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Expert Q&A: May 2020

Expert Q&A with: Dr Mehrnoosh (Nu) Dastaran OMFS

MBChB BDS MPhil DOHNS (RCS Eng) FRACDS (OMS)

"OMFS is indeed a broad scoped speciality, but it is important to remember that our roots still lie firmly in dentistry."

Dr. Dr Mehrnoosh (Nu) Dastaran

Bio:

Dr. Mehrnoosh (Nu) Dastaran is a Victorian-trained Specialist Oral and Maxillofacial Surgeon, who graduated in Medicine in 2005 from the University of Bristol and Dentistry in 2010 from King’s College London, as the highest achieving candidate in both degrees. She has undergone sub-speciality fellowships in craniofacial and skull base surgery, corrective jaw surgery and craniofacial trauma at the Royal Melbourne and King’s College Hospitals. 

Dr. Nu plays an active role in undergraduate and postgraduate surgical and dental education at the University of Melbourne and is a senior lecturer at Charles Sturt University. She has researched collaboratively with the Victorian branch of the Australian Dental Association (eviDent Foundation) and has completed a Master of Philosophy in Dental Science by Research in the field of Implantology at the University of Melbourne Dental School. 

Dr. Nu works as a specialist at The Royal Melbourne Hospital, Royal Dental Hospital of Melbourne, and in private practice in Melbourne and regional Victoria. Her special interests include corrective jaw surgery, craniofacial trauma, dentoalveolar surgery, implantology, minimally invasive salivary gland surgery and facial aesthetics.

In her spare time Dr. Nu finds it hard to sit still. She relishes musicality and movement through dance, and in particular, enjoys classical ballet and pole dancing. She also loves to explore the outdoors, whether on foot or by bicycle.

Oral and Maxillofacial Surgery is a very broad scoped specialty. What procedure(s) can an OMFS provide patients that referring dentists may not be aware of?

OMFS is indeed a broad scoped speciality, but it is important to remember that our roots still lie firmly in dentistry. 

We are trained specifically in oral surgery in a way that ensures thorough knowledge of its evidence base, and precision and attention to detail in its execution. Yes, we do place dental implants in the aesthetic zone, for example, and we do perform an array of soft and hard tissue augmentation procedures that can facilitate oral rehabilitation with dental implants. 

Many dentists do not realise that our patients can access Medicare rebates, so surgery is a lot more affordable than it might seem. Additionally, for us, implants, graft materials and some surgical guides like MGuide® fall under the prosthesis list, which means that patients often do not have to pay for them. I see this as a huge bonus, particularly as we are in the business of helping people!

Many oral and maxillofacial surgeons have additional/subspecialty interests in cancer surgery, free flap reconstruction or paediatric cleft and craniofacial surgery. My love of facial anatomy and strong background in orthognathic surgery has grown my interest in facial cosmetic surgery.

Whatever the area, it is clear that the fine motor skills, creativity and 3-dimensional perspective required for dentistry, have given us an advantage over other surgical specialties. 

A lot of dentists may not have well developed working relationships with their specialists. From your experience, how can a dentist establish a better working relationship with their specialists?

I believe in relationships that are personal, mutually beneficial, respectful, and long-term. I am a proponent of good and open communication, whether in person, over the phone or in writing. Personally, I respond best to face-to-face meetings and phone calls, because I like to put a face and/or voice to someone’s name. That is my practice style.

It works both ways though. Sometimes, specialists may seem unapproachable, and for me, sometimes, it is difficult to get beyond a receptionist when I am trying to contact a dentist or potential referrer.

So, send an email to your local specialist, and ask for a coffee date, or time for a catchup. Discuss complex cases in person or virtually (technology and Covid-19 have helped to expedite this), so that you can nut-out a treatment plan when you have all the information in one place and at your fingertips. And, importantly, if you are sending a potentially difficult referral their way, forewarn them so that they have time to prepare!

You have been involved in a lot of teaching lately.  When it comes to dentoalveolar surgery, what 3 practical tips do you have for dentists to perform extractions safer and more predictably? 

  1. Have the right equipment open and ready. For this, you need to plan for all eventualities. That way you will not have to stop-start, because it can be stressful trying to find equipment during a procedure.
  2. Communicate with your nurse. Active assistance is invaluable. This includes teaching them how to support the head, support the jaw, retract the tongue and adjust the light if it is not on target etc. without you having to ask.
  3. If you can get forceps on a tooth, always deliver it with forceps and do not be tempted to complete the extraction with an elevator. This will avoid complications like root fractures, and tuberosity and cortical plate fracture. Push, never pull.

What advice do you have for any dentists thinking of specialising in OMFS? How do you see the future relationship between dentists and specialists evolving?

If you want to specialise in oral and maxillofacial surgery, get both degrees (medicine and dentistry) completed and out of the way as soon as possible. There are no prizes for taking a lifetime to become eligible to apply for training. Generally, to specialise, you need to do things that make you stand out from others and excel, like research and work experience. 

Do not underestimate the value of general dentistry, however. There is also so much quality CPD available to general dentists now, that you can focus your attention on a few areas of interest without having to specialise.

It is important, nevertheless, to know your limitations, be able to manage your complications, and to establish relationships with specialists around you. I think that as dentistry advances, specialists and general dentists will increasingly lean on each other. Ultimately, we must not lose sight of our common goal, which is to provide the safest and best level of care for our patients. 

 

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