Why Settle on a Smile? Think Outside the Mouth

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American specialists Ranch & Coast explore an Oral Maxillofacial Surgery career

Cosmetic dentistry isn’t new – professional whitening, veneers and teeth straightening are all standard procedures in the quest for a better smile. But why stop at a smile when you can sculpt facial aesthetics?

Traditional oral surgery treats problems inside the mouth – impacted wisdom teeth, root canals or crowns. But there is a broader scope and the industry, especially dental students, is beginning to explore its potential.

Oral maxillofacial surgery combines cosmetic outcomes with surgical reconstruction to restore function, repair damage and enhance facial appearance.

What is Oral Maxillofacial Surgery?

According to the American Dental Association, oral maxillofacial surgery is a medical specialty that includes the diagnosis and surgical response to facial trauma, birth defects or damage to the face, head, jaw, neck and mouth.

Certified Oral Maxillofacial Surgeons are qualified to address soft tissue injuries, as well as damage to bone and the underlying facial structure. Their skills are life-changing for patients who have suffered through debilitating facial trauma or lived with congenital birth defects such as a cleft palate.

The Cosmetic Side

The skills of an oral maxillofacial surgeon can be applied to patients looking for improved facial aesthetics as well as reconstructive repairs. This specialty can perform surgeries that might conventionally be thought of as plastic surgery:

• Reshaping the Nose
• Ear Surgery
• Chin Reduction or Extension
• Lip Lift
• Liposuction along the Jaw or Neck
• Cheek Implants

Along with surgical procedures, there is a growing market for minimally invasive cosmetic procedures such as Botox, dermal fillers and laser treatments.
Though dentists and dentistry students may not have seen this specialty as a step into cosmetic facial enhancement – it’s a lucrative and growing market.

Beauty in Demand

In the same way that braces pay off with a self-confident smile, cosmetic procedures can have a huge impact on patient’s lives. The 2018 Plastic Surgery Statistics report by American Society of Plastic Surgeons documents the following:

17.7 million cosmetic procedures
1.8 million cosmetic surgery procedures
15.9 million cosmetic minimally invasive procedures.
5.8 million reconstructive procedures

We should note that the majority of the cosmetic surgical procedures tend toward body shaping – breast augmentation and liposuction. Nose reshaping was the most common cosmetic facial procedure in 2018 with 214,000 procedures, down by 1% from the previous year.

Facial aesthetic procedures are trending strongly toward the minimally invasive procedures. From a revenue perspective, this has significant potential. New practices or younger dentists still building a clientele can offer cosmetic services that require repeat visits and can be administered by qualified staff.
Note the 225% jump in volume from 2000 to 2018.

Any oral maxillofacial surgeon can easily build a secondary revenue track by offering treatments that reduce or hide wrinkles, plump lips, improve skin elasticity and youthfulness.

Reconstructive Surgery Trends

The Plastic Surgery report documents 5.8 million reconstructive procedures in the United States in 2018. The majority were for tumour removal or laceration repair. But over 204,000 procedures for maxillofacial repair were documented.
The report also notes that maxillofacial surgeries have increased by 158% since the year 2000.

It should be stated that the data for maxillofacial surgeries is not specific to the face. For example, though the report shows 4.4 million tumour removals – a pathological condition covered by OMS procedure – they are not distinguished by location on the body.

That said, the two tracks of reconstructive and cosmetic procedures offer an interesting, challenging and financially rewarding career opportunity.

Careers in Oral Maxillofacial Surgery

The American Dental Association’s Health Policy Institute provides statistics in a number of areas. One is a look at the number of dentists practicing in general practice and dental specialties.

The following is a look at dental practices for the past five years.



It's interesting to note the small number of oral and maxillofacial pathology specialists, given 4.4 million tumour removal procedures in the Plastic Surgery Report. Even though those data were not constrained to the face or head area, the practice area still appears to be underserved.
The question that might be asked of oral and maxillofacial surgery practitioners is what percentage of patients are reconstructive vs cosmetic?

OMS Education & Credentials

An oral and maxillofacial surgeon is not a medical doctor (MD), but all are either a Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DDM) or the equivalent degree from a four-year course of study.

