Oral Medicine Specialists Research Articles

Challenges of oral medicine specialists at the time of COVID-19 pandemic.

Challenges of oral medicine specialists at the time of COVID-19 pandemic.

Can the Measurement of Jaw-Opening Forces Assist in the Diagnosis of Temporomandibular Disorders?

To investigate the effectiveness of a novel jaw-opening-force measuring device as a screening tool to aid in the diagnosis of temporomandibular disorders (TMD). Symptomatic TMD patients (n = 58) and control TMD-free participants (n = 56) were screened by an oral medicine specialist according to the Diagnostic Criteria for TMD (DC/TMD). TMD patients were divided into three subcategories based on TMD symptoms (myofascial pain, disc displacement, and both combined). Jaw-opening forces were measured in both groups with an adjustable head device connected to a 1,000-N-load cell. Seven attempts were recorded at 10-second intervals by a data-capturing system. The geometric mean force values were obtained after discarding the first and last attempts. TMD-free participants had greater jaw-opening forces than TMD patients both without and with adjustments for age, sex, height, and weight (both P < .001). The geometric mean ± standard deviation values for TMD patients were 18.5 ± 1.62 N and 47.7 ± 1.53 N for TMD-free participants. Differences in jaw-opening forces among the three TMD subcategories were not statistically significant; however, patients with disc displacement (23.7 ± 1.46 N) had greater jaw forces than patients with myofascial pain (17.0 ± 1.74 N) and both myofascial pain and disc displacement (17.0 ± 1.56 N). This study demonstrated that differences in jaw-opening forces could be used as a diagnostic tool for TMD. Future studies should explore the potential of this device to measure improvement in jaw-opening forces following TMD treatment.

Imaging of orofacial pain.

Orofacial pain is a common complaint, with an estimated 75% of cases caused by dental disease, specifically a diseased pulp. A small percentage of orofacial pain cases will require specialist referral most commonly to oral medicine specialists or oral and maxillofacial surgeons from a dental perspective, or otolaryngologists or neurologists from a medical perspective. Following a thorough history and clinical examination, imaging is often required to narrow the differential diagnosis or answer a specific query related to the final diagnosis. A range of imaging modalities can be used to evaluate orofacial pain including dental panoramic tomography (DPT), intraoral radiographs, cone beam computed tomography (CBCT), multidetector computed tomography (MDCT), ultrasonography (US), magnetic resonance imaging (MRI) and nuclear medicine. This paper provides a guideline outlining imaging protocols for categories of facial pain divided into: (a) unilateral odontalgia; (b) unilateral facial pain; (c) combined unilateral odontalgia and facial pain; (d) trigeminal neuralgia; (e) trigeminal neuropathic pain with or without other sensory, autonomic or motor features; (f) temporomandibular joint disorders and associated pain; (g) referred pain and (h) non-specific orofacial pain. Imaging for orofacial pain should be tailored to answer a specific query related to the aetiology of the reported pain. This should result in a specific diagnosis or narrowing of the differential diagnosis as possible causes of orofacial pain are eliminated. Choosing the correct imaging modality and protocol based on the pain category is important for efficient and effective pain diagnosis and management.

Patterns of orofacial pain practice amongst oral medicine specialists in Australia.

This study aimed to evaluate and describe the current patterns of practice pertaining to orofacial pain amongst oral medicine specialists in Australia and provide insight into the access of care available to orofacial pain patients in Australia. A survey involving questions relevant to orofacial pain, patient and practitioner demographics was designed and disseminated via an online polling platform to all Australian Health Practitioner Regulation Agency registered oral medicine specialists. Results were collated online, and simple descriptive statistics were utilised for data analysis. Twenty-six oral medicine specialists were included in this study, with a survey response rate of 81.2%. All specialists considered orofacial pain practice as part of the oral medicine specialty. 96.2% assessed and managed orofacial pain patients as part of their oral medicine practice. The greatest proportion (30.8%) of oral medicine specialists were practicing in Western Australia, a state which represents 10.3% of the Australian population. All respondents reportedly diagnose temporomandibular disorders, followed by orofacial neuropathy (96.2%) and headache or neurovascular disorders (80.8%). 92.3% of specialists managed orofacial neuropathy followed by temporomandibular disorders (84.6%) and headache or neurovascular disorders (50%). This is the first study to report on patterns of orofacial pain practice amongst oral medicine specialists in Australia. Findings demonstrate that oral medicine specialists in Australia are actively engaged in the assessment and management of the orofacial pain patient. There, however, appears to be disproportionate access to care by oral medicine specialists for patients with orofacial pain across Australia.

