So You Want To Be an Oral and Maxillofacial Surgeon?

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So you want to be an oral and maxillofacial surgeon. You’re an overachiever that isn’t satisfied with just being a dentist and want the extra degree of surgical expertise. Let’s debunk the public perception myths and give it to you straight. This is the reality of oral and maxillofacial surgery.

 

What is Oral and Maxillofacial Surgery?

Oral and maxillofacial surgery, or OMFS for short, is a subspecialty of dentistry that focuses on the surgical management of the face, jaw, and oral cavity.

When most people think of OMFS, the first things that come to mind are wisdom teeth extractions and dental implants. Although these are a large part of what an OMFS does, their actual scope is much broader.

To start, all OMF surgeons are trained extensively in administering anesthesia. They learn everything from establishing and maintaining intravenous lines, to managing airways, to performing endotracheal intubation.

They are also taught how to manage any complications or emergencies that might occur during anesthesia administration. For this reason, it is very common for OMFS in the outpatient setting to simultaneously serve two roles – being both surgeon and anesthetist.

The surgical scope of OMFS also goes beyond what many expect. OMF surgeons perform a variety of reconstructive and corrective surgeries both individually and as a part of an interdisciplinary healthcare team. When treating oral and oropharyngeal cancers, for example, an OMF surgeon may work alongside a plastic surgeon and a head and neck trained ENT to remove the lesion and reconstruct the area.

They also perform a variety of corrective jaw surgeries to treat issues resulting from facial deformities, TMJ disorder, or malocclusions. A great example of this is orthognathic surgery where they manipulate the positioning of the maxilla and mandible to treat conditions like malocclusion and sleep apnea.

Additionally, they can perform emergent surgeries for life-threatening conditions such as Ludwig’s angina.

Like other surgical specialties, OMFS split their time between procedures and consultations. Those that work in an academic center will further divide their time between academic responsibilities such as teaching and research.

This brings us to an important method of differentiating an OMF surgeon’s practice.

Academic vs Private Practice

In the academic setting, OMF surgeons will on average see more complex and emergent cases compared to the community or private practice settings. Presenting concerns include severe head and neck infections, orbital floor fractures with extraocular muscle entrapment, and gunshot wounds to the face – all of which require immediate surgical intervention.

True emergencies like these are rare though and at most hospitals, facial trauma call is split between some combination of OMFS, plastic surgery, and ENT.

Community practices are few and far between.

The majority of OMF surgeons work in private practice. Here they will typically see less complexity compared to the academic setting. In general, they will also receive higher compensation and have greater flexibility in their hours.

For this reason, it is common for many OMF surgeons in academia or community to only work part-time and split their time with private practice.

Misconceptions About OMFS

OMFS is an often misunderstood field. Many people associate it with just pulling teeth; however, the procedures that an OMFS performs can be complex and have a significant impact on their patient’s day-to-day life.

It’s not uncommon to confuse OMFS, ENT, and plastic surgery given the high degree of overlap.

While somewhat of an oversimplification, think of ENT surgeons as the masters of complex work deep inside the head and neck region, such as cancer resections.

Think of plastic surgeons as masters of soft tissue, from one end of the spectrum helping ENTs with coverage after cancer resection through complex flaps, to pioneering facial aesthetics on the other end.

And think of OMFS as the masters of anything related to the teeth or temporomandibular joint (TMJ).

 

How to Become an OMFS

The path to OMFS starts with completing dental school.

After dental school, there are two pathways to becoming an OMFS: the four-year program and the six-year dual degree program. Both will certify you to practice as an oral and maxillofacial surgeon; however, the six-year degree will also grant you an MD.

In terms of the curriculum between four and six-year degree programs, there is a high degree of variability depending on the particular program.

In general, six-year degree programs will have longer surgical rotations plus added time spent on medical school coursework. In fact, with these added obligations it’s very much possible that six-year degree programs will give you less oral surgery experience than four-year programs.

OMFS is competitive as a dental school specialty. Applicants to both 4- and 6-year programs tend to be at the top of their class during dental school.

It is also the only dental specialty that requires studying for and taking the Comprehensive Basic Science Exam (CBSE) which is essentially an abbreviated USMLE Step 1 Exam. The average CBSE score for students accepted into OMFS programs is 68.9 which is equivalent to about 195 to 200 on USMLE Step 1.

So in addition to studying for dental exams and dental boards like everyone else, OMFS aspirants will need to additionally prepare for this test.

According to data from the National Matching Service, in 2021, only approximately 48% of applicants matched into either four- or six-year OMFS residency programs. Applicants that don’t match the first time around have three options.

