| Abstract|| |
Background: Oral and maxillofacial surgery (OMFS) is a dental specialty evolving from the anatomical region of head and neck. Differing from the belief, its scope does not start and end with teeth. The aim of the study was to survey the perception of OMFS among dental, medical, and paramedical professionals. Materials and Methods: A structured questionnaire cross-sectional survey made up of 17 clinical situations pertaining to various complaints of patients was distributed among 50 medical and dental undergraduates, 50 medical and dental practitioners, and 50 general populations with a total number of 250 samples who were selected randomly. The collected data was tabulated using Microsoft excel for any predictable patterns. The results were analyzed taking absolute percentages of the responses into consideration. Results: The results were compiled and tabulated and the data analyzed. While wisdom tooth removal, trauma, and facial bone fractures were recognized to be mainly treated by maxillofacial surgeons, the other maxillofacial problems were poorly recognized to be treated by our specialty. In our study, 67.3% of general public and 62.4% of medical professionals approached other medical specialist for the clinical conditions. The Chi-square results of few clinical situations were statistically significant with a P value of less than 0.05, which suggest that there is indeed a statistically significant difference between the responses of medical profession and the public on whom to approach regarding certain clinical cases. Conclusion: The study revealed that the majority of the public are lacking in knowledge about the benefits that the specialty can offer. It has been found that even though the Medical professionals are better informed, lacunae existed about information as to where our major activity lies. If patients are to have access to the best treatment available, it is essential that we edify the public about the scope of our specialty.
Keywords: Cleft lip and palate, medical practitioners, oral and maxillofacial surgery
|How to cite this article:|
Yesuratnam D, Balasubramanyam S, Nagasujatha D, Vedatrayi T, Rani B U, Pasupuleti A. Acknowledgement of horizon of oral and maxillofacial surgery by health care professionals and general population. Indian J Dent Res 2020;31:257-62
|How to cite this URL:|
Yesuratnam D, Balasubramanyam S, Nagasujatha D, Vedatrayi T, Rani B U, Pasupuleti A. Acknowledgement of horizon of oral and maxillofacial surgery by health care professionals and general population. Indian J Dent Res [serial online] 2020 [cited 2020 May 31];31:257-62. Available from: http://www.ijdr.in/text.asp?2020/31/2/257/284584
| Introduction|| |
Oral and maxillofacial surgery (OMFS) is a specialty which developed over the last 60 years from a group of dental practitioners who were treating patients with facial fractures in association with plastic surgeons. It developed as a result of the need to treat servicemen injured in World War 2.
The specialists are embarked with knowledge to treat patients with diverse and complex problems within a well-defined anatomical area including dent-alveolar surgery and facial fractures. Oral and maxillofacial surgeons manage congenital craniofacial deformities including the full range of treatments for the cleft lip and palate, all oral and facial traumas, oral and facial cancers with reconstruction using local flaps and microvascular free tissue transfer, salivary gland disease, temporomandibular joint disorders, and surgical management of complex prosthodontic problems.
Great developments have occurred in our surgical repertoire and expertise, yet it is still vaguely or sparsely understood by both the dental and medical fraternities. The awareness seems to be even worse among the general public. The previous studies conducted in the USA and the UK have reported that the medical and dental fraternity and the general public are largely unaware of the scope of maxillofacial surgery and the type of work being done by maxillofacial units.
There is a paucity of such study in this part of India; hence, the present study was undertaken to find out the awareness among medical and dental fraternity and the public on a gross scale about the specialty of OMFS and how much misconception exists about the role of a contemporary oral and maxillofacial surge.
| Materials and Methods|| |
This cross-sectional survey study was carried out at Oral and Maxillofacial Surgery Department to assess the current awareness levels of the specialty. A written questionnaire comprising of 17 clinical situations was designed and was given to 5 groups (Medical students, Dental students, Medical doctors, Dental doctors, General public). Each group comprised of 50 people each, thus giving us a total of 250 replies delineated in [Table 1]. The subjects were asked to mark a tick (√)against the specialty they thought was the most appropriate to deal with the different clinical situations. The general public had the written questionnaire in Telugu (the local language) to ensure that there was no misinterpretation about the questions asked/choices given. Uneducated people were excluded from this study. The total groups were selected randomly.
