Oral and maxillofacial surgery, or OMFS for short, is a subspecialty of dentistry that focuses on the surgical management of the face, jaw, and oral cavity.

When most people think of OMFS, the first things that come to mind are wisdom teeth extractions and dental implants. Although these are a large part of what an OMFS does, their actual scope is much broader.

Oral and maxillofacial surgery is a medical specialty that focuses on the surgical treatment of disorders of the mouth, face, jaws, and neck. The fields of orofacial pain, craniofacial surgery, facial plastic surgery, maxillofacial trauma and reconstruction, periodontics and implants are among the areas within this field.

Oral and maxillofacial surgeons treat conditions such as cleft lips or palates, sinusitis or nasal polyps, as well as other types of facial deformities. They also perform surgery on patients with cancer of the lip or tongue. They may need to remove tumors from patients’ mouths and jaws in order to treat their cancers. In some cases, oral and maxillofacial surgeons will perform reconstructive surgery for people with disabilities caused by birth defects or injuries that occurred during childhood development. This brings us to an important method of differentiating an OMF surgeon’s practice.

In this article, we’ll discuss how many years it takes to become an oral and maxillofacial surgeon and oral and maxillofacial surgeon education requirements.

Academic vs Private Practice

In the academic setting, OMF surgeons will on average see more complex and emergent cases compared to the community or private practice settings. Presenting concerns include severe head and neck infections, orbital floor fractures with extraocular muscle entrapment, and gunshot wounds to the face—all of which require immediate surgical intervention.

True emergencies like these are rare though and at most hospitals, facial trauma calls are split between some combination of OMFS, plastic surgery, and ENT.

Community practices are few and far between.

The majority of OMF surgeons work in private practice. Here they will typically see less complexity compared to the academic setting. In general, they will also receive higher compensation and have greater flexibility in their hours.

For this reason, it is common for many OMF surgeons in academia or community to only work part-time and split their time with private practice.

Misconceptions About OMFS

OMFS is an often misunderstood field. Many people mistakenly believe that OMFS only involves tooth extractions, but the procedures performed by an OMFS can be intricate and significantly influence their patients’ daily lives.

It’s not uncommon to confuse OMFS, ENT, and plastic surgery given the high degree of overlap.

While somewhat of an oversimplification, think of ENT surgeons as the masters of complex work deep inside the head and neck region, such as cancer resections.

Think of plastic surgeons as masters of soft tissue, from one end of the spectrum helping ENTs with coverage after cancer resection through complex flaps to pioneering facial aesthetics on the other end.

And think of OMFS as the masters of anything related to the teeth or temporomandibular joint (TMJ).

How to Become an OMFS

The path to OMFS starts with completing dental school.

After dental school, there are two pathways to becoming an OMFS: the four-year program and the six-year dual degree program. Both will certify you to practice as an oral and maxillofacial surgeon; however, the six-year degree will also grant you an MD.

In terms of the curriculum between four- and six-year degree programs, there is a high degree of variability depending on the particular program.

In general, six-year degree programs will have longer surgical rotations plus added time spent on medical school coursework. In fact, with these added obligations, it’s very much possible that six-year degree programs will give you less oral surgery experience than four-year programs.

OMFS is competitive as a dental school specialty. Applicants to both 4- and 6-year programs tend to be at the top of their class during dental school.

It is also the only dental specialty that requires studying for and taking the Comprehensive Basic Science Exam (CBSE), which is essentially an abbreviated USMLE Step 1 Exam. The average CBSE score for students accepted into OMFS programs is 68.9, which is equivalent to about 195 to 200 on USMLE Step 1.

So in addition to studying for dental exams and dental boards like everyone else, OMFS aspirants will need to additionally prepare for this test.

According to data from the National Matching Service, in 2021, only approximately 48% of applicants matched into either four- or six-year OMFS residency programs. Applicants that don’t match the first time around have three options.

The first, and increasingly common, option is to do a non-categorical internship year offered by an OMFS residency program and apply again. Alternatively, they can spend this gap year practicing dentistry or completing a one-year general practice residency before applying again.

The good news is that dental school is more attainable than medical school. The average dental school matriculant has a GPA of 3.5 and a composite DAT score of 20, which is around the 75th percentile. In comparison, the average MD matriculant will have a GPA of 3.7 and an MCAT score of 511, which is in the 88th percentile.

