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Face-off: Specialists split over oral surgery ruling "Patient safety must always come first."


Dr. Fodor
Patients seeking any type of medical or surgical treatment should be able to rely on their healthcare providers to have training and credentials appropriate to the treatments they administer. Unfortunately, in today's healthcare environment, this often is not the case. Patient rights and patient safety may be seriously compromised when practitioners without medical credentials are legally sanctioned to perform complex surgical procedures outside the scope of their training. The position of the American Society for Aesthetic Plastic Surgery (ASAPS) is that patient safety must always come first.

As the recent legislative session in California demonstrated, many of those who establish laws pertaining to medical and surgical practice have little understanding of the differences in training between medical doctors and dentists. Like many consumers, these legislators may mistakenly believe that the titles "doctor" or "oral surgeon" associated with dental practitioners signify training comparable to that of a medical doctor or surgeon. I have the greatest respect for the work of dentists and oral surgeons, but that does not mean I would want an individual primarily trained to treat dental conditions and jaw-related injuries to operate on my face, nose, eyelids, ears or skin.

Board-certified plastic surgeons, as well as other medical doctors certified in surgical specialties, have a sound foundation in anatomy and physiology. They are equipped with a thorough understanding of all body systems including ventilation, circulation, fluid and electrolyte balance — all vitally important to patient safety. They are trained to prevent and, if necessary, manage medical and surgical emergencies. Plastic surgeons are experts in remolding soft tissues of the body, which are primarily involved in cosmetic surgery; they understand how to protect delicate nerves, blood vessels, muscles and skin.

In contrast to the training of plastic surgeons, oral surgeons undertake a course of study in oral health and dental surgery. This training does not lead to a medical degree; it is considered advanced training in dentistry. Oral surgeons routinely deal with the bony structures of the upper and lower jaws. An oral surgeon's training is not remotely comparable to a medical doctor's comprehensive surgical residency training.

It is time that our legislators put the health and welfare of patients before the economic interests of those who seek to perform elective cosmetic surgery — or any medical treatment outside their scope of training — without undergoing the exhaustive education necessary to help ensure patient safety.

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