The study of oral medicine can be traced back to 1926, when William Gies of Columbia University recommended to the Carnegie Foundation that oral medicine be one of three topics covered in a 3-year dental curriculum.1 In 1945, the American Academy of Oral Medicine was founded, and under its auspices, the American Board of Oral Medicine today grants certification in this area. In 1988 and 1993, two World Workshops in Oral Medicine were held in Chicago, Illinois and featured preeminent international researchers, clinicians and educators.2,3 This international association of oral medicine experts accepted the following definition of oral medicine:
Oral medicine is that area of special competence in dentistry concerned with diseases involving the oral and paraoral structures. It includes the principles of medicine that relate to the mouth as well as research in biological, pathological, and clinical spheres. Oral medicine also includes the diagnosis and medical management of diseases specific to the orofacial tissues and of oral manifestations of systemic diseases. It further includes the management of behavioral disorders and the oral and dental treatment of medically compromised patients.2 In addition, the mission of oral medicine was restated as:3
The mission of oral medicine is to provide education, research and service for health care professionals and the public.
The educational component encompasses predoctoral, postdoctoral and continuing education training for the health care professional.
The research activities endeavor to be at the forefront of new developments in the field of biology as it relates to oral disease.
Service to society and health care professionals is a paramount objective of oral medicine. Oral medicine will prepare the professional to provide current and future patient care occasioned by the different mix of services demanded by the public and changing disease patterns.
Large epidemiological studies and reports from private oral medicine practice show that dentists of the future will need the skills to diagnose and treat an increasing variety of diseases of the oral cavity, head, and neck..4-6 In fact, the World Health Organization, in a 1989 study entitled "Trends in oral health care: a global perspective," predicted a significant need for the practice of oral medicine in the future.7
Oral medicine has long been a part of Navy dentistry. An oral diagnosis/oral medicine department was established at the Naval Dental School Bethesda, in 1970. The department now offers residents in all programs five courses: oral diagnosis, radiology, pharmacology, oral medicine and physiology, and a seminar in oral medicine. The department also offers two continuing education courses each year in oral diagnosis, pharmacology, and radiology in addition to a 2-year residency in oral medicine. Although the terms "oral diagnosis" and "oral medicine" are often used interchangeably, they are separate areas of practice.
Oral diagnosis deals with gathering, recording, and evaluating patient information leading to the identification of the patient’s chief complaint and abnormalities of the head and neck. The purpose of oral diagnosis is to establish a differential diagnosis and an effective treatment plan. As part of the diagnostic process, radiographic examination is often needed. Oral diagnosis/oral medicine practitioners receive advanced training in standard oral radiographic, laminagraphic, sialographic, and arthrographic techniques as well as in biochemical and other medical laboratory evaluations.
Oral medicine is concerned with the dental management of medically compromised patients, the treatment of primary oral mucosal diseases, and oral manifestations of medical treatment.
Oral diagnosis/oral medicine practitioners have special expertise in the oral management of patients with endocrine, neuromuscular, hematopoietic, cardiovascular, renal, sexually transmitted, respiratory, and gastrointestinal diseases. They are often consulted about dental treatment of patients before, during, and after radiotherapy, chemotherapy, organ transplants dialysis, bypass surgery, and major joint replacements. They can recommend special protocols for patients with diabetes, thyroid disease, leukemia, bleeding disorders, hypertension, recent myocardial infarction, hepatitis, HIV infection, emphysema, and congestive heart disease. These practitioners provide treatment for patients with oral herpes, aphthous ulcers, lichen planus, candidiasis, pemphigus, pemphigoid, erythema multiforme, and other vesiculobullous diseases of the skin and mucous membranes. In addition, they have expertise in the actions and interactions of drugs used not only in dental practice, but also in therapy for a variety of medical problems. They understand how these drugs affect oral tissues and how medications may require a change in treatment planning and definitive dental care.
Oral diagnosis/oral medicine practitioners also have special administrative skills and knowledge in the areas of patient eligibility, examination requirements, record management, radiation safety, healthcare claims, dental insurance, and other regulatory matters.
While oral diagnosis/oral medicine practitioners function well in the sick call/triage/examination environment, they can do much more. In the sick call environment, they often employ all their oral diagnostic skills but little or none of their oral medicine training. Besides managing patient inprocessing from documentation to evaluation to treatment planning, these practitioners are skilled in recognizing patients with major medical problems, drug reactions, and neoplastic and other life-threatening diseases, referring these patients to appropriate medical care before beginning dental treatment. These practitioners can ensure that all necessary medical consultations are written and that the patient is ready for treatment before being scheduled in the dental clinic. They also can ensure that all legal and regulatory requirements are observed, solving small problems before they become significant legal or political problems for the command. They can also provide expert assistance to the local naval hospital in the management of severely compromised patients and in patients with complex medical/dental needs.
As a command resource, oral diagnosis/oral medicine practitioners can smooth patient flow in more than one clinic, see patients from outlying facilities on consultation, and provide expertise in the management of patients with major medical and dental needs in a hospital setting on a part-time basis. With a better understanding of the scope of oral medicine training, the Navy can make comprehensive use of these practitioners, During a time of limited resources, every clinic director and commanding officer needs to know what services the oral diagnosis/oral medicine practitioners can provide on a command-wide basis.
References
Geis WJ. Dental education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching. Carnegie Foundation: New York, Bulletin 19.1926.
Millard HD, Mason DK. Perspectives on 1988 World Workshop in Oral Medicine. Chicago: Year Book Publishers, 1989.
Millard HD, Mason DK. Perspectives on 1993 World Workshop in Oral Medicine. Ann Arbor: University of Michigan, 1995.
Bouquot J. Common oral lesions found during a mass screening examination. J Am Dent Assoc 1990; 112:50-7.
Knapp MI. Oral disease in 181,338 consecutive oral examinations. J Am Dent Assoc 1971; 83:1288-93.
Bottomly WK. Brown RS. Lavigne GJ. A retrospective survey of the oral conditions of 981 patients referred to an oral medicine private practice. J Am Dent Assoc 1990; 120:529-33.
Pilot T. Trends in oral health care, a global perspective. World Health Organization: Geneva, 6-23 November 1989.
Excerpts courtesy of Ellis H. Hall, CAPT, DC, (ret) from Naval Dental School Clinical Update of March 1991.