The surgical specialty that counts as dentistry in one country, medicine in another
In the United States, the surgeons who rebuild shattered jaws, repair cleft palates and remove head and neck cancers are formally dental specialists; a medical degree is optional. In Britain and most of Europe the same job demands degrees in both medicine and dentistry. Oral and maxillofacial surgery is unusual in never settling on one identity.
The field covers what surgeons call the craniomaxillofacial complex: the mouth, jaws, face, skull, head and neck. Its work ranges from removing impacted wisdom teeth and fitting implants fused into bone, to orthognathic surgery, literally straight jaw, which repositions the jaws to correct deformity or treat sleep apnoea. It also includes cancer operations with microvascular reconstruction, in which tissue with its own blood vessels is moved to rebuild the face, plus fracture repair and cosmetic procedures such as rhinoplasty and facelifts.
Trauma makes these surgeons essential in emergencies. Roughly 20 to 25 per cent of trauma patients have facial injuries, from broken cheekbones and eye sockets to jaw fractures, and they need expert assessment quickly.
Training paths diverge sharply. American residencies last four or six years after dental school; six-year programmes, which emerged in the early 1990s, often add a medical degree, and about half of US programmes are dual-degree, compared with two-thirds in Canada. All told, post-secondary education typically takes 12 to 14 years, and some surgeons add a further fellowship. In Asia the field is generally a dental specialty, while Australia and New Zealand require both degrees. Some countries are shifting: Norway dropped its dual-degree requirement in favour of a medical degree alone from 2019, while in Poland most trainees are still dental graduates. The University of Alabama at Birmingham even runs a route letting medical graduates earn the dental degree needed to enter residency.
The US has roughly 9,000 such surgeons, represented by the American Association of Oral and Maxillofacial Surgeons, and their specialty is one of fourteen surgical fields recognised by the American College of Surgeons. It is demanding work, and well rewarded: a 2008 figure put average annual income at $568,968, among the highest of any surgical specialty.
Source: Oral and maxillofacial surgery