Before acceptance into dentistry school, undergraduate study of two or four years is required, according to the American College of Oral and Maxillofacial Surgeon.

Next is a four-year residency training – six if pursuing a medical degree. This is typically followed by board examinations and certification in the specialty. Overall, the OMS specialty requires between 12 and 14 years in school.

A Challenging Field

According to dental education data from the ADA, though the number of enrollees in OMS programs continue to grow, the number of graduates remains reasonably flat. Based on the figure below, only 22.77% of enrollees complete the program and graduate.

Total Enrollment and Graduates in Oral and Maxillofacial Surgery Programs, 2008-09 to 2018-19



Comparing OMS to General Practice

General Dentistry: The forecast for dentistry is strong. Without qualification by specialty, the dentistry field is projected to grow at 19.1% by 2026.

Growth Projections



From a salary perspective, it should be no surprise that dentist offices deliver the highest wages, well ahead of the second and third categories as seen in Figure 3. According to these data, the average wage of a general dental practitioner is just over $173,135 in 2017.

Highest Paying



The American Dental Association offers data on a number of topics, including practice and income statistics. Remembering the Census data indicated an average annual income of $173,135 for 2017, the income data for dental specialists show a significant differential.

The average annual income for an oral and maxillofacial surgeon is $448,140. Rounding the two numbers to the nearest thousand – the income of an OMS is 158.96% higher than a general practitioner.



Note as well that even the first quintile (lowest percentile of wage earners) is $200,000 – roughly $17,000 more than the general dentistry number, rising up to $600,000 in the highest quintile.

It is interesting as well to compare the income for practicing endodontists and oral maxillofacial surgeons. Though they both start in the first quintile at $200,000 – the differential in the third quintile is significant - $600,000 to $375,000. This drives down the median income for the endodontists.

The Bureau of Labour Statistics provides specific data on the OMS specialty, forecasting an employment increase of 9.1% and a rise in wages of 4.1%.

Summary and Insights

The specialty of oral maxillofacial surgery combines two distinct options for dentists. The growing market for cosmetic enhancement is a low-effort, easy-entry vehicle to offer dental patients add-on services.

The built-in intimacy of the patient relationship makes cosmetic services a good fit. One appointment, multiple treatments – come for a cleaning and get your lips plumped.

Reconstruction

From a surgical standpoint, the cosmetic side shouldn’t be ignored, but isn’t likely to be a primary focus.

Here is an abbreviated list of surgical practices from The American Association of Oral Maxillofacial Surgeons:
• Correction of Maxillofacial Skeletal Deformities
• Orthognathic Surgery
• Cleft and Craniofacial Surgery
• Maxillofacial Trauma
• Pathologic Conditions
• Reconstructive and Cosmetic Surgery

Your surgical skills will always have a place in trauma medicine where the need goes beyond aesthetics and clamours for function.

Prepare Yourself

The rigours of pursuing oral maxillofacial surgery as a profession require a strong commitment, with a minimum of 12 to 14 years in school and residency. The dropout rate is high, and enrolees should make sure they have sufficient supports – socially and financially.

For those who stay, oral maxillofacial surgery is a fulfilling, exciting and financially rewarding career.

For a breakdown of the latest data, see Ranch and Coast Plastic Surgery's article, click HERE.

Sources:

ADA Dental Specialty Definitions: https://www.ada.org/en/ncrdscb/dental-specialties/specialty-definitions

2018 Plastic Surgery Report: American Society of Plastic Surgeons https://www.plasticsurgery.org/news/plastic-surgery-statistics

ADA Practice Type Data https://www.ada.org/en/science-research/health-policy-institute/data-center

ADA OMS Enrolment vs Graduation: https://www.ada.org/en/science-research/health-policy-institute/data-center/dental-education

Dentistry Graphs https://datausa.io/profile/soc/dentists
• BLS Statistics by Occupation, Growth
• Census Bureau ACS PUMS 1-Year Estimate

ADA Dental Income: https://www.ada.org/en/science-research/health-policy-institute/data-center/dental-practice

OMS Procedure Types: American College of Oral and Maxillofacial Surgeon. https://www.acoms.org/page/What_is_an_OMS

Editor's note: The information supplied covers the USA market. What is the situation in the UK?