Reply: Oral Surgeons as Cosmetic Surgeons and Their Scope of Practice.

Abstract

Sir: This is a response to the letter from Keyhan, Bohluli, and Bagheri regarding our article “Oral and Maxillofacial Surgeons as Cosmetic Surgeons and Their Scope of Practice.” They wrote criticism of the titles and perceived conclusion in my article, and passionately suggest bias in my article. I feel a personal expansion of my background and views should assuage them that the article is not a bias, but an informative article. First, this article is specifically U.S. based, and not a view on global training pathways. In the United States, oral surgery is nationally referred to as oral and maxillofacial surgery, or OMFS. The article is an insight into the complexities of several issues related to this topic. The first is state credentialing and the other is the indiscriminate use of the term “board certified.” Dental boards have successfully used reverse credentialing to expand the scope of practice. This article illuminates even the dental board’s attempt to curtail the use of non–American Dental Association/American Medical Association specialty titles.1 As for writing scholarly articles as criteria for credentialing, many would disagree, specifically, the Virginia Society of Plastic Surgery, which sued Dr. Joseph Niamtu III over scope of practice. The suit was withdrawn only after a Virginia State decision.2 The authors brought up the history of nomenclature in plastic surgery societies to illustrate their point. However, they should have credited Sir Harold Gillies for the origin of facial plastic surgery.3 There are two problems in scope-of-practice arguments. The first is you cannot use historical surgical creativity when you are crossing into another established field. Second, the work of a few highly talented surgeons does not qualify the whole community. The premise of board certification is to qualify all surgeons to a minimal level that keeps the patient population safe and appropriately informed. I do not consider the oral and maxillofacial surgeons that perform Brazilian buttock augmentations and breast augmentations in a dental office, in my city, a safe example of practice creep.4 This article was not a commentary on international tracks with which I have intimate knowledge. My introduction to plastic surgery was from a French-trained plastic surgeon practicing at the forefront of cosmetic surgery in Iran, in the mid-1970s. Having lived in Tehran and seeing the expertise then, I am sure that legacy persists. I attended a Scottish dental school to eventually pursue oral and maxillofacial surgery at the Royal Infirmary-Edinburgh. Instead, immigrating to the United States, and competing a fellowship at M. D. Anderson in maxillofacial prosthodontics and dental oncology, it became clear that plastic surgery residency was the definitive U.S. training. Four years at a U.S. medical school and a Mayo Clinic otolaryngology residency eliminated any question of prerequisites. That and a combined surgical training of approximately 5000 cases, of which 30 percent were cosmetic, vastly exceeds the prerequisite oral and maxillofacial surgery minimum of 10 cosmetic cases for board certification.1 Thus, in conclusion, I respect parallel training processes, yet I do not believe that cutting corners is the appropriate answer. Citing historical origins is not an excuse for scope-of-practice creep, and saying who you are within the American Dental Association/American Medical Association board definition is not too much to ask. DISCLOSURE This publication received no specific grant or contribution from any funding agency in the public, commercial, or not-for-profit sector. P. Davison, M.D., D.D.S., M.B.A.DAVinci Plastic Surgery Ashley Newman, B.S.Georgetown UniversityHoward University College of MedicineWashington, D.C.