The consequences of expanded oral surgery scope of practice in Richmond, Virginia.

BACKGROUND

On March 25, 2001, the Commonwealth of Virginia changed the definition of dentistry and expanded the scope of practice of single-degree oral surgeons to include cosmetic procedures previously restricted to physicians. The Board of Dentistry established standards for practice under the new scope. Suggestions made by the Board of Medicine regarding these standards were disregarded. The authors reviewed the events and consequences surrounding the redefinition of dentistry.

METHODS

Events between January 1, 2000, and January 1, 2005, were reviewed. Data were gathered from public records and Internet sites, reports of physicians practicing cosmetic surgery in the Richmond metropolitan area, hospital staff committees, and medical societies.

RESULTS

Physicians in Virginia were ill prepared to participate in the legislative process. Physicians treating patients unhappy with the results of cosmetic procedures by local oral surgeons described errors in preoperative diagnosis, failure to perform the appropriate surgical procedure, or inability to perform the appropriate procedure properly. A survey of cosmetic surgeons showed that 50 percent had cared for similar patients. There was no evidence to demonstrate a significant economic effect from increased competition by oral surgeons. The authors were unable to show that oral surgeons practicing in the Richmond metropolitan area are able to match the community standard for providing care.

CONCLUSIONS

The authors continue to regard scope of practice as an educational issue. On the basis of their review, it is not clear that standards promulgated by the Virginia Board of Dentistry have thus far produced surgeons capable of matching the Richmond community standard for cosmetic surgery.