Statistical analysis was done using SAS 9.3. A Chi-square test of independence was used to compare the responses by medical professionals and the public with a P value less than 0.005 considered significant.
| Results|| |
The results are shown in Tables 1.1-1.3. Most responders in all 5 groups (76%–100%) would consult an oral and maxillofacial surgeon for wisdom tooth removal. In the case of nasal fracture, the pattern of referral was more toward ENT surgeon among medical students and practitioner's (60%), whereas in general population, it is only 2%.
Further, OMFS scored an absolute majority in clinical situations like maxillary and mandibular fractures (90%–100%) among dental and medical population. For cleft lip and palate, the referral percentage among dental students to OMFS is 74%, whereas it is 32% among medical students and only 26% among general population. For esthetic face surgery, most of the population referred it to a plastic surgeon.
The Chi-square results of few clinical situations were statistically significant with a P value of less than 0.05, which suggest that there is indeed a statistically significant difference between the responses of medical profession and the public on whom to approach regarding certain clinical cases. Some of them are atypical facial pain, difficulty/inability in mouth opening, maxillary and mandibular fractures, and oral cancer. They represent the gap needed to bridge regarding the perception of OMFS in medical profession or public and educate them regarding referrals and scope of treatment.
| Discussion|| |
This survey demonstrated the knowledge and awareness of OMFS among health professionals and general population. However, apparently, some students and professionals were not aware of the wide scope of the specialty. The public has very low awareness about the full scope of OMFS.
The OMFS is perceived as a “surgeon” by the dental professionals, while they are thought of as dentists by the medical professionals. Due to the problems of access to dental care, patients may turn to other primary health care providers for their oral health needs sometimes resulting in medical practitioners encountering patients presenting with oral and dental problems.
In our present survey, it was observed that our medical colleagues and the general public lack awareness about the OMFS specialty as shown in [Figure 1]. The results of the present study showed that 32.7% general public and 37.6% of medical professionals approached an OMFS for clinical situations shown in [Table 2]. There was a similar finding in accordance with Lau. However, there has been increase in recognition of OMFS from 21% to 34% among general public and health professionals in the study done by Ifeacho. In our study, 67.3% of general public and 62.4% of medical professionals approached other medical specialist for the clinical conditions described in [Table 2].
|Figure 1: Bar chart displaying the number of respondents opting for OMFS and other specialists for various clinical situations among medical practitioners and general public|
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|Table 2: Comparison between medical practitioners and general public on whom to approach for certain clinical situations|
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Although the internal growth and development of the specialty has continued to flourish over the last 90 years, comprehension of the same by our medical and dental colleagues as well as the general public has not been concurrent. To reflect few examples, wisdom tooth removal by a surgical method is routinely performed by an OMFS. It was observed that 76% of general public and 88% of medical professionals would seek treatment from OMFS. In the case of fractures of maxilla and mandible, 96% medical profession and 40% of general public preferred OMFS.
TM joint disorders are complicated because of its broad term that refers not only to jaw joint issues but also to pain, discomfort, or dysfunction in muscles that support the joint. In our study, 58% of general population do not know about this clinical situation.
Clinical situations like facial asymmetry pose a great challenge to oral and maxillofacial surgeon. They must satisfy the desired esthetic look of the patient. 52% of general public are unaware of the clinical situation and only 4% of general public and 58% of medical profession would refer to OMFS.
Because of the number of oral health and medical problems associated with cleft lip or palate, multidisciplinary approach with a team of doctors involved is used in treating these children's. In this study, it was seen that 32% medical professionals and 26% of general public opted for OMFS.
In the study done by Hunter et al., the reason for low awareness might be attributed to the long and complicated name for specialty. Other factors may include a lack of publicity by the media, along OMFS being in dentistry rather than in medicine.
Ameerally et al. demonstrated that if patients are to receive the most appropriate treatment for oral and facial conditions, dental and medical professionals need to have a clear understanding of what our specialty deals with. He also emphasized on the role of media to promote the specialty.
Reddy et al. stated that having a simpler name could be the first step in making the specialty well-known. He suggested OMFS specialty should be known as “facial surgery” or “oral and facial surgery” as that would give clear idea of the type of work done and could be easy to pronounce and remember.