New and Inherited STAT1 Mutations in a Chinese Family with Chronic Mucocutaneous Candidiasis: A Case Report

A mild clinical Chronic Mucocutaneous Candidiasis (CMC) phenotype with STAT1 transcription factor mutation has been identified in a Chinese family. It is a rare variant in STAT1 (NM_0073315.3c.1175T&gt;C Met392Thr). Specifically, it is a heterozygous mutation. To date, the pathogenicity of this variant in STAT1 (NM_0073315.3c.1175T&gt;C Met392Thr) for CMC has not been reported in the Human Gene Mutation Database. Thus, this is the first report about STAT1 mutation found in CMC patients from Chinese ethnic group. This study also shows the mutation on the DNA-binding domain of STAT1 for the first time. The findings will broaden the spectrum of STAT1 mutations and facilitate genetic diagnosis by the oral medicine specialists.

Changing face of medication-related osteonecrosis of the jaw: Sheba Medical Center experience-fifteen years

Our aim is to track the development of the epidemiological characteristics in patient populations diagnosed with MRONJ at the Sheba Medical Center. The files of patients diagnosed with MRONJ from 2003 until December 2017 were retrieved. Data on demographics, medical background, type and duration of drug use and triggering events at presentation was collected. The study included 448 patients, 336 females and 112 males. A decrease in the proportion of multiple myeloma patients (p < 0.05) and an increase in the proportion of patients with bone metastases of solid tumors has been observed recently. An increase in the proportion of cases in osteoporosis patients compared with oncology patients is evident (p < 0.01). Overtime a higher proportion of patients presented at an earlier stage of MRONJ (p < 0.01). As a result of changes in treatment protocols and increased awareness of oncology caregivers, including referral and consultation with Oral Medicine specialists, there has been a change in the demographics and presentation of the disease.

Self-perception and physician's awareness on early detection of tongue cancer: experience of the Oral Medicine Unit of Trieste.

The objective of this retrospective study was to characterize the outpatient oral medicine referral pattern for tongue lesions with particular emphasis on cancer. Records of patients referred to the Oral Medicine department for any tongue lesions needing biopsy between 2009 and 2016 were retrospectively analyzed. All cases diagnosed as tongue cancer were screened for medical history, referral pattern, treatment/diagnosis/follow-up. Among 266 patients, 39 were diagnosed with cancer, 43.6% were smokers and 10.3% alcohol consumers, 38.5% felt pain, 53.8% noticed the lesion or felt its presence, 46.2% were referred from another specialist. For people aware or informed of the lesion. the mean time waited before consultation was 7.9 months. In 53.8% of cases, narrow-band-imaging guided the biopsy. In 29 patients, biopsy was performed the day of the visit. Patients were referred from dentists (42.1%), Primary-care-Physician (10.5%), Emergency-Dental-Unit (7.9%), Radiotherapist (7.9%), Otolaryngologist (7.9%), Dermatologist (26%), infectious diseases unit (2.6%), auto-referral in 18.4%. Lesion was defined by referring doctor as "suspicious" (13.1%), white (10.5%), vegentans (5.3%), Lichen-like (5.3%), ulcerative (2.6%), Tumoral (26.3%), Bollous (2.6%). An unweighted Kappa Value of 0.024, assessed low concordance between referral diagnosis and diagnosis performed by the Oral Medicine specialist before the biopsy. Patients are not always aware of the risk of oral cancer. Accurate information should be provided to patients as well as to specialists rather than just dentists as regard as the risk factors for oral cancer, the importance of referral to specialized departments and timing. The use of new technologies should be widespread.

Severe Gingival Swelling and Erythema

A 62-year-old man presented to an oral medicine specialist with gingival inflammation of at least 1 year's duration. He reported mild discomfort when consuming spicy foods and denied associated extraoral lesions. His medical history revealed hypertension, hypothyroidism, and psoriasis.

Referrals by general dental practitioners and medical practitioners to oral medicine specialists in New Zealand: a study to develop protocol guidelines.

