Presidents Message March/April 2021

In Defence Of Oral Surgery Training

I recall in my undergraduate  days at Sydney University in the late 1960s being advised that I ought change disciplines because the introduction of fluoride to the water supply was already showing its efficacy in maintenance of dentitions against caries and the days of life time career in dentistry were limited. Fortunately my naivety saw me plod on to completion of the degree and, later, a career in oral surgery.

I have seen the provision of implant prosthodontics develop as a part of mainstream general dental practice when it once was the preserve of a few adventurous oral surgeons. We are fortunate in that the loss of a single tooth, whatever the cause, can now be reliably replaced without damage or to rely on support of neighbouring teeth. Full mouth clearances are, again, less frequent than they were when I graduated. That said, never in my experience has the specialty of oral surgery been needed more.

Skilled dento-alveolar surgery practitioners are in increasing demand in the private but especially  in the public sector in Australia. The three-year training course leading towards the speciality of oral surgery is difficult because of the breadth of content and intensity of clinical exposure. It is tailored to the provision of well trained personnel/specialists for the public hospitals /health-service centres. Every year the course is exceedingly over-subscribed by applicants. The competition to join is difficult and the course is robust in content. At present the Sydney course is the only one of its kind in Australia. The depth of talent of the participants has a flow on effect into the University of Sydney as teaching in the undergraduate programme is a part of the course requirements.

The complexity of health issues endured by our aging population continues to put demands on the public health system in all forms of care. Dental surgery is but a small part of multi-disciplinary management and the demand will increase in complexity and numbers.

Oral Surgery training focuses on developing skills in the removal of teeth and the preservation and/or augmentation of the area for reconstruction when desired. Liaison with specialist periodontists, prosthodontists, orthodontists and generalists in implant placement is integral to the training programme and the results to date have been most encouraging.

 Maxillo-facial surgery has now developed into a hospital-based speciality focused on corrective surgical procedures, acute surgical care and trauma. Their inter-relationship with head and neck cancer specialists will increase with the development of a sub-speciality linked with specialist prosthodontists  focused on reconstructive procedures.

The problems of the aging dentition are now obvious to all practitioners. Age and medication induced  xerostomia causes reminders of the aged dentition in the pre-fluoride era. Alveolar surgery in patients with co-morbidities is a daily event. Couple this with the burgeoning  oral surgery waiting lists in the public health the need is great, particularly so in the rural areas.

 Specialist care for those patients requiring skilled removal of deteriorated and damaged teeth is essential and this association will be lobbying authorities to recognise the abundance of patients that is in already present and increasing in volume.

Because of the long waiting lists many patients travel long distances from their local health district for relief of pain and treatment of dental infection. This situation is not restricted to the rural setting as could be assumed.  The need for expansion of personnel is obvious and planning for an increased population of Specialist Oral Surgeons hopefully soon will be paramount in health care planning for the future.

Plans are underway for a conjoint University of Sydney/ANZAOS CPD day in August this year. I am hopeful that COVID restrictions will be minimal so that a productive meeting eventuates.

The venue will be advertised just as soon as the programme is finalised.

Dr. Eric Carter

March/April 2021