Laskin et al. assessed the knowledge of 12 different specialties to determine whether such unfamiliarity is true only for OMFS or whether it occurs with other specialties also. Their study result concluded that every effort should be made to inform the public about what OMF surgeons do.
Ifeacho et al. noticed that recognition of OMFS among the general public and health professionals had increased (21%–34%) and also that the specialty had improved only marginally. Their results suggest that there was a clear division in the awareness between conditions relating to the mouth and those outside the mouth, in the head and neck region, despite the latter being well within the scope of OMFS.
Shah et al. demonstrated that regional variation exists and surgeons are responsible for educating their own community and referral circles about the scope of their practice, which will depend on the training, experience, and area of interest.
The present survey has cast light on the attitude and awareness of specialty of OMFS among health professionals and general population. Dental students and dental professionals have more knowledge about the specialty, whereas the awareness is weak among general population. However, it appears that greater progress must be made in the education of medical and dental students, as well as the general public, if the specialty OMFS is to be practiced in its full scope.
An article cited by Nayak stated that IAOMS has recognized the potential power of information technology (IT) in changing the face of oral and maxillofacial training worldwide and also stated that the need based information can be made available to OMF surgeon at his fingertips bases on handheld devices like iPad and smartphones. According to the article, our future as a specialty will not just depend on individual economic strengths but also our social and political projections through our professional association. The future will depend on what we do in the present.
The survey was performed in Kadapa district and, therefore, the results might not be applicable elsewhere. Regional variations exist, and surgeons themselves are responsible for educating their own community and referral circles about the scope of their practice, which will depend on training, experience, and areas of interest. In our study, we found the need for public awareness and practitioner's awareness for exploring full potentialities of oral and maxillofacial surgeons in Andhra Pradesh.
| Conclusion|| |
To elude confusion among medical profession and low awareness among general public, there must be improved access and efficient delivery of the quality of service provided by an oral and maxillofacial surgeon. Better education about the specialty, more interactive session among medical colleagues, and media campaign will provide good awareness about our specialty.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ameerally P, Fordyce AM, Martin IC. So you think they know what we do? The public and professional perception of oral and maxillofacial surgery. Br J Oral Maxillofac Surg 1994;32:142-5.
Nayak K. Oral and maxillofacial surgery; its future as a specialty. J Maxillofac Oral Surg 2011;10:281-2.
Reddy K, Adalarasan S, Mohan S, Sreenivasan P, Thangavelu A. Are people aware of oral and maxillofacial surgery in India? J Maxillofac Oral Surg 2011;10:185-9.
Braimah RO, Taiwo OA, Ibikunle AA. Ludwig's angina: Analysis of 28 cases seen and managed in Sokoto Northwest Nigeria. Saudi Surg J 2016;4:77-83. [Full text]
Shah N, Patel N, Mahajan A, Shah R. Knowledge, attitude an awareness of speciality of oral and maxillofacial surgery amongst medical consultants of Vadodara District in Gujarat state. J Maxillofac Oral Surg 2015;14:51-6.
Lau SL. Do you think they know about us? oral and maxillofacial surgery in Hong Kong. J Dent Health Oral Disord Ther 2014;1:44-7.
Ifeacho SN, Malhi GK, James G. Perception by the public and medical profession of oral and maxillofacial surgery–has it changed after 10 years? Br J Oral Maxillofac Surg 2005;43:289-93.
Jarosz KF, Ziccardi VB, Aziz SR, Sue-Jiang S. Dental student perceptions of oral and maxillofacial surgery as a specialty. J Oral Maxillofac Surg 2013;71:965-73.
Hunter MJ, Rubeiz T, Rose L. Recognition of the scope of oral and maxillofacial surgery by the public and health care professionals. J Oral Maxillofac Surg 1996;54:1227-32.
Laskin DM, Ellis JA Jr, Best AM. Public recognition of specialty designations. J Oral Maxillofac Surg 2002;60:1182-5.
Dr. T Vedatrayi
Department of Maxillofacial Surgery, Govt Dental College and Hospital, RIMS, Kadapa, Andhra Pradesh - 516001
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]