Oral medicine

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An oral medicine or stomatology doctor/dentist (or stomatologist) has received additional specialized training and experience in the diagnosis and management of oral mucosal abnormalities (growths, ulcers, infection, allergies, immune-mediated and autoimmune disorders) including oral cancer, salivary gland disorders, temporomandibular disorders (e.g.: problems with the TMJ) and facial pain (due to musculoskeletal or neurologic conditions), taste and smell disorders; and recognition of the oral manifestations of systemic and infectious diseases. It lies at the interface between medicine and dentistry. An oral medicine doctor is trained to diagnose and manage patients with disorders of the orofacial region.

Contents

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 

Oral medicine grew from a group of New York dentists (primarily periodontists), who were interested in the interactions between medicine and dentistry in the 1940s. [4] 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. [ citation needed ]

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". Orofacial pain Lateral head skull.jpg
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".

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 affected 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 with 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.

Lumps and swellings of the mouth

Types of lumps and swelling

It is not uncommon for an individual to experience a lump/swelling in the oral environment. The overall presentation is highly variable and the progression of these lesions can also differ, for example: development of a lesion into a bulla or a malignant neoplasm. Lumps and swellings can occur due to a variety of conditions, both benign and malignant such as:

So as seen above the list is extensive and by no means is this a complete and comprehensive representation of all the possible lumps/swellings that can occur in the mouth as to the means of acquiring a swelling in the mouth. When considering what a lump might be caused by the site of which it has appeared can be of significance. Below are some examples of swellings/lumps which usually are present as specific locations in the oral cavity: [8]

Diagnosis of the cause of a lump or swelling

If there is any suspect or unknown reason as to why a lump has arisen in an individual's mouth it is important to establish when this first was noticed and the accompanied symptoms if any. On examination ensure that there is not an obvious cause to the swelling/lump via a thorough: medical, social, dental and family history, followed by an oral examination. Whilst examining the suspected lesion there are some diagnostic aids to note which can be used to formulate a provisional diagnosis. [9] There are many factors taken into consideration in this diagnosis, such as:

Investigations

Once the surrounding tissues and the immediate management of any lumps/swellings are taken care of, an image of the full extent of the lesion is needed. This is done to establish what the lump/swelling is associated with and to ensure that any damaging probability is kept to a minimum. There are a variety of imaging technique options which are chosen based on the lesion: size, location, growth pattern etc. Some examples of images used are: DPT, Scintigraphy, Sialography, Computed Tomography, Magnetic Resonance Imaging and Ultrasound.

As described some lumps or swellings can be in close relation to anatomical structures. Commonly, Teeth are associated in a lesion which brings about the question – “are they still vital?” In order to clarify, any tooth that is associated with a lump or swelling is vitality tested, examined for any pathology or restorative deficiencies in order to determine the long term prognosis of this tooth and how this might affect treatment of the lump/swelling at hand.

Alongside any radiographs which may be justified, Blood tests may be needed in order to obtain a definitive diagnosis if there is a suspicion of potential blood dyscrasias or any endocrinopathy involvement.

Finally, a particularly vital means of diagnosis is a biopsy. These tend to be regularly done in the cases of singular, chronic lesions and are carried out in an urgent manner as lesions of this category have a significant malignant potential. The indications to carry out a biopsy include:

Once a small piece of tissue is removed for the biopsy, it is then microscopically histopathologically examined. [9]

Training and practice

Australia

Australian programs are accredited by the Australian Dental Council (ADC). They are three years in length and culminate with either a master's 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, RCPA.

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's 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. [10]

United Kingdom

In the UK, oral medicine is one of the 13 specialties of dentistry recognized by the General Dental Council (GDC). [11] 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." [12] Unlike many other countries, oral medicine physicians in the UK do not usually partake in the dental management of their patients.[ citation needed ] Some UK oral medicine specialists have dual qualification with both medical and dental degrees. [13] 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. [14] 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. [14] In the UK, oral medicine is one of the smallest dental specialties. [15] According to the GDC, as of December 2014 there were 69 clinicians registered as specialists in oral medicine. [16] As of 2012, there were 16 oral medicine units across the UK, mostly based in dental teaching hospitals, [14] and around 40 practising consultants. [15] The British & Irish Society for Oral Medicine has suggested that there are not enough oral medicine specialists, and that there should be one consultant per million population. [15] Competition for the few training posts is keen, although new posts are being created and the number of trainees increased. [15]

