3 malocclusion), and had gone through unsuccessful orthodontic treatment only (midlines off, facial asymmetry, relapse from poorly planned unstable orthodontic camouflage) and had to redo everything (including finding a new orthodontist). In the end they were alway extremely pleased after corrective jaw surgery.

 

[deleted1047421]

Looking at majority of “OMFS” in the local area, most of them, with exception of a few, are doing general extractions, grafting, biopsies (without even treatment, with most cases being referred to the program in town), under sedation. Aside from the couple of surgeons doing jaw and TMJ cases, majority are just doing basic oral surgery. Is this the case where you practice as well? Was all that training just a waste to do only these basic procedures?

I can’t speak on behalf of every oral surgeon, but I do know a lot.

Many omfs I know maintain privileges and take call at a local hospital (trauma and infections).

Even if a surgeon chose not to perform major surgery routinely, their training is hardly considered a waste.

Their training allows them to manage surgical complications.

I’ve seen many post operative complications from other dental providers.

Here are some common examples:
1) tooth root dislodged into the sublingual space in the floor of the mouth from unsuccessfully trying to extract lower wisdom teeth
2) air emphysema
3) uncontrollable bleeding from attempting to extract impacted wisdom teeth
4) deep space infections
5) implants displaced into the sinus cavity
6) root tips dislodged into the sinus
7) Mronj s/p extractions and inappropriate placement of implants in these patients
I’ve even seen some of these providers accompany their patients and show up to the er literally begging to have their patients treated.

 

[Big Time Hoosier]

Their training allows them to manage surgical complications.

This is a big thing. Always better to be over prepared than under prepared. You never know when it’ll hit the fan...

Big Hoss

 

[Sublimazing]

Looking at majority of “OMFS” in the local area, most of them, with exception of a few, are doing general extractions, grafting, biopsies (without even treatment, with most cases being referred to the program in town), under sedation. Aside from the couple of surgeons doing jaw and TMJ cases, majority are just doing basic oral surgery. Is this the case where you practice as well? Was all that training just a waste to do only these basic procedures?

I’m a 6 year OMFS and i 100% agree. I joined a practice that let’s me go to the OR every 1-2 weeks with a double/triple jaw or total joint replacement because i wanted to do actual surgery.

honestly doing 4 and especially 6 years of OMFS to only do 3rds and implants is personally baffling to me. If you’re content to make money sitting in your office doing dental alveolar then it seems crazy to me to punish yourself for 4-6 years.

 

[bergus95]

I’m a 6 year OMFS and i 100% agree. I joined a practice that let’s me go to the OR every 1-2 weeks with a double/triple jaw or total joint replacement because i wanted to do actual surgery.

honestly doing 4 and especially 6 years of OMFS to only do 3rds and implants is personally baffling to me. If you’re content to make money sitting in your office doing dental alveolar then it seems crazy to me to punish yourself for 4-6 years.

What does the rest of your practice do? The Or every 1-2 weeks sounds like the ideal setup