An oral and maxillofacial surgeon (OMS) is a dentist who completed a four-to-six-year hospital-based surgical residency focused on the mouth, jaws, and face; a general dentist is the broad-scope primary provider who performs routine extractions and refers the surgical cases out.
The split is built on referral: a general dentist keeps the straightforward extractions and sends impacted teeth, jaw surgery, and facial trauma to an oral surgeon — and the OMS typically refers the patient back to the GP once the surgery is done.
The short answer
A general dentist is trained broadly and is most people's main dentist; an oral and maxillofacial surgeon is a specialist who added the longest surgical residency in dentistry.
Both can legally perform extractions — the difference is training depth, case complexity, and how the patient arrives.
Most general dentists extract straightforward teeth themselves and refer the harder surgical work out.
An oral surgeon's practice runs heavily on those referrals, from both general dentists and orthodontists, rather than on walk-in demand.
What each one does
A general dentist runs comprehensive primary oral care — exams, fillings, crowns, routine extractions, and preventive care — and treats surgery of the mouth and jaw as one item on a much longer list.
An oral surgeon does one thing in depth: removing impacted wisdom teeth and complex extractions, placing dental implants (especially in difficult bone), corrective jaw (orthognathic) surgery, treating facial trauma and fractures, and managing oral pathology like cysts and tumors.
| Comparison | General dentist | Oral surgeon |
|---|---|---|
| Typical surgical case | Routine, single-rooted extraction | Impacted wisdom teeth, complex extractions, jaw surgery, trauma |
| Training beyond dental school | None required for routine extractions | 4–6 year hospital-based OMS residency |
| Board certification | Not applicable to this scope | American Board of Oral and Maxillofacial Surgery (ABOMS) — voluntary |
| How the patient arrives | Existing patient of record | Usually on referral, from a GP or an orthodontist |
What the OMS residency adds
Both start the same way: a bachelor's degree, then four years of dental school for a DDS or DMD, then licensure.
A general dentist can begin practicing there.
An oral surgeon continues into a hospital-based oral and maxillofacial surgery residency, at least four years per CODA's accreditation minimum — some integrated tracks also award a medical degree (MD) — built around dentoalveolar and orthognathic surgery, facial trauma, oral pathology, hospital operating-room experience, and administering the full range of anesthesia and sedation.
After residency, most oral surgeons pursue certification from the American Board of Oral and Maxillofacial Surgery (ABOMS) — voluntary, but a recognized signal to the referring dentists deciding who to send cases to.
It's the longest, most competitive residency path in dentistry; see how to become an oral surgeon for the full sequence, or the residency's CODA-set four-year minimum for what the accrediting standard actually requires.
Which surgical cases a GP keeps
There's no fixed rule — the line moves with each dentist's training, comfort, and equipment — but a common pattern holds.
General dentists tend to keep straightforward, single-rooted extractions and sometimes simple, fully-erupted wisdom teeth, where anatomy is predictable and the procedure is quick in the chair.
What tends to get referred: impacted or deeply bony wisdom teeth, multiple or complex extractions, implant placement where bone grafting or sinus work is needed, orthognathic jaw surgery, facial trauma and fractures, and biopsies of suspicious lesions.
A GP who places implants routinely refers less of that category; one focused on general practice sends more of the above to an oral surgeon.
The referral relationship runs both ways
Oral surgery is referral-driven — a general dentist or an orthodontist sends the case, and the OMS's practice depends on that relationship rather than on direct-to-consumer demand the way orthodontics or pediatric dentistry often is.
Orthodontists refer in too: cases combining braces with jaw surgery (orthognathic treatment) are typically co-managed between the two, with the OMS performing the surgery partway through the orthodontist's treatment plan.
The relationship doesn't end at the extraction or surgery.
An oral surgeon commonly refers the patient back to the referring general dentist for restorative work — a filling, crown, or denture — and, after implant placement, back to the GP or a prosthodontist for the final crown.
That two-way handoff is the point: the OMS isn't the patient's dentist of record, so the case always returns to the GP once the surgical work is done.
Pay: tracked under separate codes
The U.S. Bureau of Labor Statistics tracks general dentists on their own occupational code: SOC 29-1021, Dentists, General, with a national median of $170,950 a year (OEWS, May 2025).
See the dentist salary guide for the full breakdown.
Oral and maxillofacial surgeons have their own code too: SOC 29-1022, with a national median of $352,220 a year — typically the highest-paid dental specialty (OEWS, May 2025).
As with other specialties, most OMS own or partner in practices, so real earnings blend clinical pay and practice profit.
See the oral surgeon salary guide for the percentile breakdown, or browse current oral surgeon openings.
This article is general career information, not clinical, legal, or financial advice. Referral patterns, training requirements, and pay vary by dentist, region, and practice.