Oral Medicine Satish Chandra, Shaleen Chandra, Girish Chandra, Kamala R
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Introduction, Scope and Role of Oral Medicine in Dental Practice1

Mosby's Dental dictionary has defined oral medicine as “The discipline of dentistry that deals with significance and relationship of oral and systemic diseases. According to Taber's Medical dictionary “Oral medicine is the branch of medicine concerned with the preservation and treatment of the teeth and other orofacial tissues”. The American Academy of Oral Medicine has defined the specialty as ‘Oral Medicine is the speciality of dentistry that is concerned with the oral health care of the medically compromised patients and with the diagnosis and nonsurgical management of medically related disorders or conditions affecting the oral and maxillofacial region. However, oral medicine is the branch of dentistry that deals with the diagnosis and medical treatment of the diseases of oral cavity and surrounding structures and their relationship with systemic diseases.
The specialists of oral medicine deals with nonsurgical medical aspects of dentistry. They are concerned with the diagnosis and medical treatment of oral diseases which normally are not treated by routine dental or maxillofacial surgical procedures. Oral medicine also includes the diagnosis and treatment of oral manifestations of systemic diseases. In oral medicine special attention is paid to the dental treatment of medically compromised patients.
Only in the middle of twentieth century dental surgeons recognized oral medicine as a specialized branch. All the diseases are correlated to each other. The dentists are concerned only with the conditions in the mouth and the general clinicians ignore this part of the body as outside their area of jurisdiction.
Sir Jonathan Hutchinson (1828-1900)—Surgeon in London Hospital, is regarded as the father of oral medicine. He was first to describe number of conditions such as oral manifestation of syphilis and intraoral pigmentation. FW Brondrick (1928) published a book “Dental Medicine” and introduced the biochemical basis for understanding the dental diseases.
Hubert H Stones (1935) described the oral manifestation of systemic diseases and his book “Oral and Dental diseases” emphasized on medical aspects of oral diseases. Lester W Burket (1907-91) devoted his life to oral medicine and published first book on Oral medicine in 1964. The majority of these teachers were medically and dentally qualified. All of them emphasized on the fact that all the basic sciences which are necessary for the practice of medicine are also necessary for the practice of dentistry. Thus, oral medicine got a foundation as a specialized branch.
The physical body of man is composed of various parts, but functions as a whole unit. Its parts are interrelated to each other and with the body as a whole. Likewise dentistry cannot be considered separately from other health sciences and services, as far as diagnosis, treatment planning and treatment of the patients are concerned. Although dental surgeon is a specialist of the oral cavity, but it must be clearly understood that the patient is one single biologic unit. All the organs and systems of a body play a role in the development of a clinical lesion in the mouth. Further, local lesions of the oral cavity have a direct effect on systemic health.
Oral cavity is considered as a mirror of the body because many systemic diseases manifest first in oral cavity. Some manifest in oral cavity along with their manifestation in the body. Hence dental surgeon has an opportunity and also a professional responsibility to identify such systemic diseases observed in patient and refer to appropriate place for the treatment. This responsibility becomes more important if 2an oral health care provider is the only health care provider in contact with the community for a considerable period. His field should not be restricted to oral diseases, if he has the training, knowledge and practical ability to recognize common medical disorders requiring urgent attention like cholera, diarrhea and dysentery. The oral health practitioner must care for the oral and maxillofacial complex for the purpose of maintaining good health, motor sensory and psychosocial functions. The oral and maxillofacial complex includes the teeth, gums, oral cavity, jaws, salivary glands and contiguous craniofacial structures. The clinical responsibilities of oral health care practitioner include an understanding of the causes, risk factors, prevention and diagnosis of oral diseases and disorders. He should be regarded as a person who cares for the health and welfare of the community. He must have good abilities and knowledge for oral health maintenance and general living conditions such as habits, diet and sanitation.
Oral medicine concerning the common medical disorders and their diagnosis and treatment enables the dental students to understand the patient in a better way and they can provide better dental treatment. Their duty is not restricted to oral diseases but they have to deal with other medical disorders and their oral manifestations. So, the knowledge of oral medicine enables dental surgeons to understand the etiology, risk factors, prevention and diagnosis of oral and systemic diseases and their manifestations.
The most complex cases of oral medicine are frequently seen in the hospital practice. Hospitalized patients may have oral and dental complications which are the manifestations of diseases like HIV infection, diabetes, bleeding disorders and heart diseases. So, every hospital must have a dental department which can provide dental treatment for patients with severe systemic diseases. The oral medicine procedures can be best performed in the hospital because there is availability of both diagnostic and life saving equipment and expert clinicians of all areas of health care for consultation, if need arises. The commonly seen dental problems in hospitalized patients are oral ulcers, oral bleeding and oral infections secondary to chemotherapy or blood dyscrasias. The commonly provided services are dental care to prevent osteoradionecrosis prior to radiotherapy and dental care to prevent infection in open heart surgery and organ transplant patients.
The dental patient with severe medical problems, which may need emergency resuscitation, care of consultants of other medical fields before and after the dental procedure, and laboratory facilities before and after the dental procedures, should be hospitalized by a dental surgeon. Further private dental practitioners have to decide whether the dental procedure should be carried out in a hospital or in his own clinic. This depends upon the condition of the patient.
The patient with the following disorders for dental treatment may be admitted in the hospital:
  1. Severe cardiovascular diseases
  2. Need of general anesthesia or heavy sedation
  3. Bleeding disorders
  4. Prone to infection due to immunodeficiency
  5. Susceptibility to shock
  6. Neuromuscular or other physical disability.
Dental patients who are admitted to the hospital should have a complete medical history and head and neck examination. The hospital dental surgeon is responsible for the total well-being of the hospitalized patient, though the dental surgeon may not be able to treat all the problems that arise, he should know whom to consult in the particular situation. The dental surgeons must have a knowledge of physical diagnosis, laboratory diagnosis and advanced oral medicine which could help them to manage dental patients with severe medical problems. The dental surgeons must be able to understand the language, abbreviations etc. used by the cardiologists and the physicians. The dental surgeon should write, the necessary instructions to the nursing staff and to the patient. He should also write frequency of vital signs, medications, radiological and laboratory investigations, diet and bed rest follow-up treatment and home care by the patient.
Proper precautions, home care, follow-up instructions, details of procedure performed results of the investigations and medications etc. should be written on the discharge card. During internship and residency programs in oral medicine department, dental students and surgeons must be trained in all the above hospital procedures. These programs must train interns and residents to provide oral health and dental care for patients with complex medical disorders as well as solve the difficult diagnostic problems of the mouth and jaws. On the proper training of interns and residents in hospital procedures, depends the future of oral medicine and hospital dentistry. Therefore the routine hospital 3procedures should be the integral part of dental internship and residency programs.
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