Welcome to the place where dentistry meets medicine! This is a series of blog posts intended to bring closer the discipline of Oral Medicine to those within the field of health, patients suffering with oral disorders, or those merely interested in what’s going on in our mouth!
My post today is based on an article I recently came across. “The future of oral medicine” by Prof. Spielman (NYU), is an engaging read that highlights the issue of the Oral Medicine speciality’s “identity crisis”. This article delves into the reality that at its core, oral medicine is a medical specialty, yet given the historical perspective that the oral cavity is in the domain of dentistry, this speciality too remains with it. Spielman goes on to ask if Medicine should accept oral medicine as a new speciality, and convincingly argues that Medicine already has a long relationship in taking care of the oral cavity. He points out that many different medical specialties currently treat conditions with oral symptoms; including dermatology, rheumatology, ear nose and throat, endocrinology, gastroenterology, oncology, transplant surgery and neurology. It only makes logical sense to suggest that a unifying specialty like oral medicine be a natural referral point for all medical specialties that see oral symptoms.
Spielman also goes onto explain the perceived role of oral medicine; to detect oral cancer and oral pathology, provide a definitive diagnosis which is then managed by specialist oral surgery. Given the rapidly increasing knowledge in medical research and technology, there may come a day when the role of oral surgery is replaced by immunotherapy, and diagnosis of oral cancer is based on technological devices, resulting in detection, diagnosis and management all occurring in the same place. With that in mind, a transition between specialities that create an interprofessional and patient-centred care environment is required. Spielman goes on to argue that moving oral medicine to the field of medicine may make that transition seamless.
But, what about the now? Spielman provides a convincing argument for why Oral Medicine should become a medical specialty, but personally, I think the focus shouldn’t entirely be on which side oral medicine falls, rather how well the specialty integrates the two fields together. The West Australian health system currently lacks this integration. Most medical specialties aren’t aware that Oral Medicine exists, which in turn only results in patients with oral symptoms missing out on appropriate care. What is unifying for both fields however is the consistent push for improving patient care. Oral Medicine has a unique role to play in patient-centred management and steps of recognition and integration of this specialty into the medical field will be an important step to improving health services and in turn patient care.
If you are interested in this article the link below: Spielman AI.
The future of oral medicine. Oral Diseases. 2018. 24 (1-2): 285-288. https://doiorg.ezproxy.library.uwa.edu.au/10.1111/odi.12739
Dr Lalima Tiwari
Oral Medicine Specialist
Perth Oral Medicine and Dental Sleep Centre