Oral Medicine Practice Research Articles

Discovering a new anatomy: exploration of oral mucosa with ultra-high frequency ultrasound.

Ultra-high frequency ultrasound (UHFUS) is a recently developed diagnostic technique involving the use of ultrasound frequencies up to 70 MHz, allowing to obtain 30 µm resolution of targets located within 1 cm from the surface. Oral mucosa can be affected by diverse pathological conditions, which are currently investigated by means of clinical examination. In this scenario, intraoral UHFUS can provide additional information and support clinical assessment of oral mucosa. In this preliminary study, typical features of normal oral mucosa are described, in order to set a benchmark for the future identification of oral soft tissue alterations. Twenty healthy subjects (10 males and 10 females, mean age 30 years) were enrolled and underwent intraoral UHFUS examination. In all the subjects, tongue, buccal mucosa, gingiva, lip mucosa, and palate were scanned, and images acquired. Intraoral UHFUS scan included Brightness-mode and Doppler mode acquisitions performed with a standardized protocol. UHFUS images were postprocessed and analyzed using a dedicated software. UHFUS-based biomarkers (epithelial thickness, echogenicity, and vascularization) were employed for image description. Normal oral anatomy of the different sites analyzed was described. For all the sites, UHFUS biomarkers were characterized, and information on typical aspect of oral mucosa was retrieved. In this explorative study, we suggest a potential role for intraoral UHFUS in the study of oral mucosa, giving insights into the possibility to improve the assessment, diagnosis, and management of the conditions involving oral mucosa. UHFUS seems a promising tool, which could potentially support clinical examination in daily oral medicine practice.

A Survey of Oral Medicine Curriculum and Practice in India

Background: Oral Medicine specialists provide clinical care to patients with a wide variety of chronic diseases affecting the oral and maxillofacial region, oral manifestations of systemic diseases and behavioral disorders and provide general dental care to patients with medically compromised states. It is important to conduct studies that address the strengths and shortcomings of our specialty and the current system of its education and practice in order to yield highly skilled professionals and truly serve the oral health care needs of the public. Aim & Method: This study aims to describe the current status of Oral Medicine curriculum and practice in India. A survey was designed to assess the current status of oral medicine education and clinical practice. The survey was sent to Oral Medicine Specialists across India to assess their opinion and analyze the benefits and shortcomings of the present system. Results: 52 respondents completed the survey from various states across India. More than 87% of respondents considered management of oral mucosal diseases, salivary dysfunction, oral manifestations of dermatological diseases, HIV, oral manifestations of systemic disease and facial pain as part of Oral Medicine. Only 27% of respondents reported participating in multidisciplinary clinics for treatment of patients, and 85% of respondents agreed to the need for presence of multidisciplinary clinics. 85% of respondents agreed to the suggestion of developing a curriculum for training in Special Care Dentistry for Oral Medicine postgraduates in India. Conclusion: Limitations to this survey study include a small sample size. Future efforts at defining the scope of oral medicine practice in India and improvements in training and education can help model future graduates and inspire undergraduates to choose Oral Medicine as a career.

Gabapentinoid prescription in oral medicine and oral surgery practice. Part I − Experience from a French Orofacial pain clinic

Gabapentinoids, pregabalin and gabapentin, are neuronal voltage-gated calcium channel inhibitors mainly prescribed for the treatment of partial epilepsy and neuropathic pain. Although their efficacy as first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions) has been well established in general medical practice, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. This didactic article, the first of a two-part series, aims to present the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in Orofacial pain conditions that fall within the scope of the oral surgeon's practice.

Gabapentinoid prescription in Oral Medicine and Oral Surgery practice. Part II − a systematic scoping review of the literature