United States

The American Dental Association (CODA) accredited programs are a minimum of two years in length. Oral medicine, is an American Dental Association recognized speciality, and many oral medicine specialists fulfil 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 the dental practice. The ADA has recently started a dental practice parameters for world-class quality services. Archived 2014-05-07 at the Wayback Machine

See also

Related Research Articles

<span class="mw-page-title-main">Mouth ulcer</span> Sore on the mucous membrane of the oral cavity

A mouth ulcer (aphtha) is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause. Rarely, a mouth ulcer that does not heal may be a sign of oral cancer. These ulcers may form individually or multiple ulcers may appear at once. Once formed, an ulcer may be maintained by inflammation and/or secondary infection.

<span class="mw-page-title-main">Dentist</span> Health care occupations caring for the mouth and teeth

A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.

<span class="mw-page-title-main">Parotid gland</span> Major salivary gland in many animals

The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the mandibular ramus, and secretes serous saliva through the parotid duct into the mouth, to facilitate mastication and swallowing and to begin the digestion of starches. There are also two other types of salivary glands; they are submandibular and sublingual glands. Sometimes accessory parotid glands are found close to the main parotid glands.

<span class="mw-page-title-main">Toothache</span> Medical condition of the teeth

Toothache, also known as dental pain or tooth pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed lamina propria. The oral cavity has sometimes been described as a mirror that reflects the health of the individual. Changes indicative of disease are seen as alterations in the oral mucosa lining the mouth, which can reveal systemic conditions, such as diabetes or vitamin deficiency, or the local effects of chronic tobacco or alcohol use. The oral mucosa tends to heal faster and with less scar formation compared to the skin. The underlying mechanism remains unknown, but research suggests that extracellular vesicles might be involved.

<span class="mw-page-title-main">Oral mucocele</span> Medical condition

Oral mucocele is a condition caused by two related phenomena - mucus extravasation phenomenon and mucous retention cyst.

<span class="mw-page-title-main">Ranula</span> Medical condition

A ranula is a mucus extravasation cyst involving a sublingual gland and is a type of mucocele found on the floor of the mouth. Ranulae present as a swelling of connective tissue consisting of collected mucin from a ruptured salivary gland caused by local trauma. If small and asymptomatic further treatment may not be needed, otherwise minor oral surgery may be indicated.

Epulis fissuratum is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture. More simply, epulis fissuratum is where excess folds of firm tissue form inside the mouth, as a result of rubbing on the edge of dentures that do not fit well. It is a harmless condition and does not represent oral cancer. Treatment is by simple surgical removal of the lesion, and also by adjustment of the denture or provision of a new denture.

Inflammatory papillary hyperplasia (IPH) is a benign lesion of the oral mucosa which is characterized by the growth of one or more nodular lesions, measuring about 2mm or less. The lesion almost exclusively involves the hard palate, and in rare instances, it also has been seen on the mandible. The lesion is mostly asymptomatic and color of the mucosa may vary from pink to red.

A dental emergency is an issue involving the teeth and supporting tissues that are of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.

<span class="mw-page-title-main">Veterinary dentistry</span> Branch of veterinary medicine

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

Orofacial granulomatosis (OFG) is a condition characterized by persistent enlargement of the soft tissues of the mouth, lips and the area around the mouth on the face, causing in most cases extreme pain. The mechanism of the enlargement is granulomatous inflammation. The underlying cause of the condition is not completely understood, and there is disagreement as to how it relates to Crohn's disease and sarcoidosis.

<span class="mw-page-title-main">Calcifying odontogenic cyst</span> Medical condition

Calcifying odontogenic cyst (COC) is a rare developmental lesion that comes from odontogenic epithelium. It is also known as a calcifying cystic odontogenic tumor, which is a proliferation of odontogenic epithelium and scattered nest of ghost cells and calcifications that may form the lining of a cyst, or present as a solid mass.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

Epulis is any tumor like enlargement situated on the gingival or alveolar mucosa. The word literally means "(growth) on the gingiva", and describes only the location of the mass and has no further implications on the nature of the lesion. There are three types: fibromatous, ossifying and acanthomatous. The related term parulis refers to a mass of inflamed granulation tissue at the opening of a draining sinus on the alveolus over the root of an infected tooth. Another closely related term is gingival enlargement, which tends to be used where the enlargement is more generalized over the whole gingiva rather than a localized mass.