The aim of this study was to examine the awareness level among general dental practitioners and medical practitioners with regard to common oral mucosal diseases and orofacial pain, investigate their orofacial screening and oral medicine referral practices, assess the information to be included in the referral, and evaluate the perceived need for supplementary resources and guidelines for referral. In total, 51 general dental practitioners and medical practitioners were recruited to investigate their orofacial screening and oral medicine referral practices. Three oral medicine specialists were interviewed to understand the referrals received from dentists and physicians. Of the participants, 87.5% dentists and 52.6% physicians considered orofacial screening as treatment priority. However, 71.9% dentists performed orofacial screening routinely, whereas none of the physicians did. Of the dentists, 50% referred relevant patients to oral medicine specialists every time they encountered such cases, and 31.6% of the physicians did so. Referrals should include the patient's background and medical history, full descriptions of the lesions, and results and photos from special tests. Of the participants, 65.6% of the dentists and 78.9% of the physicians believed that continuing professional development courses in oral medicine would be beneficial, and 93.8% of the dentists and 89.5% of the physicians agreed that standardized national referral guidelines would be useful. Standardized national referral guidelines, as well as continuing professional development courses in oral medicine, would be helpful to dental practitioners in the management of patients.

Prevalence of Oral Mucosal Lesions in Patients with Hematological Disorders or Cancer: A Cross-sectional Study

Background: Oral cavity, as the main source of complications such as infection, is unfortunately ignored in cancer patients. In this study, the frequency, type, and location of oral mucosal lesions were determined among patients admitted in the hematology and oncology department. Methods: In this cross-sectional study, 88 admitted patients were examined between November 20, 2017 to August 21, 2018. Demographic data, history of smoking, and denture use were documented. Oral examinations were further conducted to evaluate oral soft tissue lesions according to the checklist. Results: 88 hospitalized patients were screened, out of whom 57(64.7%) had at least one lesion. A total of 79 oral mucosal lesions were identified and ulcerative lesions, found in 51 (57.9%) patients, were among the most frequently encountered problems. Pigmented lesions were more prevalent in smokers (P<0.001). Red and white lesions were significantly more than other lesions among complete denture wearing patients. Conclusion: In light of the high prevalence of oral complications in our patients, this study indicates the need for consultation with oral medicine specialist for a timely diagnosis and better management during the treatment process.

Recent advances in the histopathological assessment of salivary disease.

Salivary gland disease includes a wide range of unique and rare conditions that are treated by ear, nose and throat (ENT), oral and maxillofacial surgeons (OMFS) and oral medicine specialists. Histopathological diagnosis is pivotal to making a diagnosis and treatment planning. There is a vast range of conditions and controversies in the histopathological assessment of salivary gland diseases. Most colleagues in oral pathology and oral medicine work closely with the OMFS but might have missed some of the recent articles published by the speciality. We reviewed articles thought to be relevant to oral medicine and pathology specialists published over an 8-year period between 2012 and 2019 in the leading British Journal of Oral and Maxillofacial Surgery (BJOMS). A total of 44 published articles relating to the histopathology of salivary glands disease were selected. Papers were published on population studies, benign and malignant tumours, sialadenitis, metastasis to the parotid gland and cytology. The publication type and numbers published were as follows: review (n=9), meta-analysis/randomised controlled study (n=1), retrospective study (n=10) and case report/technical notes (n=23). The greatest proportion of publications published in BJOMS were case reports. This emphasises the paucity of consensus and the need for development in this field. Salivary gland disease remains an area with many controversies and would benefit from further research.

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 &amp; 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.

Immune-mediated Skin Disorders and their Oral Manifestations in the Omani Population: A Hospital-based Study.

ObjectivesWe sought to determine the prevalence of immune-mediated skin disorders (IMDs), their oral manifestations, and the related comorbidity among Omani patients with IMDs attending the outpatient Department of Dermatology and Dental Clinic at Al Nahdha Hospital, Muscat.MethodsWe conducted a retrospective study of 236 newly-diagnosed patients with IMDs who attended the outpatient clinic between September 2014 and September 2017. Data, such as age, sex, investigations, diagnosis, comorbidity, and associated oral manifestations of the affected individuals, were collected from the hospital health information system.ResultsOf the 236 diagnosed cases of IMD, lichen planus substantially comprised over half of the total cases (59.7%). This was followed by relatively fewer cases of discoid lupus erythematosus (11.0%), systemic lupus erythematosus (10.2%), and erythema multiforme (8.1%). Pemphigus vulgaris and bullous pemphigus comprised only 3.0% and 4.2% of the total studied cases, respectively. The other less common disorders found in our study were toxic epidermal necrolysis (1.7%), pemphigus foliaceus (1.3%), and gestational pemphigoid (0.8%). Oral mucosal involvement was seen more commonly with lichen planus (78.7%), pemphigus vulgaris (71.4%), and erythema multiforme (75.0%), while systemic lupus erythematosus and discoid lupus erythematosus were shown to appear with more comorbidities compared to the other skin disorders studied.ConclusionsSeveral IMDs have considerable oral involvement. These oral manifestations of the diseases may be overlooked by other specialists leading to a delay in the diagnosis and its management. In order to circumvent this delay, the analysis and evaluation of a disease need to be done by a team comprising of a dental surgeon, dermatologist, and an oral medicine specialist.