Subspecialties within OMFS

After completing OMFS residency, you can further subspecialize with a fellowship. That being said, most fellowship-trained surgeons will still perform basic OMFS procedures as well.

There are three main fellowship options: Head and Neck Oncology, Facial Cosmetics, and Cleft and Craniomaxillofacial Surgery.

Head and Neck Oncology

Head and neck oncology is a 2-year fellowship focusing on the ablation and reconstruction of malignant tumors of the head and neck, with special attention to the oral cavity, salivary glands, and maxillofacial complex. This fellowship also provides training in microvascular reconstruction.

Of note, this fellowship is more commonly completed by ENT surgeons than by OMFS.

Facial Cosmetics

Facial cosmetics is a one-year fellowship that provides additional experience with facial cosmetic procedures, including facelift, blepharoplasty, and rhinoplasty.

Cleft and Craniomaxillofacial Surgery

Cleft and craniomaxillofacial surgery is a one-year fellowship providing surgical experience in treating cleft lip and palate, craniofacial surgery, and other major facial deformities.

Of note, most craniofacial fellowship-trained surgeons are plastic surgeons.

What You’ll Love About OMFS

There’s a lot to love about the field of oral and maxillofacial surgery.

OMF surgeons see the full spectrum of patients: from young to old and healthy to sick. The types of cases that they see are also, for the most part, fairly routine. OMFS primarily performs procedures such as dental extractions, dental implants, biopsies, infections, arthrocentesis, guided bone regeneration, and trigger point injections.

Similar to other surgical specialties, OMFS provides immediate relief from various ailments. Whether relieving pain from TMJ disorder or restoring function through dental implants and orthognathic surgery, most OMFS procedures have favorable outcomes, and mortality is low.

Job satisfaction is high amongst OMF surgeons. In one survey, approximately 84% reported satisfaction with their career and 77% reported they would choose a career in OMFS again.

OMF surgeons are highly compensated, even with respect to other specialized dental and medical fields, making an average of $465,000 per year. It’s important to note that the majority of OMFS work in private practice, and those working in academic or community settings will typically receive lower compensation.

Private practice also provides greater independence, which often translates to prioritizing shorter and more straightforward cases to boost compensation.

What You Won’t Love About OMFS

That being said, OMFS is not for everyone.

The private practice route, which is common amongst OMFS, requires running a business and the additional administrative work and complexity that are associated with that.

Like many other surgical specialties, the training to become an OMF surgeon is long and comes with additional opportunity cost. Unlike the medical school pathway, residency isn’t required after dental school. That means rather than going out to practice as a general dentist and making a solid income, you’ll instead be committing an additional 4 to 6 years for OMFS residency.

OMFS residency is also highly competitive, with only 48% of applicants getting accepted each cycle.

Diversity in the field has historically been lacking with regard to gender. The field is 87% dominated by men. This has started to change in recent years with higher proportions of female students being accepted into OMFS residencies; however, as it stands now, the reality is that most OMF surgeons are men.

Should You Become an OMFS?

At the end of the day, how can you decide if OMFS is a good fit for you? If you’re set on working in the oral and maxillofacial region, then OMFS can be a great fit.

If your life outside of medicine is important to you, OMFS can provide the flexibility to perform surgery while still having time for your own family and interests.

If you love camaraderie and pride yourself on being a leader amongst leaders, you will appreciate the fact that general dentists and dental specialists will often turn to you for your help and advice.

That being said, you should only pursue OMFS if you are truly certain you want to work in the oral and maxillofacial region.

Over 50% of medical students end up changing their minds about what specialty to pursue during medical school. Since OMFS requires going to dental school instead of medical school, your options are limited if you decide OMFS isn’t for you. Going the medical school route can offer you more flexibility while still allowing you to do similar work as an ENT surgeon.

Scope Of Oral And Maxillofacial Surgery

The history of oral and maxillofacial surgery dates back to 500 BC. Even the famous ancient physician Hippocrates described the treatment for a dislocated mandible in his works. The 1800s saw the field of oral and maxillofacial surgery getting established as a field specializing in the treatment of the disease and surgery of the mouth, jaws and associated parts.

The father of surgery in India, Sushruta, has documented several procedures done on the face way back in 600 BC. Down the ages, the scope of oral and maxillofacial surgery has become multifold.

