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What oral and maxillofacial surgeons actually do - plain language

OMS specialists manage surgical problems of the mouth, jaws, face, and related structures. Their scope includes:

• Trauma care: repair of facial fractures (orbital, zygomatic, mandibular, maxillary), laceration repair, and airway stabilization after facial injury.
• Orthognathic (jaw) surgery: corrective surgery to realign jaw bones to treat functional problems (e.g., malocclusion, sleep apnea) and aesthetic concerns, often in collaboration with orthodontists.
• Tooth extractions & impacted teeth: removal of difficult third molars (wisdom teeth), impacted canines, and complicated extractions.
• Dental implant surgery: placement of single implants, full-arch reconstructions, sinus lifts, and grafting for bone augmentation.
• Pathology & oncology: diagnosis and surgical management of benign and malignant oral/facial tumors, excision of cysts, and coordination of oncologic reconstruction.
• Temporomandibular joint (TMJ) procedures: from arthrocentesis and arthroscopy to open joint surgery in select cases.
• Genioplasty, facial contouring, and selected cosmetic procedures: for functional or aesthetic reasons, depending on training and practice focus.
• Anesthesia delivery: many OMSs provide local, IV sedation, and general anesthesia in-office or hospital settings (scope and regulations vary).
• Multidisciplinary collaboration: coordinate with ENT surgeons, plastic surgeons, neurosurgeons, oncologists, orthodontists, prosthodontists, and critical-care teams.

OMS care ranges from short ambulatory procedures to lifesaving facial reconstruction in trauma and cancer care. The work is hands-on, often urgent, and requires meticulous surgical planning.

A day-in-the-life (realistic)

No two days are identical. Here’s a blended example capturing clinic, OR, and on-call elements:

• 07:30 - Pre-op planning: review CT scans, 3D models, and the surgical plan for a mandibular reconstruction. Confirm graft availability and implant inventory.
• 08:30 - OR block: perform orthognathic surgery (Le Fort I + bilateral sagittal split osteotomy) with an orthodontist and anesthesia team. Precision, stepwise execution, and time management are essential.
• 13:00 - Post-op rounds: check airway, facial swelling, drains, and patient comfort; coordinate pain control and antibiotics.
• 14:30 - Clinic: evaluate a patient with facial trauma from last night — assess a displaced zygomatic fracture and schedule surgery; perform a complex impacted third-molar extraction.
• 16:30 - Administrative: meet with the prosthodontist to plan implant-retained prosthesis sequencing; review pathology slides with the pathology team.
• On-call: respond to ED consults for facial lacerations and acute infections. Emergency airway or bleeding control may arise.

Expect a mix of high-focus surgical blocks, intensely technical clinic procedures, and emergency responsiveness, plus the documentation and coordination that make complex care possible.

Core skills & competencies

Surgical & clinical

• Mastery of oral, maxillofacial and facial anatomy (critical for safe dissection and reconstruction).
• Advanced surgical technique: osteotomies, bone grafting, microvascular concepts (if reconstructive fellowship-trained), implant placement, and soft-tissue handling.
• Airway management and perioperative anesthesia knowledge (sedation and general anesthesia safety).
• Interpreting advanced imaging: CBCT, CT, MRI, and using 3D planning tools and surgical guides.

Cognitive & planning

• Spatial reasoning for 3D surgical planning and ability to translate imaging into operative steps.
• Risk assessment and contingency planning for intraoperative complications (bleeding, nerve injury, airway compromise).
• Prosthetic foresight, planning reconstructions with final prosthetic rehabilitation in mind.

Interpersonal & leadership

• Clear informed-consent discussions and expectation management, patients often face appearance and function changes.
• Team leadership in the OR coordinate with anesthesiologists, nurses, surgical assistants, and consultants.
• Communication with referring dentists, orthodontists and other specialists.

Practice & business

• Running OR suites, managing implant inventory, negotiating with surgical centers, and sometimes leading or owning practices.
• Billing and coding knowledge for surgical and anesthesia services, plus malpractice and risk-management awareness.