Introduction: Gabapentinoids, pregabalin and gabapentin, neuronal voltage-gated calcium channel inhibitors are first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions). Nevertheless, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. A previous article, the first of a two-part series, presented the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in orofacial conditions. This second article aimed to explore the scientific literature on the subject. Material and methods: A systematic scoping review was conducted on multiple relevant databases (MEDLINE®, Cochrane®, Agence Nationale de Sécurité du Médicament et des produits de santé, Haute Autorité de Santé) and journal archives (JOMOS, JSOMFS) to assess the indications, non-indications and contraindications of gabapentinoids in an Oral Medicine/Oral Surgery context. Results: Out of 131 records selected during the initial screening, 34 matched the inclusion criteria and were used for subsequent analyses. Gabapentinoids were prescribed in three clinical contexts: orofacial pain management (32 studies), anxiolysis (1 study) and prevention of postoperative nausea/vomiting (1 study), with variable quality of evidence: high (6 studies), moderate (3 studies), low (5 studies) and very low (20 studies) quality studies (GRADE scale). Untoward effects of gabapentinoids were reported in 16 studies, mainly neurological (vertigo, drowsiness, sedation) and gastro-intestinal (nausea, vomiting, diarrhea, constipation). Gabapentinoids were ineffective in preemptive and postoperative analgesia and for the management of mucositis-related pain. Discussion: There is some evidence supporting the use of gabapentinoids in Oral Medicine/Oral Surgery in adherence with current practices observed in France and other countries (practices often extrapolated from their use in other non-orofacial painful conditions). The methodological quality of the studies included in this scoping review is often poor and publication bias is most probable in this field. Therefore, any conclusion drawn from such studies must be subject to circumspection. Conclusion: Data obtained from the present scoping review suggests the potential use of gabapentinoids as second-line treatments for anxiolysis, prevention of postoperative nausea/vomiting and the management of trigeminal neuralgia and masticatory myalgia. Other potential indications of gabapentinoids in Oral Medicine/Oral Surgery practice include cranial neuralgias, post-traumatic trigeminal neuropathies, first bite syndrome, burning mouth syndrome and migraine prophylaxis, when other treatment options are inefficient or unavailable.

Bibliographic Analysis of Oral Precancer and Cancer Research Papers from Saudi Arabia

Objective:Oral cancer and precancers are a major public health challenge in developing countries. Researchers in Saudi Arabia have constantly been directing their efforts on oral cancer research and have their results published. Systematic analysis of such papers is the need of the hour as it will not only acknowledge the current status but will also help in framing future policies on oral cancer research in Saudi Arabia. Method:The search string “oral cancer” OR “Oral Squamous Cell Carcinoma” OR “oral premalignant lesion” OR “oral precancer” OR “Oral Potentially malignant disorder” AND AFFIL (Saudi AND Arabia ) was used for retrieval of articles from Scopus database. Various tools available in Scopus database were used for analyzing the bibliometric related parameters. Results:The search revealed a total of 663 publications based on the above query. Maximum affiliations were from King Saud University (163) followed by Jazan University (109) and then King Abdulaziz University (106). A large number of international collaborations were observed, the maximum with India (176) and the USA (127). The maximum number of articles were published in the Asia Pacific Journal of Cancer Prevention (34) followed by the Journal of Contemporary Dental Practice (33) and Journal of Oral Pathology and Medicine (19). Conclusion:Saudi researchers are directing their efforts towards the public health menace of oral cancer. However, it was also observed that some institutions have emerged as front runners in research, whereas others are contributing significantly less. The health department should encourage and take necessary steps to increase the involvement of other institutions.

A Survey of Oral Medicine Curriculum and Practice in India

A Survey of Oral Medicine Curriculum and Practice in India

Practicing oral medicine and radiology in private setup: A comprehensive review

Oral Medicine and Radiology (OMR) branch is an important bridge between Dentistry and Medicine and it must not be regarded largely as an institutional specialty. The vitality of the specialty can be advanced through establishment of an independent Private practice (PP) option as is found in all other clinical dental specialities. The option of PP might create broader appeal for entry into specialty and moreover, the patients also can avail the expertise of Oral physician more easily. Therefore, together we need to develop a global strategy to promote the clinical practice of Oral Medicine among patients and all other healthcare professionals to increase awareness of the speciality.

Oral medicine and stomatology in Hong Kong and China

A review of the development, organisation, training and contemporary practice of oral medicine and stomatology in Hong Kong and China.

Intralesional triamcinolone acetonide therapy for inflammatory oral ulcers

The aim of this study was to report on the clinical indications and treatment outcomes of intralesional steroid therapy (IST) for oral ulcerative conditions in an oral medicine practice. This was a retrospective single-center study of patients with oral ulcerative conditions treated with IST. Demographic data, clinical diagnosis of the oral condition, size of the ulcer, and pain were abstracted from patients' electronic medical records. Ninety-three patients (51 females [54.8%]) were treated for persistent traumatic oral ulcers (n = 38 [40.8%]), ulcers in oral chronic graft-versus-host disease (n = 23 [24.7%]), oral lichen planus (n = 19 [20.4%]), and other conditions (14%). Complete resolution was achieved in 81.7% of patients in a median of 96 days (range 10-357 days), with 80% fully healed in a median of 84 days (range 10-140 days). Overall, patients received a median of 2 injections (range 1-5 injections) and a median dose of 12 mg per injection (range 2-36 mg). Nearly half the patients were also treated with concomitant topical steroid therapy. After the first injection, the median pain score reduced from 5 (range 1-10) to 1 (range 0-10; P < .001) and the median size of ulcers reduced from 1 cm (range 0.1-5 cm) to 0.3 cm (range 0-2 cm; P < .001). IST may be an effective treatment for inflammatory and immune-mediated oral ulcers.