The first, and increasingly common option, is to do a non-categorical internship year offered by an OMFS residency program and apply again. Alternatively, they can spend this gap year practicing dentistry or completing a one-year general practice residency before applying again.

The good news is that dental school is more attainable than medical school. The average dental school matriculant has a GPA of 3.5 and a composite DAT score of 20 which is around the 75th percentile. In comparison, the average MD matriculant will have a GPA of 3.7 and MCAT score of 511 which is in the 88th percentile.

 

Subspecialties within OMFS

After completing OMFS residency, you can further subspecialize with fellowship. That being said, most fellowship-trained surgeons will still perform basic OMFS procedures as well.

There are three main fellowship options: Head and Neck Oncology, Facial Cosmetics, and Cleft and Craniomaxillofacial Surgery.

Head and Neck Oncology

Head and neck oncology is a 2-year fellowship focusing on the ablation and reconstruction of malignant tumors of the head and neck, with special attention to the oral cavity, salivary glands, and maxillofacial complex. This fellowship also provides training in microvascular reconstruction.

Of note, this fellowship is more commonly completed by ENT surgeons than by OMFS.

Facial Cosmetics

Facial cosmetics is a one-year fellowship that provides additional experience with facial cosmetic procedures including facelift, blepharoplasty, and rhinoplasty.

Cleft and Craniomaxillofacial Surgery

Cleft and craniomaxillofacial surgery is a one-year fellowship providing surgical experience in treating cleft lip and palate, craniofacial surgery, and other major facial deformities.

Of note, most craniofacial fellowship-trained surgeons are plastic surgeons.

 

What You’ll Love About OMFS

There’s a lot to love about the field of oral and maxillofacial surgery.

OMF surgeons see the full spectrum of patients: from young to old and healthy to sick. The types of cases that they see are also, for the most part, fairly routine. Procedures like dental extractions, dental implants, biopsies, infections, arthrocentesis, guided bone regeneration, and trigger point injections are the bread and butter of OMFS.

Like most other surgical specialties, OMFS offers near-instant gratification and treatment of ailments. Whether relieving pain from TMJ disorder or restoring function through dental implants and orthognathic surgery, most OMFS procedures have favorable outcomes and mortality is low.

Job satisfaction is high amongst OMF surgeons. In one survey, approximately 84% reported satisfaction with their career and 77% reported they would choose a career in OMFS again.

OMF surgeons are highly compensated, even with respect to other specialized dental and medical fields, making an average of $465,000 per year. It’s important to note that the majority of OMFS work in private practice, and those working in academic or community settings will typically receive lower compensation.

Private practice also provides greater independence, which often translates to prioritizing shorter and more straightforward cases to boost compensation.

 

What You Won’t Love About OMFS

That being said, OMFS is not for everyone.

The private practice route, which is common amongst OMFS, requires running a business and the additional administrative work and complexity that is associated with that.

Like many other surgical specialties, the training to become an OMF surgeon is long and comes with additional opportunity cost. Unlike the medical school pathway, residency isn’t required after dental school. That means rather than going out to practice as a general dentist and making a solid income, you’ll instead be committing an additional 4 to 6 years for OMFS residency.

OMFS residency is also highly competitive, with only 48% of applicants getting accepted each cycle.

Diversity in the field has historically been lacking with regard to gender. The field is 87% dominated by men. This has started to change in recent years with higher proportions of female students being accepted into OMFS residencies; however, as it stands now, the reality is that most OMF surgeons are men.

 

Should You Become an OMFS?

At the end of the day, how can you decide if OMFS is a good fit for you? If you’re set on working in the oral and maxillofacial region then OMFS can be a great fit.

If your life outside of medicine is important to you, OMFS can provide the flexibility to perform surgery while still having time for your own family and interests.

If you love camaraderie and pride yourself in being a leader amongst leaders, you will appreciate the fact that general dentists and dental specialists will often turn to you for your help and advice.

That being said, you should only pursue OMFS if you are truly certain you want to work in the oral and maxillofacial region.

Over 50% of medical students end up changing their minds about what specialty to pursue during medical school. Since OMFS requires going to dental school instead of medical school, your options are limited if you decide OMFS isn’t for you. Going the medical school route can offer you more flexibility while still allowing you to do similar work as an ENT surgeon.

Big shout out to Dr. Michael Benichou, OMFS resident at Brooklyn Hospital Center, for helping me in the creation of this video.

If you enjoyed this article, please check out our So You Want to Be an Otorhinolaryngologist (ENT) and Plastic Surgeon pieces.

If you’d like to see what being an OMFS looks like, check out my second YouTube channel, Kevin Jubbal, M.D., where we’ll have a day-in-the-life episode of an OMFS in the future.

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