Dental Medicine 5

Oral medicine
Oral Medicine is defined by the American Academy of Oral Medicine as the discipline of dentistry
concerned with the oral health care of medically complex patients – including the diagnosis and
management of medical conditions that affect the oral and maxillofacial region.
An oral medicine doctor has received additional specialized training and experience in the
diagnosis and management of oral mucosal abnormalities (growths, ulcers, infection, allergies,
immune-mediated and autoimmune disorders) including oral cancer, salivary gland disorders,
temporomandibular disorders (e.g.: problems with the TMJ) and facial pain (due to musculoskeletal
or neurologic conditions), taste and smell disorders; and recognition of the oral manifestations of
systemic and infectious diseases. It lies at the interface between medicine and dentistry. An oral
medicine doctor is trained to diagnose and manage patients with disorders of the orofacial region,
essentially as a "physician of the mouth."
It represents an emerging specialty of Dentistry. On March 2, 2020, Oral Medicine became the 11th
ADA recognized dental specialty.
History[edit]
The importance of the mouth in medicine has been recognized since the earliest known medical
writings. For example, Hippocrates, Galen and others considered the tongue to be a "barometer" of
health, and emphasized the diagnostic and prognostic importance of the tongue. [1] However, oral
medicine as a specialization is a relatively new subject area. [2]:2 It used to be termed "stomatology" (-
stomato- + -ology).[2]:1 In some institutions, it is termed "oral medicine and oral diagnosis".
[2]:1
American physician and dentist, Thomas E Bond authored the first book on oral and maxillofacial
pathology in 1848, entitled "A Practical Treatise on Dental Medicine". [2]:2[3] The term "oral medicine"
was not used again until 1868.[3] Jonathan Hutchinson is also considered the father of oral medicine
by some.[2]:2 Oral medicine grew from a group of New York dentists (primarily periodontists), who
were interested in the interactions between medicine and dentistry in the 1940s. [4] Before becoming
its own specialty in the United States, oral medicine was historically once a subset of the specialty
of periodontics, with many periodontists achieving board certification in oral medicine as well as
periodontics.
Scope
Oral medicine is concerned with clinical diagnosis and non-surgical management of non-dental
pathologies affecting the orofacial region (the mouth and the lower face).
Many systemic diseases have signs or symptoms that manifest in the orofacial region.
Pathologically, the mouth may be afflicted by many cutaneous and gastrointestinal conditions. There
is also the unique situation of hard tissues penetrating the epithelial continuity (hair and nails are
intra-epithelial tissues). The biofilm that covers teeth therefore causes unique pathologic entities
known as plaque-induced diseases.
Example conditions that oral medicine is concerned with are lichen planus, Behçet's disease and
pemphigus vulgaris. Moreover, it involves the diagnosis and follow-up of pre-malignant lesions of the
oral cavity, such as leukoplakias or erythroplakias and of chronic and acute pain conditions such as
paroxysmal neuralgias, continuous neuralgias, myofascial pain, atypical facial pain, autonomic
cephalalgias, headaches and migraines. Another aspect of the field is managing the dental and oral
condition of medically compromised patients such as cancer patients suffering from related oral
mucositis, bisphosphonate-related osteonecrosis of the jaws or oral pathology related to radiation
therapy. Additionally, it is involved in the diagnosis and management of dry mouth conditions (such
as Sjögren's syndrome) and non-dental chronic orofacial pain, such as burning mouth syndrome,
trigeminal neuralgia and temporomandibular joint disorder.
Lumps and swellings of the mouth
It is not uncommon for an individual to experience a lump/swelling in the oral environment. The
overall presentation is highly variable and the progression of these lesions can also differ, for
example: development of a lesion into a bulla or a malignant neoplasm. Lumps and swellings can
occur due to a variety of conditions, both benign and malignant such as:
 Normal variation lesions

o Pterygoid hamulus: This is a hook-shaped structure protruding postero-
laterally from the inferior boundary of the medial plate of the pterygoid
process
o Parotid papillae: This is the exiting duct from the parotid gland which is
commonly found adjacent to the upper second molar on the buccal mucosa
o Lingual papillae: Seen covering the dorsum of the tongue
 Inflammatory
o Abscess: An abscess is a painful collection of pus, usually caused by a
bacterial infection[citation needed]
o Cellulitis: Commonly due to a bacterial infection spreading to the deeper
layers of the skin leading to a multitude of complications
o Cysts: A cyst is an epithelial lined sac of tissue that has either fluid or semi-
fluid content inside
o Sialadenitis: Infection of the salivary glands
o Pyogenic granuloma: Is a relatively common, tumor-like, exuberant tissue
response to localized irritation or trauma[6]
 Chornic granulomatous disorders
o Orofacial granulomatosis: This is an uncommon condition but is seen to be
increasing in prevalence. This condition presents with facial/labial swellings
commonly accompanied with angular stomatitis or cracked lips, ulcers,
mucosal tags, cobblestone mucosea or gingival swellings
o Crohn's disease: This is a disease affecting the bowel but commonly has
oral lesions associated. Examples of some oral presentations are: raised
gingival lesions, hyperplastic folds/cobble-stone mucosa, ulcers, facial
swelling and/or angular cheilitis
o Sarcoidosis: Sarcoidosis is a multi-system condition which may lead to
gingival enlargement or salivary gland swelling which may result in
xerostomia
 Developmental[7]
o Unerupted teeth
o Odontogenic cysts
o Eruption cysts
o Haemangioma
o Lymphangioma
o Palatal tori and mandibular tori: formation of new bone upon the surface of a
present bone
o Lingual thyroid: this is an abnormal mass of ectopic thyroid tissue seen at
the base of tongue
 Traumatic
o Denture-induced hyperplasia
o Epulis
o Fibroepithelial polyp
o Haematoma
o Mucocele
o Surgical emphysema
 Hormonal
o Pregenancy epulis
o Oral contraceptive pill gingivitis
 Metabolic
o Amyloidosis
 Drugs
o Phenytoin
o Calcium channel blockers
o Ciclosporin
 Allergy
o Angioedema
 Infective
o HPV
 Fibro-osseous
o Cherubism
o Fibrous dysplasia
o Paget's disease
 Neoplasms
o Carcinoma
o Leukeamia
o Lymphoma
o Myeloma
o Odontogenic tumours
o Minor salivary gland tumours
So as seen above the list is extensive and by no means is this a complete and comprehensive
representation of all the possible lumps/swellings that can occur in the mouth as to the means of
acquiring a swelling in the mouth. When considering what a lump might be caused by the site of
which it has appeared can be of significance. Below are some examples of swellings/lumps which
usually are present as specific locations in the oral cavity:[8]
 Gingiva
o Congenital hyperplasia
o Abscesses
o Pyogenic granuloma
o Neoplastic
o Pregnancy epulis
o Drug-induced hyperplasia
o Angioedema
o Papilloma/warts
 Palate
o Torus palatinus
o Abscesses
o Unerupted teeth
o Pleomorphic adenomas/salivary neoplasms
o Invasive carcinoma from maxillary sinus
o Kaposi’s sarcoma
o Developmental swellings associated with Paget’s disease
 FOM
o Most commonly salivary calculi and denture-induced hyperplasia
o Mucocele
o Ranula
o Mandibular tori
 Tongue and buccal mucosa
o Congenital haemangioma
o Congenital macroglossia
o Mucocele
o Vesiculobullous lesions
o Ulcers
o Hyperplasia

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Oral medicine

 Normal variation lesions

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