Prospect of Oral Medicine and the Pedagogical Deficiencies

: Oral medicine is principally considered as medical specialty but ended up in dentistry and now suffers an “Identity crisis”, bestriding both dentistry and medicine. We discuss the toil faced by the subject and the specialists in India and Internationally in the curriculum, at awareness level and the perseverance to change the consequence. Automated searches of Medline, Pubmed and the Cochrane Library were conducted for data collection; additional searches of main oral medicine journals were done manually using the keywords Growth and future of Oral medicine, Trends in oral disease, awareness of Common Oral Diseases, career preferences in dentistry, referral pattern to an oral medicine unit and survey of oral medicine practice. Several recent reviews have discussed the nature and extent of training the Oral Medicine specialists currently receive and the need for further enhancement of dental curriculum. Despite these apprehensions, we are quite passionate about the future. This enthusiasm is balanced by the realization that some impairments lie in our path. These collective signals are a clear wake-up call for our discipline. Key words: Curriculum, Dentistry, Oral disease, Oral Medicine.

Awareness of oral medicine among medical practitioners, evidence of the unbridged interdisciplinary gap.

Inadequate awareness of oral health and related disciplines appears to be common among medical practitioners. This study was designed to evaluate the awareness of oral medicine (OM) specialty and its scope of practice among Jordanian medical practitioners and to outline potential strategies for improvement where appropriate. A specially designed questionnaire was electronically distributed to Jordanian medical practitioners and thereafter via personal interviews to improve the response rate. The questionnaire comprised nine questions and covered demographical details and characteristics of participants, in addition to their awareness of OM and agreement to refer a group of common oral and dental conditions to OM specialists. Pearson Chi-square tests were used to examine the significance of association between the variables of respondents and awareness of OM. Significance level was set at P values < 0.05. A total of 1492 respondents completed the questionnaire, of which 779 (52.2%) were aware of OM as an independent specialty. Age group, higher degrees in medicine, country of graduation, and the specialty type were significant determinants of OM awareness level. Oral ulceration and other mucosal pathology, including fungal infections, were the most likely conditions to be referred to OM specialists while participants had apparent problems separating the scope of practice of OM from other dental disciplines. This study provides evidence on the profound interdisciplinary gap between medicine and dentistry and highlights the importance of more focused education and training in oral health-related disciplines to be provided to clinicians and medical trainees as described.

Oral Medicine for undergraduate dental students in the United Kingdom and Ireland-A curriculum.

Oral Medicine focuses on care for patients with chronic, recurrent and medically related disorders of the orofacial region that are distinct from diseases of the periodontal and tooth tissues, with an emphasis on non-surgical management. At present, there are no shared outcomes for Oral Medicine to define the standards to be achieved before new graduates become registered dentists engaged with ongoing professional development. We present a consensus undergraduate curriculum in Oral Medicine agreed by representatives from 18 Dental Schools in the United Kingdom and Republic of Ireland. The scope of Oral Medicine practice includes conditions involving the oral mucosa, salivary glands, neurological system or musculoskeletal tissues that are not directly attributable to dental (tooth and periodontium) pathology. Account is taken of the priorities for practice and learning opportunities needed to support development of relevance to independent clinical practice. The outcomes triangulate with the requirements set out by the respective regulatory bodies in the UK and Republic of Ireland prior to first registration and are consistent with the framework for European undergraduate dental education and greater harmonisation of dental education. This curriculum will act as a foundation for an increasingly shared approach between centres with respect to the outcomes to be achieved in Oral Medicine. The curriculum may also be of interest to others, such as those responsible for the training of dental hygienists and dental therapists. It provides a platform for future collective developments with the overarching goal of raising the quality of patient care.

Employment Type and Career Satisfaction Among Oral Medicine Specialists.