Computing systems, telehealth, and personal data: what is up?

Dear Editor, I have read with great interest the comment published by the team coordinated by Prof. Paulo Sergio da Silva Santos (), where the authors emphasized the importance of dentists (in particular a specialist in Oral Medicine) and Teledentistry strategies in the COVID-19 pandemic. I have been following the work of this nationally recognized team, known for their experience and excellence in the hospital environment, offering qualified dental care for patients with special medical needs. Personally, I have deep [...]

New WHO odontogenic tumor classification: impact on prevalence in a population.

Objectives:This study approaches the history of reclassifications and redefinitions around the odontogenic keratocyst (OK), as proposed by the World Health Organization (WHO), and aims to understand the impact of those changes on the prevalence and epidemiology of odontogenic tumors (OTs).Methodology:Cases of OTs diagnosed in an Oral Pathology service between January 1996 and December 2016 were reviewed. Demographic data of patients such as age, gender and site of lesions were retrieved from their respective records.Results:Within the studied period, 7,805 microscopic reports were elaborated and 200 (2.56%) of these were diagnosed as OTs. Out of these 200, between 1996 and 2005, prior to the 2005 WHO classification, there were 41 (20.5%) OTs cases, being odontoma the most frequent (23; 56.09%), followed by ameloblastoma (8; 19.51%) and myxoma (03; 7.31%). Between 2006 and 2016, after the previous 2005 WHO classification there were 159 (79.5%) OTs, being odontogenic keratocystic tumor (KCOT) the most frequent (68; 42.76%), followed by odontoma (39; 24.52%) and ameloblastoma (21; 13.20%).Conclusions:As of today, the most recent WHO classification to be followed brings KCOT back to the cyst category, which will impact on the prevalence and epidemiology of OTs; thus, this study was able to identify a considerable increase (287.80%) in the prevalence of OTs when the 2005 WHO classification was utilized. Despite being an important academic exercise, classifying odontogenic lesions and determining whether to place the odontogenic keratocyst in a cyst or tumor category is crucial to establish the correct diagnosis and treatment to follow, whether by oral medicine or oral surgery specialist, or by the general practitioner.

The Prevalence of Oral Lesions among Palestinian Dental Patients Attending Oral Medicine Dental Clinics at Al-Quds University

Objectives: In Palestine, there are no data about the prevalence of oral lesions or their associated risk factors. Thus, this study came to assess the prevalence and the risk factors of oral lesions among adult dental patients visiting Al-Quds University (AQU) Dental Clinics. Materials and Methods: Three hundred Twenty patients were diagnosed clinically for the presence of oral lesions at oral medicine clinics at Al-Quds University in the period between 2015 to 2016. Their age ranged from 21 to 60 years old (mean age: 40.2 ± 17.6). Senior students were trained to conduct the oral exam under the direct supervision of Oral Medicine specialist. Trained students also collected data on patients’ demographics, dental history, medical history and other health related habits. Descriptive and bivariate analyses were generated to describe lesions prevalence and associations with other suggested factors. Results: A total of 68 lesions were found in this study (29.4% of study’s sample). Recurrent aphthous ulcer, traumatic ulcer and geographic tongue were the most common oral lesions. Ten oral potentially malignant lesions were diagnosed (8 cases were Leukoplakia, 2 cases were erythroplakia). Non filtered smoking cigarettes were associated with reported lesions. Oral lesions were noticed to increase with age. Oral lesions were more common on the Tongue, labial and buccal mucosain this study. Conclusions: This study revealed high prevalence of apthous and traumatic ulcer while potentially malignant lesions like leucoplakia and erythroplakia were also seen in patients who were smokers. Dentists should have a high level of awareness during oral examination and intervention should be performed to raise awareness among the population about the harmful effects of smoking on oral health.