OMFS has consistently served as a link between medicine and dentistry, expanding its scope to encompass the diagnosis and treatment of diseases affecting the mouth, jaws, face, and neck. The scope thus is extensive.

The following are the fields of interest for the maxillofacial specialty: 

Procedures are done under local anesthesia, conscious sedation and general anesthesia.

• Removal of impacted teeth and complex buried dental roots.
• Pre-implant surgery, including the use of implants to retain facial or dental prostheses and associated bone grafting techniques as part of jaw reconstruction.
• Removal of cysts and tumours of the jaws
• Treatment of infections of the jaws and face
• Facial injuries, management of complex fractures and soft tissue injuries of the mouth, face, and neck.
• Head and neck cancer, precancerous lesions, vascular tumors: surgical resection, including neck dissections.
• Reconstructive surgery, including microvascular free tissue transfer.
• Orthognathic surgery for the correction of facial deformities and disproportions.
• Primary and secondary surgery for cleft lip and palate and other congenital facial deformities.
• Management of benign and malignant lesions of the salivary glands.
• Removal of complex facial skin tumours and reconstruction
• Cosmetic surgery including facelifts, eyelid and brow surgery and rhinoplasties.
• Temporomandibular joint surgery

Oral and maxillofacial surgeons are known to work alongside a variety of specialists in other fields, such as orthodontists, restorative dentists, ENT surgeons, oncologists, plastic surgeons, and neurosurgeons to provide a comprehensive approach in certain cases of head and neck surgery.

This enormous expertise that a maxillofacial surgeon holds can go unnoticed unless there is awareness amongst the general public about the scope of service that could be provided. The face, a delicate and complicated structure of the human body that includes teeth, tongue, upper and lower jaws, cheeks, chin, nose, forehead, eyes, ears, and neck, necessitates the expertise of a surgeon who is well-versed in the facial region.

Oral Surgery Residency Acceptance Rate

The Oral and Maxillofacial Surgery (OMFS) Program has a long history as one of the premier oral and maxillofacial Surgery programs in the United States.

Surgical training in all areas of oral and maxillofacial surgery prepares our residents for successful completion of board certification. In fact, 100 percent of graduates within the last 20 years have achieved board certification through the American Board of Oral and Maxillofacial Surgeons or the Canadian Board of Oral and Maxillofacial Surgeons.

Many graduates complete fellowship training in specialized areas of oral and maxillofacial surgery including cleft and craniofacial surgery, cosmetic surgery and trauma surgery.

The Oral and Maxillofacial Surgery Program boasts some of the most highly recognized and internationally renowned faculty, including Raymond White, DDS, PhD, and Timothy Turvey, DDS.

The program is also home to the Adams School of Dentistry Craniofacial Center team and the facial gender affirmation surgery clinic. The program uses technological advances in surgical technique and planning and takes pride in the UNC system’s support of innovation and advancement.

Didactic education for residents is a paramount foundation and a comprehensive didactic lecture schedule has been implemented to ensure broad knowledge in all areas of surgical care. Supplemental didactic education from field experts was spearheaded by program director Elda Fisher, MD, whose commitment to resident education is unsurpassed.

We strive to instill values in our residents and throughout the program that exemplify the highest standards in ethics, professionalism and compassion.

We support personal endeavors, including family and other personal goals, and aim to be a champion of all aspects of resident well-being.

The sense of family within the Oral and Maxillofacial Surgery Program is strong, and we pride ourselves on our commitment to care for each other.

Program Structure

UNC Hospitals and the Adams School of Dentistry residency program in Oral and Maxillofacial Surgery is a six-year integrated program ending in completion of an MD degree from the UNC School of Medicine. The six-year integrated program includes exposure and/or rotations in general surgery, surgical ICU, plastic surgery, otolaryngology, and pediatric and adult anesthesia.

The Oral and Maxillofacial Surgery program is accredited by CODA and complies with all rules and regulations of CODA and the ACGME. Program completion leads to qualification for certification by the American Board of Oral and Maxillofacial Surgery, completion of the MD degree from the University of North Carolina (the #1 ranked medical school in Primary Care in the country) and eligibility for all CODA-accredited fellowship programs and ACGME programs.

