By Dan Schulte, J.D.
MDA Legal Counsel
From the June 2008 issue of the Journal
Question: I read your April Journal article, titled "Is Lip Augmentation within the Scope of Dental Practice?" Did these comments apply to oral surgeons? Were you saying that oral surgeons have the same scope of practice as general dentists? Please explain your answer further. Thank you.
Answer: We have received many calls on this issue. Some think that my April article says that the scope of practice of a dentist with a certification in oral and maxillofacial surgery is limited by the dental scope of practice statute (MCL 333.16601). Others have suggested that based on the article such an incorrect conclusion may be drawn, implied or construed.
The article does not state that the scope of practice of a dentist with a certification in oral and maxillofacial surgery is the same as a dentist without the certification. No such conclusion should be drawn, implied or construed. The article only dealt with the dental scope-of-practice statute and therefore applies only to general dentists (those without any specialty certification).
The only mention of the specialty certifications is in the second paragraph of the article. All that said was that a general dentist may provide services for which a specialty certification is available, even though the dentist has not obtained a specialty certification. I am often asked whether this is the case, and that is why it was mentioned. A general dentist who is practicing oral and maxillofacial surgery is limited by the dental scope-of-practice statute. The explanation of that scope of practice and its application to lip augmentation was the subject of the April article. It is correct and will not be repeated here.
In Michigan, there are significant differences in the regulation of general dentists and dentists who are certified in oral and maxillofacial surgery. First, in addition to being licensed as a dentist, those certified in oral and maxillofacial surgery are required by Michigan Administrative Code Rule 338.11513 to have 1) completed not less than three years of hospital training in an accredited oral and maxillofacial surgery program approved by the Michigan Board of Dentistry, and 2) successfully completed a written and clinical examination that includes anatomy, radiology, pathology, local and general anesthesia, major surgical procedures, history and physical evaluations, management of hospitalized patients and intra-oral surgery including infections, and the completion and submission of four case histories documented by the hospital administrator and its chief of oral and maxillofacial surgery.
Second, Rule 338.11513 states that the practice of oral and maxillofacial surgery "includes the diagnosis and surgical and adjunctive treatment of the diseases, injuries, and deformities of the human mouth, jaws, and associated maxillofacial structures" (emphasis added). The inclusion of the mouth and maxillofacial structures in Rule 338.11513 is a significant difference from the scope of dental practice, which is limited to the teeth, alveolar process, gums, jaws and their dependent tissues (by MCL 333.16601) and does not extend to the mouth or maxillofacial structures
The additional education and training that dentists certified in oral and maxillofacial surgery must obtain and the wording of Rule 338.11513 enables them to perform procedures (those involving the mouth and associated maxillofacial structures) that would not be permitted by the dental scope-of-practice statute.
Gray’s Anatomy includes the lips as a part of the mouth, and therefore the surgical and adjunctive treatment of the lips (e.g., the administration of Botox or other injections for augmentation) would be within the Rule 338.11513 scope of practice of a dentist who has obtained a certification in oral and maxillofacial surgery.
A final note: This article you are reading deals only with the scope of practice for a dentist with a specialty certification in oral and maxillofacial surgery. The scope of practice of dentists holding other specialty certifications is not addressed in this article.