ORAL MANIFESTATION OF CROHN DISEASE - A CASE REPORT

A 29-year-old male patient was referred to a specialized service with gingival lesions that lasted 10 years. The medical history showed untreated Crohn disease. Intraoral examination detected firm nodules at the vestibular retromolar region of the right and left mandibular molar, red in color, recovered by ulcerated mucosa, and both measuring 2 cm. The buccal mucosa revealed a swollen, cobllestone appearance and showed deep linear ulcerations. Incisional biopsy was performed, and histopathologic analysis showed a connective tissue with intense chronic inflammatory infiltrate and neutrophils, blood vessel neoformation, and epithelioid cells. We recommended the use of 0.12% topical chlorhexidine. Because of persistent oral lesions, the patient was redirected to a gastroenterologist for further investigations and systemic treatment. Clinical control remains for 2 months. Approximately one-third of Crohn disease patients develop extraintestinal manifestations. Treatment of oral lesions included treatment of the intestinal disease and cooperation between gastroenterologists and specialists in oral medicine.

Concordance between clinical and histopathologic diagnosis and an audit of oral histopathology service at a Nigerian tertiary hospital.

IntroductionAlthough histopathological diagnosis remains the gold standard; good clinical impression is potentially a key diagnostic tool in rural resource-limited settings. Thus, good concordance between clinical impression and histopathological diagnosis is thus a very crucial diagnostic oral pathology tool in low- and middle-income countries (LMICs).MethodsThis retrospective study was performed at the Oral pathology and Oral diagnoses units of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Osun state. Clinicopathological reports of all biopsies between the period of 2008-2017 were retrieved and analyzed. Descriptive analysis of data was done using Stata 14. Frequency of oral lesions and rates of accurate clinical diagnoses were evaluated for lesional sites and clinician's qualification/specialization.ResultsIn 592 biopsied cases, the mean age was 36.1years with higher female predilection (54.4%). Odontogenic tumors (OTs) were the most prevalent category of lesions (25.3%, n=149), followed by reactive lesions (12%, n=71). Absolute concordance was recorded for 54.6% (k=0.5) of the cases; with highest concordance observed in fibro-osseous lesions (65.6%, k=0.43), and least in pulp/periapical lesions (3.5%). Concordance was higher in females (59.5%, k=0.53) than males (48.3%, k=0.44). Oral medicine specialists had the highest concordance index (62.5%, k=0.59).ConclusionThe findings in this research indicate that, on a general note, the degree of concordance between clinical and histopathological diagnosis is poor. Hence, improvement in diagnostic skills (irrespective of clinical specialty) is important to improve treatment outcomes, particularly in LMICs. Continuous personnel training and utilization of advanced diagnostic techniques can potentially help bridge the diagnostic gaps.

Analysis of clinical oral medicine practices at the University of Pennsylvania: a 5-year retrospective study.

The aim of this study was to characterize oral medicine (OM) clinical practices at the University of Pennsylvania (Penn), determine the importance of OM clinical services, and emphasize aspects of training for OM specialists. Nonprobability sampling of OM resident patient logs for patients receiving clinical care from 2008 to 2013 was conducted. OM resident patient logs included clinical diagnosis, International Classification of Diseases, ninth edition code, medical history, clinical procedure, Current Procedural Terminology code, attending physician, and resident participation notes. Outpatients in OM medical practices (n = 6024) averaged 1.56 diagnoses from OM specialists. Orofacial pain (45.02%) and oral mucosal diseases (34.28%) comprised the majority of OM diagnoses. The most common procedures were tissue biopsies (59.34%) and treatments for temporomandibular disorders (29.9%). Inpatients (n = 313) comprised 3.46% of Penn OM hospital services, and cardiovascular disorders (38.99%) were the most common admitting diagnoses in this group. In the OM dental practice (n = 1648), 42.05% of patients had a median of 3 medical comorbidities (range = 2-11), of which cardiovascular disorders (27.13%) were most prevalent. Analysis of Penn OM clinical practices emphasizes the breadth and multidisciplinary nature of OM services and importance of comprehensive postdoctoral training in all domains of OM.

Multidisciplinary Management of Desquamative Gingivitis with Periodontal Disease

Oral lichen planus is a disorder that affects the oral mucosal. Desquamative gingivitis (DG) is usually a manifestation of oral lichen planus (OLP) and may be the only clinical presentation of these disorders. There is erosion of the superficial epithelium layer. Such lesions impede proper oral hygiene indirectly increase the long-term risk for plaque-induced periodontal disease via plaque accumulation. This case report presents a multidisciplinary management of an Indian male, who suffer from OLP related desquamative gingivitis with the diagnosis of generalized chronic periodontitis. The patient was jointly managed by oral medicine specialist, periodontist and prosthodontist. Proper mangement and long term maintenance can significantly reduce the morbidity in patients associated with these conditions.