Oral Health Group

Professional Responsibility

June 1, 2007
by Bruce R. Pynn, DDS, MSc, FRCD(C)

While many oral and maxillofacial surgeons (OMFS) continue to battle for access to hospital resources for their patients, others have tired of this struggle and have chosen not to affiliate themselves with any hospital. The immediate personal benefit of this choice is relief from emergency call coverage. While clearly tempting, this change in practice style will no doubt have an unfortunate long-term effect on patient care and our profession. Management of facial trauma gave birth to our specialty during times of armed conflict and remains an integral part of our specialty training and professional scope of practice. Care of those with facial injuries provides an important contribution to our professional and larger human communities.

According to Dr. Howard Holmes, Assistant Head in Oral and Maxillofacial Surgery and Anesthesia, University of Toronto and Mount Sinai Hospital, trauma cases that have been referred from peripheral sources have more that tripled over the past few years. While the Graduate Program in Oral and Maxillofacial Surgery is pleased to provide needed service, the trend is disturbing none-the-less.


Dr Daniel Laskin, Professor and Chairman Emeritus at Virginia Commonwealth University, recently reminded us that it took years of consistently skillful care provision by our OMFS fore-bearers to demonstrate our comparative competence in treating facial fractures. The unparalleled expertise we have progressively shown in the treatment of mandibular fractures, then zygomatico-maxillary injuries, followed by mid-facial and orbital fractures, have enabled the current level of unrestricted OMFS privilege in treating all forms of facial injuries. We are respected members of hospital trauma teams. Moreover, our expertise in the management of trauma, due to our unique combination of dental and surgical training, has opened other doors for the measured expansion of our current scope of practice. Further, it provides OMFS with an excellent opportunity to work closely with our other related medical and surgical specialty colleagues such as oncology, plastic surgery, medicine, anesthesia, neurosurgery, ophthalmology, and otolaryngology. For these reasons we hope that most OMFS will continue to provide their community with these needed and valued skills in trauma management.

Another disturbing trend is the so-called “cherry picking” practices that have evolved in dentistry over the past few years. It would seem that some dentists and dental specialists are intentionally choosing not to involve themselves in the provision of lower paying services or are choosing not to provide care to socio-economically or medically disadvantaged patients. These patients eventually end up on the doorstep of the teaching centers as “they would be interesting cases for the students,” or they will present themselves to the nearest dentist or specialist who does not limit care on the basis of these criteria. Considering the evolving age demographics of our Canadian population, this will inevitably over-burden these compassionate providers and will limit access to those in need.

This trend is not just limited to dentistry, it also exists in other medical specialties such as plastic surgery. Here the trend is toward sub-specialization where surgeons often opt to do only aesthetic surgery in private clinics. General plastic surgery is almost becoming a subspecialty unto itself, according to Dr. Arnis Freiberg, Professor Emeritus at the University of Toronto.

We can appreciate that dentists and surgeons may want to change their practice style so as to better fit their life style or to sub-specialize into areas of their specific interest or skill. As well, geography and demographic situations may dictate the style of the practice. However, community-based dentists and dental specialists including OMFS have an important role to play within their community, not only to the patients but also to their fellow care providers. While it is acceptable to focus on areas of interest, we hope that care providers will not forget their roots, their communities, or their profession. We hope that all care providers will remember the wise adage that success is not defined by what we get but rather by what we give

Dr. Bruce Pynn is Oral Health’s editorial board member for oral and maxillofacial surgery. He maintains a private practice in Thunder Bay, ON.

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