California oral surgeons want to expand scope

The California Legislature is considering a bill that would give oral and maxillofacial surgeons the right to perform elective cosmetic surgery on the jaw, face and adjacent structures. The bill is ardently opposed by the California Society of Plastic Surgeons and other physician groups.

Oral surgeons are authorized to perform such surgeries in 28 states and Washington, D.C. James Wells, MD, immediate past president of the American Society of Plastic Surgeons, wants to make sure California doesn't become the 29th.

Facelifts and other elective cosmetic procedures are beyond the scope of oral surgical training, which Dr. Wells said does not include the same level of patient care responsibilities as shouldered by medical residents.

Dr. Wells works alongside oral surgeons on cases such as automobile crashes and cleft palettes. The oral surgeon handles the boney structural work while he handles the aesthetic, soft tissue side. He said this kind of collaboration gives patients the best outcome.

Oral surgeons "do wonderful foundation work," he said. But allowing them to do soft tissue surgery is a completely different situation. "We have a number of plastic surgeons who were oral surgeons," Dr. Wells said. "They didn't feel comfortable taking the next step without more training."

California's oral surgeons say they already are doing reconstructive surgery in emergency departments and should be allowed to do similar procedures on an elective basis.

Carol O'Brien, general counsel for the American Assn. of Oral and Maxillofacial Surgeons, said unlike general dentists, all AAOMS surgeons have had four to seven years of hospital-based residency.

"Oral and maxillofacial surgeons on trauma call reconstruct patients' faces," she said. "They take care of traumatic injuries of the face, cheek bones, forehead, eye orbit. Our doctors do have the education and training to do extensive reconstructive surgery."

The bill passed California's Senate and has been unanimously approved by a panel as it moves toward a vote by the full Assembly.