Textbook of Oral Medicine Anil Govindrao Ghom, Savita Anil Ghom (Lodam)
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  • Oral Diseases— An Introduction
  • Neoplasm
  • Infection Control in Dental Office
  • Case History
  • 2Investigations in Dentistry

Oral Diseases—An IntroductionCHAPTER 1

Anil Ghom
The ultimate aim of entire dental education is to see how well it prepares the practitioners to serve patients. To become a good practitioner, it is essential to have a thorough understanding of the basic sciences related to dentistry.
Stomatology is the science of structure, function, and disease of the oral cavity. Study methods include examination of related histories, evaluation of clinical signs and symptoms and use of biochemical, microscopic and radiological procedures to establish a diagnosis and a plan for therapeutic management.
Diagnosis is the process of evaluating patient's health as well as the resulting opinions formulated by the clinician. Oral diagnosis is the art of using scientific knowledge to identify oral disease processes and to distinguish one disease from another.
History of oral medicine starts when William Gies of Columbia University in 1926 recommended that oral medicine topics should be covered in dental curriculum. In 1945, the American Academy of Oral Medicine was formed. Definition of oral medicine was accepted in 1933 by international association of oral medicine. It states that:
‘Oral medicine is that area of special competence in dentistry concerned with diseases involving the oral and paraoral structures. It includes the principles of medicine that relate to the mouth as well as research in biological, pathological, and clinical spheres. Oral medicine also includes the diagnosis and medical management of diseases specific to the orofacial tissues and oral manifestations of systemic diseases. It further includes the management of behavioral disorders, the oral and dental treatment of medically compromised patients’.
It can also be defined as ‘diagnosis and treatment of oral lesions as well as non-surgical management of temporomandibular joint disorders and facial pain and dental treatment for medically compromised patients in an outpatient sitting, or in an inpatient sitting under general anesthesia, including specialty care in periodontics and endodontic’.
The goal and objective of oral medicine are discussed below. The goal is to provide education, research and service for healthcare professionals and the public.
  • Education: It consists of predoctoral, postdoctoral and continuing education training for the healthcare professional.
  • Research: It includes activities in the field of biology as it is related to oral disease.
  • Service: Service to society and healthcare professionals is the objective of oral medicine. Oral medicine includes training the professional to provide current and future patient care.
Changes in current trends in epidemiology suggest that in future, oral medicine professionals will have to come across and diagnose various different oral diseases. According to 1989 study by WHO “trends in oral healthcare, a global perspective” stated that in future, greater role is required by oral medicine professionals.
The mouth is our primary connection to the world. It is how we take in water and nutrients to sustain life. Oral health is an essential and integral part of overall health throughout life and is much more than just healthy teeth. The word “oral” refers to the whole mouth, including the teeth, gums, hard and soft palate, linings of the mouth and throat, tongue, lips, salivary glands, chewing muscles, and upper and lower jaws. Good oral health means management of tooth decay, gum disease, chronic oral pain conditions, oral cancer, birth defects such as cleft lip and palate. Good oral health also includes the ability to carry on the most basic human functions such as chewing, swallowing, speaking, and smiling.
In the field of oral medicine, a basic understanding of various diseases and their impact on oral tissue is required, so that it is easy to recognize the presence of any major systemic diseases and then accordingly make the correct diagnosis and treatment plan so as to do thorough justice to the sufferer.
The field of oral medicine consists chiefly of the diagnosis and medical management of the patients with complex medical disorders involving the oral mucosa and salivary glands as well as orofacial pain and temporomandibular joint disorders. Specialists trained in oral medicine also provide dental and oral healthcare for patients with medical diseases that affect dental treatment, including patients receiving treatment for cancer, diabetes, cardiovascular diseases, and infectious diseases.
Oral medicine practice provides physical and medical evaluation, head and neck examination, laboratory analysis, oral diagnosis and oral therapeutics for such conditions as: vesiculobullous, ulcerative mucosal diseases, painful and burning mucosa, infectious oral diseases, oral conditions arising from medical treatment, oral manifestations of systemic diseases and salivary gland dysfunction.
The specialist will perform a comprehensive and/or specialized examination, provide consultation, possibly 4 perform and interpret laboratory tests and perform or prescribe treatments or make the appropriate referrals.
Dental management of medically compromised patients is becoming a routine and increasingly important part of dental practice. Several factors contribute to this phenomenon. First, the population continues to age. Many older patients have multiple medical conditions. Second, as medical care becomes more effective and cost issues are emphasized, many patients are being treated on an ambulatory basis to avoid hospitalization. Consequently, these individuals are in the community and readily seek dental care. Third, the sophistication of medical treatment is prolonging life. And fourth, the level of and access to available dental care has improved, resulting in more patients (regardless of medical status) wanting dental treatment. Therefore, behavior disorders and diseases of the mouth as manifestations of systemic disease are seen at an increasing rate, and require prompt and adequate care by experienced specialists.
Philosophically and in practice, dentistry is similar to one of the various specialties of medicine and consequently, it is imperative that the dentist understands the medical background of patients before beginning dental therapy, which might fail because of the patient's compromised medical status or result in morbidity or death of the patients.
The dentist trained in oral medicine should be philosophically atuned to the patient and have knowledge of medically important diseases as well as of dental problems. The dentist should be well-versed in the use of rational approaches in diagnosis, medical risk assessment and treatment.
The hospital is frequently the setting for the most complex cases in oral medicine. Hospitalized patients are most likely to have oral or dental complications of bone marrow transplantation, hematological malignancies, poorly controlled diabetes, major bleeding disorders, and advanced heart disease. The hospital that wishes to provide the highest level of care for its patients must have a dental department.
The hospital dental department should serve as a community referral center by providing the highest level of dental treatment for patients with severe systemic disease and management of the most medically complex patients is best performed in the hospital because of the availability of sophisticated, diagnostic and life-sustaining equipment and the proximity of expert consultants in all areas of healthcare.
Most difficult and unusual problems evaluated by the dentist are seen as consultations. To handle consultations properly, the dentist must be familiar with the proper method of requesting and answering consultations.
The role of imaging in oral medicine varies greatly with the type of problem being evaluated. Certain problems, such as pain in the orofacial region, frequently require imaging to determine the origin of the pain. For other conditions, however, such as soft-tissue lesions of the oral mucosa, imaging offers no new diagnostic information.
Thus, to conclude oral medicine expert is an important professional in dental and medical team of nations healthcare scheme to public. Oral medicine personal is also expert in studying, diagnosing and treating the mouth disease.
Suggested Reading
  1. Burden of Oral Disease-Introduction- Centers for Disease Control, www.cdc.gov/oralhealth/publications/library/.../pdfs/introduction.
  1. Geis WJ. Dental education in the United States and Canada: A report to the Carnegie Foundation for the advancement of teaching. Carnegie Foundation: New York, Bulletin 19; 1926.
  1. Gnanasundaram N. Nine gems of the speciality and ten commandments for specialists in oral medicine and radiology. JIAOMR. 2006: 18 (4): 196–201.
  1. Knapp MI. Oral disease in 181,338 consecutive oral examinations. J Am Dent Assoc. 1971; 83: 1288–93.
  1. Millard HD, Mason DK. Perspectives on 1988 World Workshop in Oral Medicine. Chicago: Year Book Publishers,  1989.
  1. Millard HD, Mason DK. Perspectives on 1993 World Workshop in Oral Medicine. Ann Arbor: University of Michigan,  1995.
  1. Pilot T. Trends in oral health care, a global perspective. World Health Organization:  Geneva, 6-23 November, 1989.