Education & training pathway (how long and what it takes)

OMS training is long and competitive,  but structured. Common U.S. pathway:

1. Undergraduate degree (4 years): strong science prerequisites and extracurriculars are important.
2. Dental school (DMD/DDS, 4 years): comprehensive dental education; exposure to oral surgery exercises.
3. OMS residency (4 to 6 years typical): residency programs vary,  some are 4 years, others are 6 years and include an integrated medical school pathway resulting in an MD or substantial medical rotations. Residency includes hospital-based general surgery exposure, anesthesia training, trauma management, and progressively advanced OMS procedures.
4. Fellowship (optional): for microvascular reconstruction, oncology, or craniofacial specialties.
5. Board certification / eligibility: In the U.S., the American Board of Oral and Maxillofacial Surgery (ABOMS) certification process involves qualifying and oral exams and may require a case log, depending on board processes. Licensure in dentistry is required; hospital privileges depend on credentialing.
6. Continued learning: CME, surgical technique updates, and possibly additional credentialing for office anesthesia.

Total training time after high school: typically 12–14+ years (4 undergrad + 4 dental + 4–6 residency), depending on chosen pathway.

Salary & compensation (real-world numbers)

Compensation for OMS varies by region, practice model (private vs hospital-employed), subspecialty, and call duties:

• Median U.S. earnings: Oral and maxillofacial surgeons are among the higher-paid surgical specialists in dental/medical fields. Median compensation often ranges broadly (commonly cited in the high six figures in many surveys), but specifics vary year-to-year and by source.
• Factors increasing pay: high procedural volume (implantology, orthognathic surgery), ownership stakes in practice, locum work, and cosmetic procedures.
• Other considerations: on-call and emergency coverage, hospital privileges, overhead (staff, equipment, OR costs), and malpractice insurance costs will impact net income.

When evaluating compensation, consider lifestyle tradeoffs: surgical volume, hospital on-call, and practice ownership demands.

Job outlook & practice opportunities

• Strong demand for specialized surgical care: trauma, implants, and orthognathic surgery remain stable demand areas.
• Practice settings: private group practice, hospital-employed roles, academic faculty (education and research), military service, and integrated care centers.
• Geographic gaps: rural and underserved regions sometimes lack OMS coverage, offering recruitment incentives.
• Evolving areas: computer-guided implantology, virtual surgical planning, 3D-printed reconstructions, and regenerative medicine (bone graft substitutes) expand practice scope.

Career trajectories include clinical leadership, academic roles (program director), or surgical subspecialization in oncology/craniomaxillofacial reconstruction.

Pros & cons:  honest appraisal

Pros

• Mix of high-skill surgery and immediate patient impact (function and appearance).
• Diverse practice, trauma, routine extractions, implants, and complex reconstruction.
• High professional respect and potential for strong financial reward.
• Opportunity to use cutting-edge tech (3D planning, guided surgery).

Cons

• Long training and high educational debt for many.
• High responsibility and significant medicolegal risk in facial surgery and anesthesia.
• Irregular hours and on-call duties, especially early in practice.
• High-pressure scenarios (airway compromise, major trauma) requiring resilience and rapid decision-making.

Tips to succeed (practical, not generic)

1. Get early exposure: shadow OMS surgeons during dental school; help in clinics and learn OR etiquette. That exposure clarifies fit and builds mentorship.
2. Build surgical dexterity: suturing, small-bone handling, and microskills practice (simulation labs) before residency applications.
3. Master imaging interpretation: CBCT/CT reading and virtual planning tools are crucial. Learn to manipulate DICOM datasets and plan osteotomies digitally.
4. Learn anesthesia basics: airway management and sedation knowledge are non-negotiable; proficiency improves patient safety and versatility.
5. Network and find mentors: strong references, letters, and research/case reports help residency matching and future collaboration.
6. Balance business acumen: if you plan to lead or own a practice, learn billing, coding, staff management, and contract negotiation early.

Would I like it? Personality & fit checklist

You’ll likely enjoy OMS if you:

• Thrive in high-stakes, procedure-oriented environments.
• Love 3D problem solving and working with bone, soft tissue, and prosthetic planning.
• Are resilient, decisive, and comfortable with urgent care scenarios.
• Want a career that blends clinical autonomy, surgical craftsmanship, and interdisciplinary collaboration.

If you prefer low-oncall schedules, rapid-decision-free clinic work, or minimal hands-on procedures, OMS might not be ideal. Take the next step: a career assessment can help clarify.

My MAPP Fit

Successful oral and maxillofacial surgeons often show strong Investigative (problem-solving), Realistic (hands-on, mechanical), and Enterprising (leadership, autonomy) drives on career assessments. If you’re curious whether your motivational profile matches OMS demands, try a free career assessment at www.assessment.com. It’s a useful, evidence-based checkpoint before committing to the long training road.

Is this career path right for you? Find out Free.

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