In the United States and Canada, there are twelve recognized dental specialties in which some dentists choose to train and practice, in addition to or instead of general dentistry. In the United Kingdom and Australia, there are thirteen.

<span class="mw-page-title-main">Orofacial pain</span> Medical condition

Orofacial pain is a general term covering any pain which is felt in the mouth, jaws and the face. Orofacial pain is a common symptom, and there are many causes.

<span class="mw-page-title-main">Salivary gland disease</span> Medical condition

Salivary gland diseases (SGDs) are multiple and varied in cause. There are three paired major salivary glands in humans: the parotid glands, the submandibular glands, and the sublingual glands. There are also about 800–1,000 minor salivary glands in the mucosa of the mouth. The parotid glands are in front of the ears, one on side, and secrete mostly serous saliva, via the parotid ducts, into the mouth, usually opening roughly opposite the second upper molars. The submandibular gland is medial to the angle of the mandible, and it drains its mixture of serous and mucous saliva via the submandibular duct into the mouth, usually opening in a punctum in the floor of mouth. The sublingual gland is below the tongue, on the floor of the mouth; it drains its mostly mucous saliva into the mouth via about 8–20 ducts, which open along the plica sublingualis, a fold of tissue under the tongue.

<span class="mw-page-title-main">Tooth pathology</span> Medical condition

Tooth pathology is any condition of the teeth that can be congenital or acquired. Sometimes a congenital tooth disease is called a tooth abnormality. These are among the most common diseases in humans The prevention, diagnosis, treatment and rehabilitation of these diseases are the base to the dentistry profession, in which are dentists and dental hygienists, and its sub-specialties, such as oral medicine, oral and maxillofacial surgery, and endodontics. Tooth pathology is usually separated from other types of dental issues, including enamel hypoplasia and tooth wear.

References

  1. ↑ "Odd Tongues: The Prevalence of Lingual Disease". The Maxillofacial Center for Diagnostics & Research. Archived from the original on 11 October 2013. 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. Archived from the original on 2015-02-06.
  4. ↑ "Career Paths of Oral Medicine Doctors". American Academy of Oral Medicine. Retrieved 2 February 2018.
  5. ↑ 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. doi:10.1111/head.12272. PMID   24261452. S2CID   44571343.
  6. ↑ "Oral Pyogenic Granuloma: Background, Pathophysiology, Etiology". 2019-02-01.{{cite journal}}: Cite journal requires |journal= (help)
  7. ↑ "Dental cysts | Cambridge University Hospitals". www.cuh.nhs.uk. Retrieved 2019-02-12.
  8. ↑ Felix, David H; Luker, Jane; Scully, Crispian (2013-10-02). "Oral medicine: 11. lumps and swellings: mouth". Dental Update. 40 (8): 683–687. doi:10.12968/denu.2013.40.8.683. ISSN   0305-5000. PMID   24279221.
  9. 1 2 Crispian., Scully (2008). Oral and maxillofacial medicine : the basis of diagnosis and treatment (2nd ed.). Edinburgh: Churchill Livingstone. ISBN   9780443068188. OCLC   123962943.
  10. ↑ "Proposed prescribed qualification for the Dental Specialty: Oral Medicine Scope of Practice" (PDF). Dental Council, New Zealand. Retrieved 2 August 2013.
  11. ↑ "Specialist lists". General Dental Council.
  12. ↑ "Look for a specialist". General Dental Council. Archived from the original on 2014-12-08. Retrieved 2014-12-07.
  13. ↑ "What is Oral Medicine?". British Society for Oral Medicine. Retrieved 7 December 2014.
  14. 1 2 3 "Specialty Training Curriculum for Oral Medicine" (PDF). General Dental Council. July 2010.
  15. 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.
  16. ↑ "Facts and figures from the GDC register December 2014" (PDF). General Dental Council.
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