Clinical Dental Student Perception of Oral and Maxillofacial Surgery as a Specialty at Qassim University

ABSTRACT

The objective of the current research was to assess and gain insight into the perceptions held by dental students enrolled in the clinical program at Qassim University regarding the specialty of oral and maxillofacial surgery (OMFS). A survey-based cross-sectional study was carried out at the dental clinics of Qassim University, following approval from the Dental Research Center of the university. The study targeted a population consisting of 80 dental interns and undergraduate students (BDS) enrolled at Qassim University. From each academic year (third year to interns), a random selection of 20 students was made, ensuring representation from both male and female sections. Upon analyzing the data regarding the intern and class year of dental students, it was found that there were no statistically significant associations with regard to question 3: “What do you perceive as the most commonly performed procedure by oral and maxillofacial surgeons in practice?” (P = 0.759a). Among intern and dental students, a significant majority identified extraction of the third molars as the most frequent procedure carried out. The lowest percentage (70.4%) was reported among the intern classes, whereas the highest percentage (91.7%) was reported among the fourth-year students. The perceptions of dental students toward OMFS undergo changes during their undergraduate training. By gaining a deeper understanding of these perceptions, the academic faculty specialized in OMFS can enhance their ability to educate students and, in turn, strengthen the overall specialty.

INTRODUCTION

Oral and maxillofacial surgery (OMFS), a specialized field of dentistry, focuses on the diagnosis, clinical management, and surgical treatment of various conditions affecting the maxillofacial complex, including those resulting from trauma, congenital abnormalities, developmental issues, and iatrogenic factors. Notwithstanding the progress made in the field, there persists a deficiency in the comprehensive comprehension among dental and medical practitioners concerning the exact extent and proficiency of OMFS.[1]

Despite efforts made by OMFS specialists to raise awareness, there remains a significant lack of public familiarity and understanding regarding the specialty. A study by Hunter et al. revealed that only 72% of the surveyed public had some knowledge or had heard about OMFS.[2] Similarly, a study carried out in England by Ferreira found that 79% of the general public had little to no knowledge or awareness of the specialty.[3] However, a later study by Ifeacho et al.[4] highlighted that OMFS specialists have made significant strides in creating awareness about their field.

The patient’s understanding and awareness of the OMFS specialty significantly impact the planning and execution of treatment options. However, if dentists lack perception or knowledge about the OMFS specialty, it can lead to challenging situations, as patients may present at dental clinics or emergency units with conditions requiring immediate consultation by OMFS specialists. It is crucial for attending dental surgeons to possess a comprehensive understanding of OMFS to make informed decisions regarding patient management. Therefore, the objective of this current study is to analyze the perceptions of a population of dental students regarding the OMFS specialty. The primary focus of this analysis will revolve around the comprehension levels of dental and medical professionals regarding the treatments offered by OMFS, their pattern of referral, and the general perception of this specialty. The purpose of this study’s findings is to redefine the educational goals within undergraduate dental student education, with the ultimate objective of enhancing well-informed referrals and advancing the quality of care to the patient.

MATERIALS AND METHODS

This cross-sectional study utilizing a survey methodology was conducted in the dental clinics of Qassim University from May 2023 to July 2023. Ethical approval was obtained from the Dental Research Center of Qassim University (EA/57/2016). The target population for this study consisted of 80 dental interns and undergraduate students (BDS program) from Qassim University. A total of 20 students were randomly selected from each academic year, including third-year students to interns, from both the male and female sections. Only those who have agreed to participate in the study were included. All participants were provided with a clear explanation of the overall objective and structure of the study. The questionnaire’s validity and reliability were confirmed through rigorous pilot testing, expert evaluation, and statistical analyses, ensuring its accuracy and consistency in measuring the intended constructs.

All participants completed a self-administered questionnaire survey. The questionnaire comprised the following sections: Demographic information such as gender and academic year, as well as data on participants’ experience with OMFS procedures, referral patterns, as well as general opinions on the specialty, were collected. The mean and standard deviation were calculated for the collected data. Statistical analyses were conducted using SPSS v. 21.0 software to evaluate the overall differences between groups. These analyses involved performing t-tests and Chi-square tests.

RESULTS

The analysis of the dental students’ intern and class year revealed no statistically significant associations with regard to question 3: “What do you perceive as the most commonly performed procedure by OMFS in practice?” (P = 0.759). A significant proportion of both interns and dental students held the perception that among the procedures frequented and performed was the extraction of third molars. Among the intern classes, the lowest percentage (70.4%) had this perception, while the highest percentage (91.7%) came from the fourth-year students [Figure 1].