With fewer oral medicine (OM) specialists than members of other dental specialties, growing the profession to meet patient needs depends on demonstrating to dental educators, students, and practitioners the value and variety of career opportunities in this specialty. The aim of this study was to investigate the type of employment and career satisfaction of current OM specialists. An electronic survey was distributed to all 393 active members of the American Academy of Oral Medicine in May 2016. The questionnaire assessed respondents' sociodemographic characteristics, type of OM training received, workplace setting, type of OM practice, and career satisfaction. Career satisfaction rates were stratified by age and gender. A total of 124 respondents completed the entire survey, for a response rate of 31.6%. Among the respondents, 62.1% were males, the median age was 52 years, and 85.7% had completed an OM postdoctoral training program in North America. The median length of respondents' program was two years (range 1-6), and program types were one or a combination of certificate (44.1%), master's degree (21.2%), and postdoctoral fellowship (9.3%). A third (31.4%) of the respondents were employed at a university. The median score for respondents' satisfaction with their current job was eight on a scale from 0 to 10, though younger respondents (<39 years of age) were less satisfied with their positions than were older respondents (p<0.001). Management of oral mucosal diseases represented 23.7% of the respondents' patient care time. These OM specialists reported a high degree of satisfaction with their careers. These findings may help increase recognition of OM as a desirable career path and of the varied career opportunities available in academia, hospitals, and private practices.

The use of topical steroid preparations in oral medicine in the UK.

Topical corticosteroids (TCs) are the most commonly prescribed drugs in oral medicine practice. Use in management of immune-driven inflammatory oral mucosal disease is predominantly off-label and poorly supported by evidence, yet oral medicine specialists have considerable collective experience of prescribing, administering and managing these medications. TCs are also prescribed by others in healthcare including general dental practitioners. Successful TC use is influenced by accurate diagnosis, TC choice (potency and formulation), patient acceptability (including ease of use, taste and texture), frequency of application, duration of treatment, adverse effects, patient support and medication regulations and access. The aim of this review is to provide an overview of TC use in oral medicine practice. Recommendations are based on collective experience to help selection of the appropriate TC to maximise therapeutic efficacy and minimise the potential for adverse effects. This is within an understanding of medicines regulation and preparation availability when prescribing in both secondary and primary care.

Patient reported outcome and experience measures of oral disease in oral medicine.

A recent meeting of health ministers from over 40 countries worldwide deemed that time and money should be spent on outcome and experience measures that would allow us to determine whether our health systems deliver outcomes that truly matter to patients. This meeting, along with recent national programmes to promote the use of outcome measures in evaluating medical and surgical interventions, highlighted the important role that patient reported outcome measures (PROMs) and patient reported experience measures (PREMs) have in healthcare. Oral medicine as a speciality has promoted the use of PROMs to some extent in the recent past with the use of generic and oral health specific measures in the literature and the delivery of plenary lectures at international scientific meetings. We could find no publications regarding the use of PREMs in oral medicine. This article highlights the commonly used PROM tools in the oral mucosal disease and salivary gland literature and makes recommendations for the evaluation of the development properties of currently used instruments and the establishment of core outcome sets in the commonly managed conditions in an oral medicine setting. It is also hoped that by looking at the types of PREM tools available we can determine a suitable instrument for the evaluation of patient experience in oral medicine practice.

Development of a managed clinical network in oral medicine.

Oral medicine is concerned with the oral health care of patients with chronic, recurrent and medically related disorders of the oral and maxillofacial region, and with their diagnosis and non-surgical management. For historical reasons care for conditions falling within the scope of oral medicine practice has been inconsistent with limited planning of clinical services. Managed Clinical Networks (MCNs) bring advantages to all stakeholders with a positive impact on patient pathways and access to equitable and quality care across a network of providers working in a coordinated way to make best use of NHS resources. MCNs provide a framework to address the limitations of legacy arrangements and are very relevant to dentistry. Here we describe oral medicine MCN development in Yorkshire and the Humber within the framework of the Five year forward view NHS policy. A step-wise approach is being taken across the region to introduce an MCN model that reflects cooperative working between oral medicine, oral surgery, oral & maxillofacial surgery and other stakeholders. Preliminary data are already informing how a regional oral medicine MCN can be further developed with the potential for translation of the lessons learned to other regions.

Impact of chronic oral mucosal diseases on quality of life in Kurdish patients, Preliminary observations in Sulaimani city

