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| Year : 2011 | Volume
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| Issue : 5 | Page : 620-621 |
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| Defining the role of Oral Physicians |
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Eswar Nagaraj
Department of Oral Medicine and Radiology, SRM Dental College and Hospital, Chennai, India
Click here for correspondence address and email
| Date of Web Publication | 7-Mar-2012 |
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How to cite this article:
Nagaraj E. Defining the role of Oral Physicians. Indian J Dent Res 2011;22:620-1 |
The past decade has heralded a lot of interest amongst Medical and Dental professionals toward the specialty of Oral Medicine. This can be partially attributed to the increased incidences of patients reporting with oral lesions to the outpatient clinics. The rise in medical awareness amongst the general population, environmental changes due to rise in pollution levels, allergic incidences to newer drugs, recent pandemic status of HIV etc., may all be attributed to the increased incidences of oral lesions. [1] The stomatological diseases fall under the grey areas of Medicine and Dentistry. The general physician often fails to understand the dental and the oral concepts contributing to oral diseases. The dentist falls very much short of knowledge regarding the systemic, environmental, food and drug influences on oral lesions. [2] So a need for a competent oral physician to handle these oral diseases has been felt to a great extent in the recent time.Oral physicians are often sought nowadays to manage the oral symptoms or to know if the oral disease poses a risk of oral cancer or cross infection in the clinics.
An oral physician is identified by the medical community as a dentist who is adequately trained in the field of Medicine, Radiology and Applied Oral pathology in order to manage variety of stomatological diseases that fall outside the scope of routine dentistry. An oral physician is expected to have a thorough knowledge in the field of oral diagnosis and be competent to handle any disease condition contributing to sore mouth, oral cancer and orofacial pain. To be a successful oral physician, in depth knowledge in stomatology, general medicine, pharmacological science, environmental allergens etc., are mandatory. A clear understanding of hypersensitivity / idiosyncratic reactions to various drugs and the effects of environmental /dietary factors on oral mucosa distinguishes him from his allied specialists.
It is important for the medical and dental community to understand the boundaries of oral medicine practice. Though an oral physician is bestowed with adequate knowledge to diagnose variety of oral manifestations of local and systemic origin, his competency in the field of medicine is focused around management of sore mouth, orofacial pain and oral precancer. More precisely, the target population for oral physician are cases ofxerostomia, anemic stomatitis, specific herpetic, candidal and vincents infections, senile mucositis and Gingivitis, apthous stomatitis, allergic, atopic stomatitis, oral lesions of mucocutanous diseases, oral precancers, post Herpetic and non surgical cases of trigeminal neuralgias, temporomandibular joint disorders, burning mouth syndromes and atypical facial pain. These clear cut boundaries must be understood not only by the medical population but also by an emerging oral physician so that he can plan whether to provide intervention by himself or to just contribute with diagnosis and refer to the concerned specialists. Oral medicine practice can be modeled like diabetology or cardiology practice, where the patients are treated on a long-term basis and perennially followed up. During the course of illness, the patients must be kept as symptom free as possible. Medical community often look upon the oral physician to provide a time frame of illness in case of chronic oral diseases or provide his personal experience about cancer potential, remissions and recurrences for any oral lesion. The knowledge in this zone can be attained only by living with the patients through longitudinal or cohort study and not by mere screening in an oral medicine department focusing only on diagnosis.
The changing trends in the disease pattern and newly emerging concepts in the management has thrown a lot of light in successfully treating oral diseases, which were once thought to be incurable and often attributed to the psychosomatic causes. Since 1994, advancements in research methodologies, instant online access to systematic reviews and citing of the articles through online have paved way for evidence-based approach in the management of oral diseases. This in turn helps us to compare etiologies, disease prognosis, outcome patterns etc., with the documented evidence in the literature.
Creation of database is mandatory to go ahead with longitudinal or cohort studies and to personally monitor the changing disease patterns in our epidemics. For example, xerostomia, mucinous erosion, sodium lauryl sulfate, cinnamaldehyde, peppermint oil, glutan etc., [3] are proven aphthous-inducing factors. The heavy metals in alternate medicinal preparations,quinolones, statins, ACE inhibitors, are identified as Lichenoid-inducing agents. The higher levels of trace element concentration in drinking water are associated with precipitation of Lichenoid reactions. [4] Nowadays all the cases of Lichen Planus are thoroughly reviewed to justify the diagnosis and to rule out Lichenoid reactions. The role of peppermint oil, cinnamon oil, clove oil, class - II preservatives, parabens, propylene glycol, balsam of peruetcare attributed for crohn's stomatitis and fixed atopic eruptions in the oral cavity. [5],[6]
The new trends in the management show a lot of promise in handling stomatological diseases. Logistic use of drug preparations which are exclusively marketed to suit the needs of oral physician like medium /high potency topical steroidalora paste, chemotherapeutic orapaste and mouthwashes, antihistaminic orapaste, miracle mouthwashes, immunomodulators, mucin stimulators, saliva substitutes, non foaming non flavored tooth paste preparations, Benzyd amine mouth washes, probiotics etc may prove valuable to maintain a long symptom-free period without much systemic complications until the remissions occur. These preparations also augment the effects of systemic drug therapy.
To conclude, sustained success in the speciality of oral medicine depends on the following: (1) good diagnosticability, (2). indepth knowledge in identifying and removing the etiology from local, genetic, environmental, drug sources, systemic sources etc. (3) Logistic use of therapeutics in managing the symptoms and treating the oral illness, (4) Modification of diet and habits to suit the outcome and (5) Correction of underlying sytemic deficiencies, harmonal and immune dysfunctions.
 References | |  |
| 1. | Bell GW, Smith GL, Rodgers JM, Flynn RW, Malone CH. Patient choice of primary care practitioner for or ofacial symptom. Br Dent J 2008;204:672. 
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| 2. | Rogers RS, Bruce AJ. Preface Oral Medicine/Oral Dermatology Dermatol Clinics 21 2003:xi - xii
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| 3. | Lamey PJ, Lamb AB. Proospective study of aetiological factors in Burning mouth syndrome. BMJ 1988;296:1243-6.
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| 4. | Lamey PJ, Lamb AB. Burning mouth syndrome Psychological and allergic aspects. J Oral Path Med 1994;23:216-94.
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| 5. | AxellT. Hypersensitivity of oral mucosa, clinic and pathology. Acta Odonto Scand 2001;59:315-9.
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| 6. | Vincent SD, Lilly GE. Clinical, historic, and therapeutic feature of apthous stomatitis. Literature review and open clinical trial employing steriods. Oral Surg Oral Med Oral Pathol 1992;74:79-86.
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| Authors | | |
Correspondence Address:
Eswar Nagaraj
Department of Oral Medicine and Radiology, SRM Dental College and Hospital, Chennai
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.93444
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