Figure 1.

Most commonly performed procedure by oral and maxillofacial surgeons in practice. (P = 0.759a)

Upon analyzing the dental students’ intern class year, no statistically significant outcome was noted with regard to question 4: “What do you perceive as the most commonly performed procedure by periodontists in practice?” (P = 0.314). A substantial majority of both younger and senior classes selected periodontal surgery as the most prevalent procedure conducted by periodontists. [Figure 2].

Figure 2.

Survey results showing the perception of younger and senior dental student classes of most commonly performed procedure by periodontists in practice. (P = 0.314a)

The analysis involving the intern and class year among dental students revealed no statistically significant associations with regard to question 5: “Who (specialty) would you refer a patient to for removal of impacted third molar teeth?” (P = 0.177). Interns exhibited a high referral rate of 96.3% to oral and maxillofacial surgeons, while fifth-year students had a referral rate of 93.1%, indicating a similarly elevated level of referrals by both groups. In contrast, younger classes, including third-year and fourth-year students, showed lower referral rates of 79.2 and 90.0%, respectively [Figure 3].

Figure 3.

Survey results showing the perception of younger and senior dental student classes of which specialty they would refer a patient for the third molar removal (P = 0.177a, b)

Upon analyzing the intern and class year among dental students, a statistically significant relation was identified with regard to question 6.: “Who would you refer a patient for surgical placement of dental implants?” (P = 0.004). Among the senior classes, a significant proportion of students were selected for patients referred to the periodontist for dental implant placement, with 59.3% for interns and 48.3% for fifth-year students. On the other hand, the younger classes showed lower preference for periodontists, with only 16.7% of third-year students and 30% of fourth-year students opting for this referral.

Interestingly, a considerable number of students in both intern and fifth-year classes preferred referring patients to OMFS, with 40.7% of interns and 51.7% of fifth-year students selecting this option. Similarly, a majority of third-year students (54.2%) and fourth-year students (60%) also preferred referral to OMFS. Notably, none of the students from senior classes chose to refer patients to prosthodontics for implant procedures. In contrast, a higher percentage of students in the younger classes, specifically 25% of third-year students and 10% of fourth-year students, preferred referring to this specialty for dental implant procedures [Figure 4].

Figure 4.

Survey results showing the perception of younger and senior dental student classes of which specialty they would refer a patient for dental implant placement (P = 0.004)

The analysis of the intern and class year among dental students revealed no statistically significant associations with question 7: “If you had a child born with a cleft lip and palate deformity, from what specialist would you seek care for your child?” (P = 0.129). Both senior and younger classes displayed a notable referral rate, as 81.9% of seniors and 82.2% of younger classes chose to seek treatment from OMFS specialists to manage congenital deformities like cleft lip and palate. Upon analyzing the intern and class year among dental students, no statistically significant association was found with question regard to 8.: “If you sustained a mandibular fracture, from what specialist would you seek treatment?” (P = 0.625). Both senior and junior dental students showed a high preference for OMFS specialists for the treatment of mandibular fractures. Among senior dental students, 96.3% of interns and 96.6% of fifth-year students chose to seek treatment from OMFS specialists. Similarly, among the younger dental students, 87.5% of third-year students and 100% of fourth-year students preferred the same specialty for mandibular fracture repair. On the other hand, there were low referrals to general surgery specialties among younger and senior-class students. Referrals to plastic surgery were minimal, with only 1% of senior dental students and 1% of younger dental students opting for this specialty [Figure 5].

Figure 5.

Survey results showing the perception of younger and senior dental student classes of which specialty they would seek treatment from if they had sustained a mandibular fracture. (P = 0.625a, b)

The analysis of the classes year-wise among dental students yielded no statistically significant associations with regard to question 9: “Do you consider OMFS to be a dental or medical specialty?” (P = 0.210). A significant majority of senior dental students, with 77.8% of interns and 75.9% of fifth-year students, shared the belief that OMFS encompasses both medical and dental specialties. Among the remaining senior dental students, a significant portion considered OMFS to be strictly a dental specialty, with 14.8% of interns and 24.1% of fifth-year students holding this perspective. A majority of 54.2% of third-year classes and 55.0% of other classes shared the belief that OMFS encompasses both medical and dental specialties. In contrast, only 41.7% of third-year and fourth-year classes perceived the specialty was primarily rooted in dental origins [Figure 6].

