Oral and Maxillofacial Surgeons (OMS) are surgical specialists focusing on complex procedures involving the craniofacial region. Their expertise encompasses the hard and soft tissues of the mouth, face, jaws, and neck. They treat diseases, injuries, and defects in this anatomical area, serving as a bridge between medicine and dentistry. This specialization requires extensive post-doctoral training, qualifying them to manage conditions from routine tooth extractions to major facial reconstruction.
Professional Scope and Training
The path to becoming an Oral and Maxillofacial Surgeon begins with four years of dental school, resulting in a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree. Following this, the aspiring surgeon must complete a minimum of four to six years of rigorous, hospital-based surgical residency training.
The residency involves rotations in general surgery, internal medicine, and anesthesiology, providing a broad medical foundation for managing complex patients. The training emphasizes evaluating patient health and developing comprehensive surgical and anesthetic plans. Some OMS professionals opt for a six-year track that includes obtaining a Medical Doctor (MD) degree alongside their surgical certificate.
Board certification through the American Board of Oral and Maxillofacial Surgery (ABOMS) is an optional credential. Achieving this Diplomate status requires successfully passing a qualifying written examination and a practical oral certifying examination after completing residency. This certification demonstrates a surgeon’s specialized knowledge and commitment to maintaining the highest standards of care.
Standard Surgical Procedures
Many patients first encounter an OMS for common procedures. The removal of impacted third molars, commonly known as wisdom teeth, is a frequent procedure due to their position near sensitive structures.
The difficulty of this extraction often relates to the tooth’s proximity to the inferior alveolar nerve (IAN), which provides sensation to the lower lip and chin. When the tooth roots are in close contact with the IAN canal, the risk of temporary or permanent nerve injury can increase, requiring advanced surgical techniques and specialized imaging like Cone-beam CT.
In high-risk cases, a procedure called coronectomy may be performed, which removes the crown while intentionally leaving the root fragments to minimize the chance of nerve damage. The OMS must also manage the risk to the lingual nerve, which provides sensation to the tongue.
Dental implant placement is another routine procedure where the OMS inserts a titanium fixture directly into the jawbone. This fixture acts as an artificial tooth root, which the body’s bone tissue integrates with through a process called osseointegration. Often, bone grafting is required first to ensure the jawbone has sufficient volume and density to support the implant.
Pre-prosthetic surgery involves modifying the hard and soft tissues of the mouth to create a stable base for dentures or other prosthetic devices. Procedures like alveoloplasty, which smooths and reshapes the jaw ridge after tooth extraction, are performed to prevent painful pressure points. The removal of excess bony growths, such as torus palatinus (on the roof of the mouth) or lingual tori (on the lower jaw), is also common to ensure proper prosthetic fit and comfort.
Addressing Complex Conditions and Reconstruction
Oral and Maxillofacial Surgeons manage severe facial trauma, acting as first responders in emergency room settings for injuries to the facial skeleton. They treat fractures of the mandible (lower jaw), maxilla (upper jaw), zygomas (cheekbones), and orbits (eye sockets). The goal of treatment is anatomic reduction, precisely realigning the fractured bone segments, followed by stable fixation using small titanium plates and screws, a technique known as rigid internal fixation.
Corrective jaw surgery, known as orthognathic surgery, is performed to realign the jaws to improve function, facial aesthetics, and dental occlusion for patients with severe skeletal discrepancies. Common procedures include the Le Fort I osteotomy, which separates and repositions the tooth-bearing segment of the maxilla. The Bilateral Sagittal Split Osteotomy (BSSO) is used to advance or set back the mandible.
The OMS also diagnoses and surgically manages cysts and tumors within the jaws, which can be odontogenic (arising from tooth-forming tissues) or non-odontogenic. Treatment ranges from simple enucleation, the complete removal of a cyst, to aggressive surgical resection for certain tumors like ameloblastoma. When a large section of the jawbone is removed, the surgeon often performs immediate reconstruction, sometimes using microvascular free flaps and bone grafting to restore the jaw’s integrity.
Surgical intervention for severe temporomandibular joint (TMJ) disorders is reserved for cases where conservative treatments have failed. Minimally invasive TMJ arthroscopy uses a small camera and instruments to examine the joint, remove scar tissue, or flush the joint space, offering a quicker recovery. For more advanced damage, open-joint surgery may be necessary to repair, reposition, or even replace the joint.
Anesthesia and Sedation Management
OMS residency training includes mandatory rotations on the medical anesthesiology service, where they learn to manage airways, establish intravenous access, and monitor patients alongside physician anesthesiologists. This training qualifies them to administer all forms of pain and anxiety control safely in an outpatient setting.
Sedation levels range from local anesthesia, which numbs the surgical site while the patient remains fully awake, to inhaled minimal sedation using nitrous oxide. For more involved procedures like complex extractions, intravenous (IV) sedation is commonly used, which induces a state of deep relaxation and amnesia, often referred to as “twilight sleep.” This method allows for precise control of the sedative level since the medication is delivered directly into the bloodstream.
OMS are also qualified to administer general anesthesia in their accredited offices for complex or lengthy procedures. The safety of in-office anesthesia is maintained through strict protocols, specialized monitoring equipment, and certified surgical staff. This extensive training ensures patient comfort and allows for a broad range of surgical procedures to be performed efficiently outside of a hospital operating room.