Chronic oral mucosa disorders are often recurrent or painful with a long standing course that affects the quality of patients’ life. Scoring such effect with a predominance of oral health– specific quality-of-life measures currently used to a limited extent in oral medicine practice.&#x0D; Objectives: to measure the impact of chronic oral mucosal diseases on quality of life in Kurdish patients. Evaluate the efficacy of the discipline-specific quality-of-life measure developed in the field of oral medicine.&#x0D; Patients and Methods: Fifty patients with different chronic oral mucosal diseases participated in this study and filled the questionnaire.&#x0D; Results: The quality-of-life mean score significantly differed among various chronic oral mucosal diseases. Nevertheless, there were no significant differences in medication nor patient support. Behçet’s disease had the highest value (3.36). They had a significantly high score for pain, functional limitation, social and emotional domains. Positive, simple–count score was only significantly differentiating between recurrent aphthous ulceration and recurrent herpes labialis (24 versus 9.62). Chronic oral mucosal diseased patients have moderate difficulty in carrying out daily oral hygiene (mean score 2.34). They felt discomfort with certain food features (mean score 2.02). Also, they were not satisfied with their treatment (mean score 2.5) and were worry from no curing (mean score 2.09). They had bothering from the unpredictability of their oral condition (mean score 2.04). They were moderately satisfied with the level of support and understanding shown to them by family (mean score 2.2). Fortunately, chronic oral mucosal diseases did not disrupt their social activities and did not hold them to the feeling of isolation (mean score 0.98 and 0.74 respectively).&#x0D; Conclusion: Dentists should pay particular attention to mucosal-diseased patients because they are likely to experience oral impacts on daily performances. They should also consider the 26 questions included in the chronic OMD-QOL system for better understanding those patients’ need.

A survey of oral medicine education, training and practice among dermatologists in the UK and Ireland

Oral mucocutaneous diseases are common and patients with these conditions are frequently assessed by dermatologists. An accurate and comprehensive oral examination is important for a complete dermatological assessment. The aim of this study was to assess education and training, knowledge, and clinical practice of oral medicine among dermatologists in the United Kingdom (UK) and Ireland. A cross-sectional survey was conducted by means of an internet-based survey tool. This was available to British Association of Dermatology (BAD) members in UK and Ireland on the association's website. Members were asked to respond to a 10-part questionnaire that enquired about their knowledge of oral diseases, training in oral medicine, performing an oral examination and oral biopsy. Completed responses were received from 95 dermatologists. The majority of respondents were consultant dermatologists (72%) who were university based. While the majority reported that knowledge of oral diseases was important, only 52% were confident in recognising the normal variants of the oral cavity. Just 55% were confident in recognising oral malignancy and even less (42%) the different forms of oral ulceration. Over three-quarters had never attended an oral medicine clinic or attended an external oral medicine course as part of their training. Two thirds had not been taught normal oral anatomy or how to perform an oral examination. The majority reported that their training in oral medicine was not adequate to perform their job. This study shows that in this, albeit small, group of dermatology specialists and trainees most appear ill-equipped to recognise and diagnose diseases of the oral cavity due to a lack of training in oral medicine.

World Workshop on Oral Medicine VI: Patient-reported outcome measures and oral mucosal disease: current status and future direction

This systematic review aimed to (1) explore the patient-reported outcome measures (PROMs) currently used in the oral mucosal disease literature and report on the type and context of the use of these instruments and (2) provide a future direction for PROMs in Oral Medicine practice and research. A systematic review of published English-language articles relating to the use of PROMs in the oral mucosal diseases literature was performed in November2013. In total, 131 articles met the inclusion criteria; these articles addressed the following oral mucosal conditions: lichen planus (75); recurrent aphthous stomatitis (30); mucous membrane pemphigoid/pemphigus vulgaris (14); orofacial granulomatosis (1); and multiple oral mucosal diseases (11). The most commonly used instruments were visual analog scales (VAS) and the oral health impact profile (OHIP). Limited progress has been achieved with use of PROMs in Oral Medicine in the last few decades in both clinical practice and a research setting. With the engagement of allied medical disciplines in PROM usage and the promotion of PROMs by national health care bodies globally, advancement of PROMs is imperative for Oral Medicine. Exposure through the World Workshop on Oral Medicine (WWOM), along with potential involvement in the Core Outcome Measures in Effectiveness Trials (COMET) or other such initiatives, will enable worldwide collaboration to promote the development and utilization of valid and reliable PROMs in oral medicine, and improve patient care.

The practice of oral medicine in the United States in the twenty-first century: an update

The aim of this study was to describe the practice characteristics of Oral Medicine trained dentists in the United States. This study was a cross-sectional survey of members of the American Academy of Oral Medicine. Patient demographic characteristics, referring providers, medical comorbidities, diagnoses, and practitioner information were collected during a 5-day practice week. The survey was open during the years 2011 and 2012. Information from 916 patients was entered by 74 practitioners from 20 states. The mean number of practitioners seen before consulting Oral Medicine providers was 2.2, and patients had experienced symptoms for 16.8 months before the initial encounter. Common chief complaints were nonulcerative mucosal lesions, orofacial pain, and dry mouth. Patients with cardiovascular disease were at a higher risk of developing lichenoid lesions, and those with psychiatric conditions were at higher risk of reporting burning mouth symptoms. Diagnoses and procedures performed by Oral Medicine practitioners complement practice characteristics of general and specialty dentists in the United States.