Oral and Maxillofacial
Oral and maxillofacial is seen as the bridge between
medicine and dentistry and even requires a degree in both to become an oral and
maxillofacial surgeon. It is the diagnosis and treatment of diseases affecting
the mouth, jaws, neck and face and includes the management of the hard and soft
tissues in these areas. More complicated cases are usually referred here from
dentists. Patients come here are with varied cases such as salivary gland
diseases, facial disproportion (imbalance between upper and lower jaws), facial
pain, impacted teeth, facial injuries, head and neck cancers, cysts and tumours
of the jaw as well as other issues that can affect the oral mucosa such as
mouth ulcers and infections. Oral and maxillofacial surgery requires a degree
in both dentistry and medicine. There are two pathways that can be taken. Those
who have a degree in dentistry spend one year in a dental practice, followed by
an oral and maxillofacial job before applying to medical school. Those who have
a medical degree either enter core surgical training and then dental school or
vice versa. After achieving a medical and dental degree, core surgical training
and are registered with the general medical council and the general dental
council, you are eligible for specialist training.
During my work experience at an oral and maxillofacial unit
I realised how many different applications of dentistry there actually are. I
shadowed a dental consultant, an orthodontist, the trauma clinic, a restorative
consultant and surgery. It made me more certain on my choice in dentistry as I
realised how much I enjoyed being in that environment. There is a core team
that works together incredibly well to make every patients appointment as
efficient and calm as possible. Many people are uncomfortable at the dentist
and it was really nice to see how every member on the team worked to make it
relaxed for them through the dentist explaining procedures as detailed as
possible; so they understand everything fully; and the nurses sorting out the
work space to make it as clear as possible and engaging in conversation to
distract the patients. It was really inspirational when a patient would come in
distressed about a certain problem and the dentists were always able to help
them as much as possible until they left satisfied with the result. It made me
realise that dentistry is a lot of problem solving and that through spending
just 10 minutes with one patient you can give them so much more confidence with
their smile. You could see how stressful an environment it was with so many
patients to see in a day with so many varied cases but the dentists always
spoke to me avidly about how they loved the challenge. It made me realise that
even though dentistry is a very intense profession it is worth it for the
excitement of being challenged and the satisfaction of having helped someone.
The difference between a dental practice and oral and
maxillofacial unit is that only at the hospital can operations requiring
general anaesthetic be undertaken as an anaesthetist is required. Therefore
major complex surgery occurs here such as cancer and major trauma to skull
base. At a dental practice they can do procedures such as tooth extraction and
fillings but if there is a difficulty in a patient then it may be referred to
the hospital. An example would be if a dentist extracted a wisdom tooth but it
cracked and some of the root remains in the gum. This is a more difficult task
so some dentists refer them to the hospital. The training for the two is also different
as both dentists and oral and maxillofacial surgeons have to complete a
university degree in order to perform general dental treatment but to work at
the hospital they would need to also complete a medical degree and specialty
training to carry out the more intricate surgeries.
During my work experience I shadowed a dental consultant who
dealt with patients that had been referred to the hospital by their regular
dental practice. The dental consultant saw many patients that all had very
different cases. The first patient needed a teeth extracting, however has necrosis
(death of a portion of tissue due to disease, injury or loss of blood supply). The
lack of blood supply in the area meant that the gum may not heal properly after
removal and might cause further decay and need long term antibiotics to treat
it with. The necrosis was due to alendronic acid prescribed for the treatment
of osteoporosis. The tooth desperately needed to be removed so the dentist
booked a pre-op for an extraction under local anaesthetic. Another patient had
a permanent tooth behind a primary tooth. The dentist had to decide the most
appropriate method to remove the primary tooth. And another patient had holes
in their back teeth and their sinuses were being affected. This shows how
varied and more complex the cases were at the hospital.
For a couple days I observed an orthodontist. Most of the
patients were young and were being assessed for their need for braces or the
adjustment of them or the removal. There was however one older patient who had
a case of sleep apnoea that was thought to be caused due to the tongue being
too far back in the throat which reduced breathing. The orthodontist had to decide whether
orthognathic surgery would help the condition. Healing from the surgery can be
more difficult in older patients and there is a higher risk of nerve damage.
The orthodontist had to be able to assess very different cases as well as give
different treatments in the same day. There was little time between patients
but the orthodontist was able to remain calm and deal with each patient with
her utmost patience and attention. When I asked her why she wanted to
specialise as an orthodontist she told me about how she’d looked into the other
areas of dentistry but this is what interested her the most. She’d had braces
as a child which sparked her initial interest and she saw braces and teeth
alignment as a puzzle that she had the chance to solve.
I witnessed multiple tooth extractions in dental surgery at
the hospital. I saw biopsy’s (mouth tissue removal under local anaesthetic to
then send for testing), wisdom teeth removal, removal of snapped tooth from a
failed extraction and the removal of dental screws in the jaw. The most
memorable moments for me in surgery were when a patient started panicking under
local anaesthetic and when a prisoner came in for treatment. The first occasion
was when a patient needed a tooth removed and was put under local anaesthetic
and soon turned very pale and started shaking. She had expressed concerns over
the injection to the dentist prior. The dentist and the dental nurse had to
work quickly to calm the patient. They removed any equipment that was crowding
her, leant her back in the chair, gave her water and engaged her in general
conversation to distract her. She soon eased and they were able to proceed with
the extraction. It was impressive to see how quickly and calmly they handled
the situation. The other scenario was with a prisoner who needed four dental
screws being removed from his jaw. He came across quite aggressive with the
dentist but the dental surgeon remained calm and was able to carry out the
extraction of the screws while keeping a peaceful environment. It was
interesting to see how varied the patients can be.
In the trauma clinic it was mostly reviews after treatment.
One younger patient was referred after their dentist found a dark patch which
suggested an infection in the gum. The patient had trauma on their adult teeth
a few years prior and had experienced infection straight after and the dentist
concluded the tooth had died. The infection then returned and the patient was
able to feel extreme temperatures on the tooth which suggested nerves might
still be present. The dentist working the trauma clinic was a first year
dentist and she said she extremely valued the experience she was receiving at
the hospital as she was learning a lot due to the variety in the cases she was
encountering daily.
There was a very clear difference to me personally between
my dental practice work experience and my hospital work experience. The
hospital was a lot more unpredictable and the cases were a lot more complex;
especially concerning surgery. I saw a whole new side to dentistry and was able
to grasp how varied an area it is. At the practice I was able to see a
continuation of care and saw how rewarding it was for the dentist to treat the
same patients for an extended period of time and build relationships with them.
Overall, both environments had very talented medical professionals and they
both demonstrated to me the importance of a team in these stressful
environments.
Written by Lizzie Nash
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