Oral Medicine

Lecture Notes
 THE PRACTICE OF ORAL
MEDICINE

Dr Abdullahi Alhashimi
23.02.2016
• a relatively new specialty
• used to be termed "stomatology”
• American physician and dentist, Thomas E
Bond authored the first book on oral and
maxillofacial pathology in 1848, entitled
"A Practical Treatise on Dental Medicine
• The term "oral medicine" was not used
again until 1868
• Jonathan Hutchinson is also considered
the father of oral medicine by some
• Before becoming its own specialty in the
United States, oral medicine was
historically once a subset of the
specialty of periodontics.
Oral medicine (oral and maxillofacial
medicine or stomatology)
• oral health care of patients with chronic
recurrent and medically related
disorders of the mouth and with their
diagnosis and non-surgical management.
• Oral medicine specialists are concerned
with the nonsurgical medical aspects of
dentistry. These specialists are involved
in the primary diagnosis and treatment
of oral diseases that do not respond to
conventional dental or maxillofacial
surgical procedures.
Fundamentals of oral medicine
• Recognition of the interaction of oral
and systematic health
• Integration of medical and oral health
care
• Management of pharmacotherapeutics
necessary for treatment of oral and
systemic diseases
• Investigation of the etiology and
treatment of oral diseases through basic
science and clinical research
• Research, teaching, and patient care
• Provision of care for medically complex
patients and for those undergoing cancer
therapy
 Scope of the field
• (1) diseases of the oral mucosa,
• (2) infectious diseases of the orofacial
region
• (3) orofacial pain
• (4) salivary gland and chemosensory
disorders
 Training and practice
• Australia
• three years in length and culminate with either a Master
degree (MDS) or a Doctor of Clinical Dentistry degree
(DClinDent).
• Canada
• three years in length and usually culminate with a
master's (MSc) degree.
• Most residents combine oral medicine programs with oral
and maxillofacial pathology programs leading to a dual
specialty. Graduates are then eligible to sit for the
Fellowship exams with the Royal College of Dentists of
Canada
• UK
• One of the 13 specialties of dentistry
recognized by the General Dental Council
(GDC).
• Most specialists have dual qualification with
both medical and dental degrees.
• After 2010, the medical degree was no longer a
prerequisite for entry into specialist training.
• Specialist training is normally now 5 years
• The British Society for Oral Medicine has suggested
that there are not enough oral medicine specialists,
and that there should be one consultant per million
population.
• USA
• Not a recognized specialty
• residency training programs are a minimum of 24
months.
• Some programs have the opportunity to obtain other
advanced degrees (e.g.: Masters or Ph.D.), and these
are typically 3-5 years in length.
ORAL MEDICINE IN THE HOSPITAL

• Hospital is the frequent setting for the

most complex cases in oral medicine.
• Hospitalized patients are most likely to
have oral or dental complications of
bone marrow transplantation,
hematologic malignancies, major
bleeding disorders, etc..
• The hospital that wishes to provide the
highest level of care for its patients must
have a dental department.
• Examples of problems or needs that are
rarely seen in outpatient practice but
are commonly seen in hospitalized
patients are oral ulcers, oral bleeding,
chemotherapy; dental care to prevent
osteoradionecrosis
 Procedures performed
• Biopsies. Surgical removal of tissue or
bone specimen for analysis to obtain a
diagnosis.
• Ordering and interpretation of tests.
Such tests include imaging studies (x-
rays, CT scans, MRIs), salivary and
blood tests and microbiological
investigations.
• Medical management. Treating with
topical and systemic medications to
treat a wide range of conditions.
• Specialized injections. Injections in the
mouth or face for diagnostic purposes,
or for administration of medication for
pain relief, anesthesia, or inflammation
• advise dentists about the treatment of
patients with complex medical
conditions.
• Oral medicine doctors receive special
training in general medicine, oral
pathology and oral radiology.
 Life and Careers in Oral Medicine
• An oral medicine doctor is trained to
diagnose and manage patients with
disorders of the orofacial region,
essentially as a "physician of the mouth."
• Examples include: the diagnosis and
management of oral mucosal
abnormalities (growths, ulcers, infection,
allergies, immune-mediated and
autoimmune disorders, cancers),
salivary gland disorders,
temporomandibular disorders and facial
pain, taste and smell disorders; and
recognition of the oral manifestations of
systemic and infectious diseases.
 Practice settings
• Private practice: provide specialized care
for the orofacial conditions, and general
dental care to patients with complex
medical conditions (providing a mix of
the practice of dentistry and medicine).
• Dental and medical schools Oral medicine
doctors generally balance their time
between teaching, patient care and
research.
• At dental schools, they generally teach
oral diagnosis and treatment planning,
dental management of medically complex
patients, and oral medicine topics (e.g.:
mucosal abnormalities, salivary gland
disorders, facial pain, etc.).
• At medical schools, they may teach medical
students and residents about conditions of
the oral cavity and orofacial region.
• Hospital / Healthcare facility. In
hospital dental services, oral medicine
doctors providing care in hospital
outpatient clinics, care for inpatients,
emergency rooms and operating rooms.
They often work closely with specialty
service lines including oncology, stem
cell and solid organ transplantation, and
cardiac medicine.
• Research / Scientific study. Many oral
medicine doctors conduct research studies
and write and publish articles in the literature
and textbooks on the subject of medical
conditions of the orofacial region, and the
dental management of complex medical
conditions. They may conduct clinical research
studies while treating patients in the settings
listed above, or perform studies /
experiments in a research laboratory.
 Partnership
• This includes:
• General dentists and dental specialists (e.g.:
oral and maxillofacial pathologists,
periodontists, oral and maxillofacial surgeons)
• Primary care physicians (e.g.: family medicine,
internal medicine)
• Dermatologists
• Oncologists
• Otolaryngologists
• Gastroenterologists
• Rheumatologists
• Neurologists
• Plastic surgeons
• Physical therapists
• Mental health specialists (e.g.:
psychiatrists and psychologists)
 Education and Training
• According to USA system, an oral medicine
training program includes the following
components:
• Formal instruction and clinical practice in:
• biomedical sciences, pathology, pharmacology,
research and behavioral science
• laboratory medicine and diagnostic tests
• obtaining a medical history and performing a
physical examination
• oral radiology, oral pathology, orofacial
pain and general dentistry
• Medical rotations in the hospital,
outpatient clinics (minimum of two
months), with participation in hospital
rounds, which may include
• internal medicine
• neurology
• cardiology
• infectious diseases
• dermatology
• oncology (medical oncology or radiation
oncology)
• otolaryngology (ear, nose and throat)
• Performance of research and scientific
projects
 Career Paths of Oral Medicine Doctors
• Examples of career paths that oral
medicine doctors have followed include
• private practice
• hospital based dentists
• department chairs / chiefs at dental
schools, medical schools and hospitals
• faculty at medical schools and cancer
centers
• Deans of dental schools
• director of residency programs (general
practice and oral medicine residency
programs)
• editors of national and international
dental journals
• researchers at dental schools, medical
schools and other institutions
Referrals in oral medicine
• Best in typescript to ensure
legibility
• Accuracy is crucial
• Referral letter that is very long can be
as annoying to the recipient as one that
is so brief as to be almost rude (please
see and treat)
Essential details of a referral letter
Example of a referral form
Reasons for referral
Clinical features possibly suggestive of
head and neck malignancy