Oral medicine

Oral medicine (sometimes termed dental medicine, oral and maxillofacial medicine or stomatology) is a specialty focused on the mouth and nearby structures. It lies at the interface between medicine and dentistry.

The specialty is defined within Europe under Directive 2001/19/EC.

History

The importance of the mouth in medicine has been recognized since the earliest known medical writings. For example, Hippocrates, Galen and others considered the tongue to be a "barometer" of health, and emphasized the diagnostic and prognostic importance of the tongue.[1] However, oral medicine as a specialization is a relatively new subject area.[2]:2 It used to be termed "stomatology" (-stomato- + -ology).[2]:1 In some institutions, it is termed "oral medicine and oral diagnosis".[2]:1 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".[2]:2[3] The term "oral medicine" was not used again until 1868.[3] Jonathan Hutchinson is also considered the father of oral medicine by some.[2]:2 Before becoming its own specialty in the United States, oral medicine was historically once a subset of the specialty of periodontics, with many periodontists achieving board certification in oral medicine as well as periodontics.

Scope

The orofacial pain region: "pain localized to the region above the neck, in front of the ears and below the orbitomeatal line, as well as pain within the oral cavity; [including] pain of dental origin and temporomandibular disorders".[4]

Oral medicine is concerned with clinical diagnosis and non-surgical management of non-dental pathologies affecting the orofacial region (the mouth and the lower face).

Many systemic diseases have signs or symptoms that manifest in the orofacial region. Pathologically, the mouth may be afflicted by many cutaneous and gastrointestinal conditions. There is also the unique situation of hard tissues penetrating the epithelial continuity (hair and nails are intra-epithelial tissues). The biofilm that covers teeth therefore causes unique pathologic entities known as plaque-induced diseases.

Example conditions that oral medicine is concerned with are lichen planus, Behçet's disease and pemphigus vulgaris. Moreover, it involves the diagnosis and follow-up of pre-malignant lesions of the oral cavity, such as leukoplakias or erythroplakias and of chronic and acute pain conditions such as paroxysmal neuralgias, continuous neuralgias, myofascial pain, atypical facial pain, autonomic cephalalgias, headaches and migraines. Another aspect of the field is managing the dental and oral condition of medically compromised patients such as cancer patients suffering from related oral mucositis, bisphosphonate-related osteonecrosis of the jaws or oral pathology related to radiation therapy. Additionally, it is involved in the diagnosis and management of dry mouth conditions (such as Sjögren's syndrome) and non-dental chronic orofacial pain, such as burning mouth syndrome, trigeminal neuralgia and temporomandibular joint disorder.

Training and practise

Australia

Australian programs are accredited by the Australian Dental Council (ADC). They are three years in length and culminate with either a Master degree (MDS) or a Doctor of Clinical Dentistry degree (DClinDent). Fellowship can then be obtained with the Royal Australasian College of Dental Surgeons, FRACDS (Oral Med) and or the Royal College of Pathologists of Australasia, FRCP.

Canada

Canadian programs are accredited by the Canadian Commission on Dental Accreditation (CDAC). They are a minimum of three years in length and usually culminate with a master's (MSc) degree. Currently, only the University of Toronto, the University of Alberta, and the University of British Columbia offer programs leading to the specialty. 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 (FRCD(C)).

India

Indian programs are accredited by the Dental Council of India (DCI).Oral Medicine is in conjunction with oral radiology in India and it is taught in both graduate and post graduate levels as Oral Medicine and Radiology.They are three years in length and culminate with a Master degree (MDS) in Oral Medicine and Radiology.

New Zealand

New Zealand has traditionally followed the UK system of dual training (dentistry and medicine) as a requisite for specialty practice; the University of Otago Faculty of Dentistry currently offers a 5-year intercalated clinical doctorate/medical degree (DClinDent/MBChB) program. On 9 July 2013, the dental council of New Zealand proposed that the prescribed qualifications for oral medicine be changed to include the new DClinDent in addition to a medical degree, with no requirement for a standard dental degree.[5]

UK

In the UK, oral medicine is one of the 13 specialties of dentistry recognized by the General Dental Council (GDC).[6] The GDC defines oral medicine as: "[concerned with] oral health care of patients with chronic recurrent and medically related disorders of the mouth and with their diagnosis and non-surgical management."[7] Unlike many other countries, oral medicine physicians in the UK do not usually partake in the dental management of their patients. Some UK oral medicine specialists have dual qualification with both medical and dental degrees.[8] However, in 2010 the GDC approved a new curriculum for oral medicine, and a medical degree is no longer a prerequisite for entry into specialist training.[9] Specialist training is normally 5 years, although this may be reduced to a minimum of 3 years in recognition of previous training, such as a medical degree.[9] In the UK, oral medicine is one of the smallest dental specialties.[10] According to the GDC, as of December 2014 there were 69 clinicians registered as specialists in oral medicine.[11] As of 2012, there were 16 oral medicine units across the UK, mostly based in dental teaching hospitals,[9] and around 40 practising consultants.[10] 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.[10] Competition for the few training posts is keen, although new posts are being created and the number of trainees increased.[10]

USA

The American Dental Association (CODA) accredited programs are a minimum of two years in length. Oral medicine, however, is not an American Dental Association recognized specialty, but many oral medicine specialists fulfill a very important role by teaching at dental schools and graduate programs to ensure dentists and other dental specialists receive excellent training in medical topics pertinent to dental practice.

See also

References

  1. ↑ "Odd Tongues: The Prevalence of Lingual Disease". The Maxillofacial Center for Diagnostics & Research. Retrieved 11 September 2013.
  2. 1 2 3 4 5 John, Pramod (2014). Textbook of oral medicine (3rd ed.). JP Medical Ltd. ISBN 9789350908501.
  3. 1 2 "Bond's Book of Oral Disease". The Maxillofacial Center for Education & Research.
  4. ↑ Shephard, Martina K.; MacGregor, E. Anne; Zakrzewska, Joanna M. (December 2013). "Orofacial Pain: A Guide for the Headache Physician". Headache: The Journal of Head and Face Pain. 54 (1): 22–39. PMID 24261452. doi:10.1111/head.12272.
  5. ↑ "Proposed prescribed qualification for the Dental Specialty: Oral Medicine Scope of Practice" (PDF). Dental Council, New Zealand. Retrieved 2 August 2013.
  6. ↑ "Specialist lists". General Dental Council.
  7. ↑ "Look for a specialist". General Dental Council.
  8. ↑ "What is Oral Medicine?". British Society for Oral Medicine. Retrieved 7 December 2014.
  9. 1 2 3 "Specialty Training Curriculum for Oral Medicine" (PDF). General Dental Council. July 2010.
  10. 1 2 3 4 Clare Marney; Jim Killgore (7 December 2012). "Where dentistry meets medicine" (PDF). Medical and Dental Defence Union of Scotland. p. Soundbite; Issue 06 pp 8–9.
  11. ↑ "Facts and figures from the GDC register December 2014" (PDF). General Dental Council.
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