“Why is there a dentist in the operating room?”

By Juliana Gomez, DDS

I loved dentistry. The autonomy of private practice, the (relatively) shorter training, the immediate gratification when you are able to fix a problem or alleviate someone’s pain in a single visit. My path was altered when I chose to pursue Oral and Maxillofacial Surgery (OMFS) residency—but I remember my time in dental school and the smiles that I fixed quite fondly. That being said, the last filling that I performed was in school about three years ago, and I do not exactly miss doing root canals.

Dentists are experts in treatment of the mouth, where they cover an enormous range of disciplines- surgery, prevention, restoration, and preservation of the health of the oral cavity. We work closely, on occasion, with our dental colleagues. Oral and maxillofacial surgeons have a much different scope of practice than dentists.

After graduating dental school (NYU 19’), I began an intern year prior to formally applying for the OMFS Match. During that time I spent a full year on a busy Oral and Maxillofacial Surgery service at the University of Florida in Jacksonville, FL and earned a certificate in Oral and Maxillofacial General Surgery in June 2020. By this point, I had under my belt undergraduate, dental school and an intern year- so 8 years post-secondary education, having completed undergrad in 3 years. 

Matching into OMFS residency was a breath of fresh air. Interestingly, it was a double celebration, as OMFS applicants find out that we have also been accepted to the medical school associated with our residency program as part of the match. We then sign a contract for 6 years of residency training (4 with the non-MD track) and get started. I was fortunate enough to match into Ascension Macomb-Oakland Hospital in Detroit, Michigan. 

The OMF surgeon is an expert in facial surgery, and can subspecialize in a number of fields via 1-3 years of fellowship training. These include head and neck oncologic resection and reconstruction, cleft and craniofacial surgery, plastic and reconstructive surgery (independent track) and full body and facial cosmetic surgery to name a few. OMFS are the referral service for reconstruction of the head and neck, thoracic and extremity reconstruction at some institutions. We are even the surgical airway consult service at some institutions. We are experts in sedation anesthesia and perform general anesthesia, spending about half a year or more on anesthesia service as residents. We spend time on general surgery service to obtain a general surgery certificate, perform endocrine surgery, and are consulted to provide surgical access for anterior cervical spine surgery or perform enucleation of the globe of the eye, for example. 

The scope of OMFS is extensive as supported by our 13-19 years of post-secondary education as well as our dual graduate degrees, and overlaps with plastic surgery, ear nose and throat surgery, general surgery, anesthesiology, dermatology and ophthalmology to name a few. However, not too many providers of all levels are aware that we exist- or that we are a FACS specialty with an extremely broad scope.

As an on-call OMFS intern, I was consulted on emergent airways, complex panfacial trauma, to control a sentinel bleed from a laryngectomy site, to drain a post thyroidectomy hematoma impinging on the airway, to address infected clavicular hardware, infected spine hardware, to work up facial cleft patients, and to perform lateral canthotomies, tonsillar and peritonsillar procedures, to work up a necrotizing fasciitis of the gluteal region for reconstruction by our team and temporal artery biopsy to diagnose giant cell arteritis, for example. All of this in addition to managing patients on our orthognathic surgery, head and neck oncologic and extremity reconstruction, cleft and craniofacial, trauma, temporomandibular joint surgery and reconstruction teams, as well as the oral trauma and dental cases. 

Having put this all in perspective, I am still in training, and I do not yet have the MD behind my name (depending on the program we get this around PGY-4,5). So, I am a dentist by training with the above supplemental experience in an expanded scope specialty, for which I am extremely grateful. OMFS’ train extensively to be able to do what they do, and I plan to use my remaining years of residency to become proficient in all this specialty has to offer.

Referring to the question I have been asked much too often- the ‘dentist’ is in the operating room because they are highly qualified to be there and have the training to support it. 

Juliana Gomez, DDS is a second-year resident in the Department of Oral and Maxillofacial Surgery at Ascension Macomb-Oakland Hospital in Detroit, MI. She completed undergraduate studies at Florida Atlantic University and went on to earn her DDS at New York University College of Dentistry. She completed a one-year certificate in Oral and Maxillofacial General Surgery at the University of Florida-Jacksonville prior to beginning residency in Detroit and is currently obtaining her MD at Wayne State University, School of Medicine. Currently, she is the conference chair for the medical student division of AMWA. Dr. Gomez’s academic interests include head and neck reconstructive surgery, treatment of maxillofacial pathology, and extremity reconstruction.

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