Year 1: OMFS (7 months), Anesthesia (4 months), Pediatric Anesthesia (1 month)
Year 2: UNC School of Medicine
Year 3: UNC School of Medicine (6 months), OMFS (6 months)
Year 4: UNC Hospitals General Surgery (11 months), Elective (1 month)
Year 5: OMFS (7 months), Asheville-Mission Hospital ENT/Plastics/Additional Trauma (4 months), Elective (1 month)
Year 6: OMFS Chief Resident

Admissions Information

Applicants must utilize the Postdoctoral Application Support Service (PASS) administered by the American Dental Education Association and the Postdoctoral Dental Matching Program (MATCH).

Each applicant must complete the background check questions and return them to the program director. Final acceptance requires a personal interview.

Tuition, Stipend Support and Benefits

The Oral and Maxillofacial Surgery Residency Program at the University of North Carolina School of Dentistry does not charge students for tuition and fees.

During the six years of the dual degree program, residents pay tuition and fees for the third and fourth years of medical school.  These fees are found on the UNC School of Medicine website.

The stipend schedule for UNC Hospitals is based on the program level training and is competitive with the Southeast hospital system. It varies from year to year.

Out-of-state students and international students with permanent resident status (“green card”) are encouraged to establish legal residence in North Carolina and to apply for classification as a state resident for tuition purposes.  Guidelines and application forms for establishing residency are available from the UNC-Chapel Hill Graduate School.

Regardless of the availability of stipend support, teaching responsibilities are required as a part of the program.

2021-2022 Salary Scale

Postgraduate Year Determination
Stipend levels for trainees entering programs beyond their first core residency training program will be determined on the basis of the number of accredited years required by the ACGME for eligibility in that program, regardless of any other advanced or GME training the trainee may have completed.

Benefits

• Multiple options for health, dental, vision and supplemental insurance
• Eligible for on-campus parking
• Additional monthly freedom pay stipend for meals at UNC Health
• University Gym Access
• Professional Liability Coverage
• UNC Peer Support Program
• Voluntary Legal Plan for personal legal needs
• Flexible spending accounts for medical and dependent care (childcare expenses)

How Many Years To Become A Oral And Maxillofacial Surgeon

This field of oral and maxillofacial surgery is exciting and challenging, requiring mastery of skills to address both functional and aesthetic elements of the head, face, mouth, jaw, and neck. Thus, it requires specialized training—beyond a bachelor’s degree—of at least 8 years total.

Oral And Maxillofacial Surgeon Education Requirements

There are several education requirements to become an oral and maxillofacial surgeon. Oral and maxillofacial surgeons usually study advanced dentistry and oral sciences, biology or dentistry. 33% of oral and maxillofacial surgeons hold a bachelor’s degree and 21% hold a doctoral degree. We found these by analyzing 281 oral and maxillofacial surgeon resumes to investigate the topic of oral and maxillofacial surgeon education more precisely.

The most common colleges for students to pursue their goal of becoming an oral and maxillofacial surgeon are Meharry Medical College and the University of California, Santa Barbara.

For those who would rather stay in your pajamas during the day, we prepared some online courses that can help in oral and maxillofacial surgeon education paths.

We prepared a list of oral and maxillofacial surgeon certifications that you should consider. The necessary certifications that oral and maxillofacial surgeons must have to succeed are Board Certification in Oral & Maxillofacial Surgery and Dental Assistant (RDA).

Conclusion

To start, all OMF surgeons are trained extensively in administering anesthesia. They learn everything from establishing and maintaining intravenous lines to managing airways to performing endotracheal intubation.

They are also taught how to manage any complications or emergencies that might occur during anesthesia administration. For this reason, it is very common for OMFS in the outpatient setting to simultaneously serve two roles—being both surgeon and anesthetist.

The surgical scope of OMFS also goes beyond what many expect. OMF surgeons perform a variety of reconstructive and corrective surgeries both individually and as a part of an interdisciplinary healthcare team. When treating oral and oropharyngeal cancers, for example, an OMF surgeon may work alongside a plastic surgeon and a head-and-neck-trained ENT to remove the lesion and reconstruct the area.

They also perform a variety of corrective jaw surgeries to treat issues resulting from facial deformities, TMJ disorder, or malocclusions. A great example of this is orthognathic surgery, where they manipulate the positioning of the maxilla and mandible to treat conditions like malocclusion and sleep apnea.

Additionally, they can perform emergent surgeries for life-threatening conditions such as Ludwig’s angina.

Like other surgical specialties, OMFS split their time between procedures and consultations. Those that work in an academic center will further divide their time between academic responsibilities such as teaching and research.