Figure 6.

Survey results showing the perception of younger and senior dental student classes of nature of specialty: dental or medical. (P = 0.210)

The analysis year-wise among dental students revealed statistically significant results with regard to question 10: “How do you view the specialty of OMFS” (P = 0.034). Both senior and younger classes held a high regard for the specialty, with 96.3% of interns and 89.3% of fifth-year students in agreement. Similarly, 75.0% of third-year students and 80.0% of fourth-year students expressed a positive view of the specialty. A small proportion of the interns (3.7%) and fifth-year students (10.7%) did not express any opinion about the OMFS specialty. Among the younger class students, a low percentage of 10.0% was observed among fourth-year students, while the third-year students had a higher percentage of 25.0% in this category [Figure 7].

Figure 7.

Survey results showing the perception of younger and senior dental student classes of the importance of OMFS. (P = 0.034)

DISCUSSION

The study revealed notable changes in dental students’ perceptions of the OMFS specialty across undergraduate education levels, with certain nonstatistically significant questionnaire responses providing valuable insights, consistent with prior research emphasizing the acknowledgment of specific procedures and referrals to OMFS among dental students and healthcare professionals. Rocha et al., in Brazil and Jarosz et al., in the USA found common perceptions among dental students regarding the involvement of OMFS specialists in procedures like facial trauma management, correction of dentofacial deformities (including cases of cleft lip and palate), mandibular reconstructive surgeries, temporomandibular joint surgeries, extraction of third molars, and dental implant procedures.[1,5] Similarly, studies by Subhashraj and Balanand-Subramaniam in Pondicherry, India, corroborated that dental students acknowledged the role of OMFS specialists in managing maxillofacial fractures, tooth fractures, maxillofacial pathologies, dental implant procedures, and the extraction of third molars.[6]

Despite lacking statistical significance, the clear preference expressed by dental students across all classes for referring patients with impacted third molars to OMFS specialists aligns with consistent findings from prior studies by Rocha et al., Subhashraj and Balanand-Subramaniam, and Jarosz et al., underscoring dental students’ inclination to seek OMFS specialists for cases related to “third molar problems” and “removal of third molar tooth,” indicating a widespread recognition among dental students of the specialized expertise of OMFS specialists in managing impacted third molars.[1,5,6] Although not statistically significant, this study observed noteworthy referral rates to OMFS for cleft lip and palate repair and mandibular fracture, consistent with findings from a study in Birmingham, UK, by Ifeacho et al.,[4] indicating a shared understanding among dental students of the varied responsibilities of OMFS specialists, encompassing conditions like cleft lip and palate repair, alongside procedures such as tongue cancer treatment, assessment of oral lumps, and jaw fracture repair, reaffirming the prevalent tendency among dental students to refer such cases to OMFS specialists.

Consistent with earlier research, our study’s results on the perception of OMFS as either a medical or dental specialty echo findings from a study by Shrinivas Rangarajan et al.[7] in Fort Lauderdale, FL, where 81% of participants, primarily dentistry students, believed that OMFS specialists are both dentists and physicians, stemming from the notion that acquiring medical education either before or after dental education is a prerequisite for pursuing this specialty. Recent studies on dental implant placement referral patterns highlight consistent preferences for OMFS specialists, with Cottrell et al. reporting a 51% referral rate by general dentists in Boston.[8] Another study by Hunter et al. revealed that dental students referred to OMFS 56% of the time, while practitioners referred 52% of the time.[2] In contrast, Mayer and Goupil’s study in Connecticut found an equal distribution of dental implant referrals between OMFS specialists and periodontists among general dentists.[8,9]

As a cross-sectional study, it captures data at a specific point in time, potentially missing out on changes in perceptions and attitudes over time among dental students. The study focuses on perceptions, which can be subjective and might not necessarily align with actual experiences or future career choices among dental students. While the study focused on a single dental school, it provides valuable insights into dental students’ perceptions of OMFS, and future multischool studies could offer additional perspectives on recognizing and managing shifts in students’ perceptions during their training for well-informed referrals.

CONCLUSION

The study underscores the evolving perceptions of dental students toward OMFS, emphasizing the need for continued awareness and education within undergraduate dental programs to enhance well-informed referrals and strengthen the overall specialty.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.