J Oral Maxillofac 50:771-772.

Surg

1992

SCREENINGFOR HUMAN IMMUNODEFICIENCY VIRUS IN PATIENTSWITH LYMPHADENOPATHY To the Editor:-Once again, the Editor has done an impressive job (J Oral Maxillofac Surg 50: 1, 1992). In a logical, rational, and comprehensive manner he has guided us through the complex swamp of the current status of the acquired immunodeficiency syndrome problem. This should serve as a primer for OMSs to position themselves in any discussion. On a different level, a clinical aspect of concern to the practitioner and the patient is the alteration in index of suspicion of the diagnostic examination. Before interventional elective surgery (eg, impactions, orthognathic surgery, and even extractions) patients presenting with cervical adenopathy should be initially screened by fine-needle or excisional biopsy, even in the presence of other nonacute oral surgical findings. Oral and maxillofacial surgical procedures should be deferred until the determination has been made that the patient is not immunocompromised. The imposition of surgery and anesthesia on the immunodeficient patient is unwarranted and fraught with complications. It is the responsibility of the cautious practitioner to avoid this situation. EUGENE FRIEDMAN,

DDS Massapequa, New York

MAINTAINING THE DIVERSITYOF OUR SPECIALTY To the Editor:-1 had hoped that the subject of the contended involvement of the American Association of Oral and Maxillofacial Surgeons (AAOMS) Board of Trustees and any of its agencies in the emergence of dual-degree training programs had finally been clarified and understood by the membership. However. I see that Dr Irwin A. Small has again raised the issue of a national decision on the subject of dual-degree training (JOMS 50:102, 1992). The amount of rhetoric, and the corresponding misperceptions and misunderstandings of this subject, has been voluminous. 1 had hoped that the rational and reasoned discussions at the Open Forums had diffused some of the irrational emotion regarding this subject. The deliberations and reports of our Strategic Planning Committee, with representation from the House of Delegates, should have made Dr Small realize that the House of Delegates has participated in this debate. As far as reaching a decision by national

consensus on this issue, I think most of the members of the AAOMS realize that this is impractical, counterproductive, and inappropriate, if not illegal. Neither the AAOMS House of Delegates nor its Board of Trustees is in the position to mandate the cessation of double-degree training programs, and I question what would occur if a consensus conference or referendum would decide that there should not be doubledegree oral and maxillofacial surgeons. We know that double-degree programs are not new. They have existed since the late 1960s. The recent increase in the number of the double-degree programs can be attributed, in part, to the increase in oral and maxillofacial surgery training from 3 to 4 years, which was necessary to allow for more clinical training to reflect our actual current scope of practice. Lest we forget, this also resulted in our revised definition. With this change, many programs also viewed the offering of an MD degree favorably, and the number of candidates for oral and maxillofacial surgery training who desired an MD degree perhaps increased for the same reason. The matching program still indicates that the number of applicants for MD-OMS training is far greater than the number of positions available, so one might say the MD program is in part applicant-driven. The number of programs offering MD oral and maxillofacial surgery training increased significantly in the early 1980s and continues to elevate. There are currently about nine developing a doubledegree program. However, not unlike programs in other surgical disciplines, some will not be able to implement an MD-integrated curriculum or establish the appropriate affiliations for such a program. It is important to note that the current “Standards” for the 4-year program represent the essential core surgical training for both types of programs, deviation from which the AAOMS and ADA will not tolerate. Currently, of the 108 accredited programs, 34%, or 3 1% are integrated MD oral and maxillofacial surgery residency programs. Fourteen (or 13%) offer the medical degree as an option, most of which are addressing change to the integrated MD training. In addition, there is a slight increase in the number of programs offering a PhD track, MS degrees, surgical fellowships, research fellowships, all for the advancement of the specialty. I do not believe it would be healthy to stifle the educational process as it relates to enhanced educational and training opportunities for future members if the specialty is to prosper and maintain its rightful place in the health care arena. The AAOMS, through its Committee on Residency Education and Training and Section on Education, advises the Commission on Dental Accreditation of the American Dental Association on minimum standards for residency training programs. It would not be appropriate for us to advocate a limit as to the amount of education a trainee can receive. I contend that a negative vote on the doubledegree issue by referendum or a consensus conference would do nothing but split our specialty. Those with double degrees or in training for a double degree would be put on notice by the AAOMS that they are unwelcome. This would be totally counterproductive to what we all have been en-

Screening for human immunodeficiency virus in patients with lymphadenopathy.

J Oral Maxillofac 50:771-772. Surg 1992 SCREENINGFOR HUMAN IMMUNODEFICIENCY VIRUS IN PATIENTSWITH LYMPHADENOPATHY To the Editor:-Once again, the Ed...
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