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Think Like an Oral Surgeon


Think Like an Oral Surgeon

by Jay B. Reznick, DMD, MD

Once upon a time, I lived a very sheltered life. I used to think that all general dentists had it as good as those in my neighborhood in suburban Los Angeles. I thought they all had oral surgeons down the street to whom they could refer all of their extractions, biopsies and emergency patients. It never occurred to me that the vast majority of general dentists were about 100 miles from the closest surgeon and that their patients typically had to wait a month or two for a routine appointment. As a result, they were faced daily with having to do the same procedures that I routinely do for my referring dentists and their patients.

It was only after having dinner with Dr. Howard Farran, where we discussed the need for continuing education in oral surgery for general dentists, that I was enlightened about the problem. The amount of oral surgery education in dental school pales in comparison to other disciplines. As a consequence, most general dentists are understandably uncomfortable with having to diagnose and treatment plan those patients who present to their practices with surgical problems that require immediate treatment. In addition, there have been very few opportunities for dentists in practice to get the surgical education they lack without taking time from their practices and traveling to the small number of universities or dental meetings that offer oral surgery courses. As a result, my online CE series on Dentaltown.com was born, in order to bring that much-needed information directly to dentists at their homes or offices. My series covers the basics of oral surgery, as well as surgical extractions and impactions. More than 5,000 dentists have taken advantage of these courses.

So, if you find yourself doing oral surgery in your practice, either because you cannot easily refer your patients or if you enjoy doing surgical procedures, I hope you will find this article series in Dentaltown Magazine useful and educational. I will try to cover a variety of topics that will be of interest to you. I will start with discussing some of the very basics.

The typical oral surgeon goes through at least four years of advanced education after dental school to become proficient in the specialty. No amount of continuing education will turn you into an oral surgeon. One of my goals is to help you think more like an oral surgeon, so that you can approach patients and problems the same way that a surgeon does. With a solid foundation in surgical education, you will be able to handle most clinical situations with confidence and competence.

How much surgery do you truly want to do in your practice, and why?
This depends on how much oral surgery training you've already had, the availability of a surgeon to your practice, the community in which you practice and what else you have to do. Surgical procedures, no matter how expertly performed, have complications. Are you prepared to deal with the complications of surgery such as post-op pain, swelling, infection, numbness, bleeding, broken root tips and sinus perforations? Do you want to? Do you have backup from a surgeon, just in case complications get out of hand? Remember, that if you encounter a problem, you will be held to the standard of care in your community, which is commonly the same as for the specialist. Even if you practice in a rural area, you do not have to do everything surgical that walks in your door - even if you have time on your schedule. Being able to work within your comfort zone is important. I cannot tell you how often, when I need to complete a one-hour extraction marathon for a local dentist, that patient subsequently asks me for the name of a new dentist because he has lost confidence in his. You want everything that you do in your office to be a practice builder. Putting a patient (and yourself ) through a prolonged, stressful surgical procedure does just the opposite. Sometimes, referring the patient to the right specialist does more for your bottom line than treating the patient in your office.

Now that I have tried to dissuade you from ever picking up forceps, let's talk about oral surgery. Remember that patients' mouths are connected to the rest of their bodies and that medical conditions they might have, or medications they might take, can have serious implications on how we plan and execute our surgical treatment. Also, what we do to patients can affect their medical problems and general health. Without an understanding of these interactions, we are merely dental technicians. Some of the more relevant conditions include diabetes, cardiac disease, hypertension and patients on anticoagulant drugs. [Editor's note: For a more detailed explanation of this, please take Dr. Reznick's course "Practical Oral Surgery for the General Dentist: Medical Evaluation of the Oral Surgery Patient" on Dentaltown.com]

In dental school, we were taught that when doing a crown prep or any other restorative procedure, we should have an image in our "mind's eye" of what that final preparation should look like. That way, we would be able to anticipate each step of the procedure, and know which instruments we would need, so we could have them close at hand. For some reason, that same concept was never taught in surgery. In my early years, I worked in a couple of group practices and aided some of my GP colleagues who had been assigned "simple" extractions. It was no wonder to me they ran into problems. They were trying to remove teeth broken off at the gingival margin with just a dental mirror, large straight elevator, universal forceps and no plan! How could they possibly succeed? Surgery is no different than a restorative procedure in that respect.

Before you pick up your first instrument, you need to mentally walk through the procedure, so that you will have the necessary instruments on your tray. Having the right instruments is critically important. You cannot work efficiently using the same four instruments for every extraction. If you are going to perform oral surgery in your practice, it is worth your while to have a set of basic surgery instruments that are designed for the particular type of procedure you are doing. This will make your life much easier. By mentally visualizing each step in a surgical procedure, you will also be able to anticipate any possible complications and have a plan for dealing with them. So when that root tip breaks off, instead of unsuccessfully digging at it with your straight elevator for 15 minutes, you will immediately use your root tip pick, and if that doesn't work, you will have your surgical hand piece revved-up without missing a beat. And, if you encounter sudden bleeding, you will deal with it without hesitation.

As I've already mentioned, it takes at least four years of full time study to become a specialist in oral surgery. No amount of continuing education will ever approach close to that. However, if you find yourself faced with oral surgery patients in your practice and you are not satisfied with the amount of training you have had in school or afterward, I urge you to get that training now. Just as you are constantly improving your knowledge and skills in restorative procedures, aesthetic dentistry, sleep dentistry, CAD-CAM and practice management, improving your oral surgery know-how will help you take better care of your patients. In addition to the online CE courses on Dentaltown.com, there are a number of DVD's, videos and Web sites available from a number of sources that can help improve your surgical skills. With the growth of the Internet, online education is becoming more common and is accepted by most state dental licensing agencies to fulfill your license renewal requirements. Whichever resource you use to improve your oral surgery skills, it will be well worth the investment.

If you want to learn more about a certain topic within the realm of oral surgery, please e-mail me at jreznick@sccofs.com.
Author's Bio
Jay B. Reznick, DMD, MD is a Diplomate of the American Board of Oral and Maxillofacial Surgery. He received his Dental degree from Tufts University, and his M.D. degree from the University of Southern California, and trained in Oral and Maxillofacial Surgery at L.A. County- USC Medical Center. His special clinical interests are in the areas of facial trauma, jaw and oral pathology, dental implantology, sleep disorders medicine, laser surgery, and jaw deformities. He also has expertise in the integration of digital photography and 3-D imaging in clinical practice. Dr. Reznick is one of the founders of the Web site OnlineOralSurgery.com, which educates practicing dentists in basic and advanced oral surgery techniques. He is the Director of the Southern California Center for Oral and Facial Surgery in Tarzana, California. He can be reached at jreznick@sccofs.com.
Dentaltown Magazine
September 2025
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