Oral & Maxillofacial Medicine

Published February 2017 28 lectures
Emeritus Prof. Crispian Scully
University College London, UK
Summary

Oral Medicine is a recognized and increasingly important dental speciality in many parts of the world, it is a speciality that recognizes and fosters the interplay between medical health and oral health. Oral Medicine was originally called Dental Medicine, and sometimes is now termed Oral and Maxillofacial Medicine, and in... read morethe Ibero-American world and in Southern Europe is often termed Stomatology. Its dental activities rely greatly on the underlying biology of disease and evidence-based outcomes. However, full recognition of the importance of Oral Medicine to patient care, research and education is not yet totally universally acknowledged.

Oral Medicine often involves chronic, serious, painful, life-changing or even life-threatening outcomes. It is a relatively young dental specialty in many countries, whose scope of practice is typically to provide diagnosis and non-surgical care to patients with a variety of conditions affecting the orofacial region, whether local disorders or related to systemic diseases.

Oral Medicine works closely also with other dental specialties such as geriatric dentistry, oral surgery, periodontology, paediatric dentistry and special care dentistry, and with medical specialities, especially dermatology, gastroenterology, hematology, hepatology, imaging, immunology and infectious diseases, maxillofacial surgery, neurology, oncology, otorhinolaryngology, paediatrics, pathology, psychiatry, psychology, rheumatology and transplantology. Some of these medical specialties also have dental representation such as oral pathology (oral and maxillofacial pathology) and oral radiology (oral and maxillofacial radiology). Oral Medicine generally has active research components, often interacting with other dental specialties and special care patients, and also often interlinking with research in the fields of pathology, medicine and pharmacology.

Leaders in Oral Medicine have been instrumental in dental education since the 1920s. One of the early pioneers in the field was in the USA where Francis P. McCarthy was one of the first to meld the knowledge of dermatology and pathology to provide care to patients with complex oral mucosal manifestations. Dr. McCarthy was also the first to introduce Oral Medicine lectures at a dental school (Tufts) in 1925. Subsequently, the field of Oral Medicine grew with the teachings of Dr. Samuel Charles Miller at New York University (NYU) in the 1940s and 1950s, and flourished under Dr. Lester Burket at the University of Pennsylvania, Dr. David Mitchell at Indiana University in the 1960s and 1970s, and Dr. Sol (Bud) Silverman Jr (University of California in San Francisco : UCSF) whose presence spanned 50 years in the field. Their teachings, publications and graduates helped kindle and intensify interest in the field of Oral Medicine.

Thus although Oral Medicine is a relatively young specialty, a recent international survey found that thirty-three of thirty-seven countries surveyed (89 percent) reported Oral Medicine as a recognized specialty, a distinct field of study, or an actively de-veloping specialty/distinct field of study. In addition, there are at least 22 countries that now identify as having postgraduate programmes in Oral Medicine.

In the US the role of an Oral Medicine specialist has been defined as a dentist with advanced training who specializes in the diagnosis and non-surgical management of oral disease of patients with complex medical conditions. This specialist treats conditions such as oral mucosal disease, salivary gland dysfunction, oral manifestations of systemic disease, and orofacial pain. The specialist may provide interdisciplinary patient care in conjunction with medical specialists in hospitals and outpatient medical clinics, and in collaboration with other dentists in dental schools/hospital and in private practice, regarding the supervision of oral health care and provision of dental therapeutic procedures for patients with complex medical conditions requiring multidisciplinary healthcare intervention for best practice. The definition has been approved by the National Uniform Claim Committee (NUCC), a US organization chaired and hosted by the American Medical Association.

Oral Medicine in the UK is defined by the General Dental Council (GDC), as being concerned with the oral health care of patients with chronic recurrent and medically related disorders of the mouth and with their diagnosis and non-surgical management.

Yet beyond such accepted definitions it now is important to recognize that the spectrum of orofacial diseases is changing, in large part associated with infections brought about by human immunodeficiency virus (HIV), iatrogenic immunosuppression, an increase in infections, an aging population and the incidence in the developed world of diseases previously restricted to poorer countries. Consequently, practitioners in Oral and Maxillofacial Medicine now treat an even greater number of very sick patients.

The WHO has identified important target groups for oral health care and, even after the U.S. surgeon general issued the landmark report in 2000 ‘Oral Health in America’ which described the poor oral health of the USA as a “silent epidemic”, oral diseases remain prevalent across the country despite notable improvements in oral health. This poses a major challenge for the U.S. Department of Health and Human Services (HHS).

Oral Medicine clinical units typically offer care to at least patients with a wide variety of orofacial complaints in examples such as dry mouth, halitosis, lumps, trismus and white lesions. However, there is a significant variation both within countries and across the globe, and other dental and/or medical units may offer similar care in some areas. The remit of disorders seen in Oral Medicine thus includes for example allergies, cancers, infection and malignant disorders. This series will cover some of the commonest conditions seen by Oral Medicine practitioners.

(28 Lectures)