Oral medicine (stomatology) across the globe: birth, growth, and future

World Workshop on Oral Medicine VIII: Barriers to research in oral medicine: results from a global survey

OBJECTIVES

To explore factors influencing research interest and productivity and perceived barriers to conducting research in Oral Medicine (OM).

METHODS

Invitations to participate in an online survey were e-mailed to a network of international OM practitioners and related professional organizations. Questions captured respondents' demographic/professional variables and gauged research interest, productivity, and perceived barriers to conducting research specifically in OM. Statistical analysis was conducted via descriptive, logistic regression, and multivariate modeling.

RESULTS

Five hundred and ninety-three OM practitioners from 55 countries completed the survey, with 54%, 25%, and 21% practicing in high, upper-middle, and lower-middle-income countries, respectively. Eighty-six percent of respondents were interested in conducting research. Age (less interest with an increase in age), working in academia, and practicing in a lower-middle vs high-income country were significant predictors of research interest. Self-reported research productivity was significantly greater among males, those working in academia, and those who graduated from programs that mandated research presentation/publication. Obtaining research funding was a significant barrier among respondents from lower and upper-middle-income countries, whereas finding time for research was a reported barrier by respondents from high-income countries.

CONCLUSION

The results of this survey identified perceived barriers to conducting research in OM and highlighted solutions to address such barriers.

Clinical reasoning pattern used in oral health problem solving - A case study in Indonesian undergraduate dental students

BACKGROUND

Health professionals are known to use various combinations of knowledge and skills, such as critical thinking, clinical reasoning, clinical judgment, problem-solving, and decision-making, in conducting clinical practice. Clinical reasoning development is influenced by knowledge and experience, the more knowledge and experience, the more sophisticated clinical reasoning will be. However, clinical reasoning research in dentistry shows varying results .

AIMS

This study aims to observe the clinical reasoning pattern of undergraduate dental students when solving oral health problems, and their accordance with their knowledge acquisition.

MATERIAL AND METHODS

This qualitative study employed the think-aloud method and the result was assessed through verbal protocol analyses. Five respondents from final year dental undergraduate students were agreed to participate. A unique hypothetical clinical scenario was used as a trigger. The audio data were transcribed, interpreted, and categorized as a clinical reasoning pattern; and the concept maps created were assessed by a Structure of Learning Outcomes (SOLO) taxonomy as knowledge acquisition.

RESULTS

Observations on clinical reasoning patterns and the level of knowledge acquisition in five undergraduate dental students showed varying results. They applied clinical reasoning patterns according to their knowledge acquisition during didactical phase. Learners with inadequate knowledge relied on guessing, meanwhile learners with adequate knowledge applied more sophisticated reasoning pattern when solving problems.

CONCLUSIONS

Various problem-solving strategies were encountered in this study, which corresponded to the level of knowledge acquisition. Dental institutions must set minimum standards regarding the acquisition of conceptual knowledge accompanied by improvement of clinical reasoning skills, as well as refinement of knowledge and procedural skills.

Oral medicine services: a two-centre study of 99,603 patients between 2015 and 2020

Objective

This study aimed to investigate the patterns of patients managed at the oral medicine service centres at the Faculty of Dentistry, University of Otago, New Zealand and Weifang People’s Hospital, Weifang, China.

Materials and methods

Patients’ clinical records were collected from 2015 to 2020. Patient data from electronic and paper records were examined. The data included in this study for each patient were age, sex, ethnicity, source of referral, clinical investigation, diagnosis, and management.

Results

There were 99,603 patients included in the analysis. Most of the patients (56.5%–71.0%) were women aged 50 to 70 years. Referrals were typically from internal sources (20.0%–52.7%), medical practitioners (27.5%–29.6%), and dental practitioners (18.3%–28.3%). The main clinical investigations included blood tests (22.1%–25.4%), diagnostic imaging (12.2%–28.3%), and biopsy (9.4%–12.8%). Oral and maxillofacial pathology accounted for 73.9% to 83.3% of all diagnoses. The main treatment was self-care (15.2%–36.6%), and the most prescribed medication was a corticosteroid (26.4%–30.2%).

Conclusions

Most patients in oral medicine clinics were 50 to 70-year-old women. Blood tests, imaging, and biopsy were the main clinical investigations. Most of the diagnoses were oromucosal diseases. The main treatments were self-care and corticosteroid prescriptions.

Oral medicine (stomatology) in Brazil: the first 50 years and counting

This review outlines the historical perspective, status, and future challenges of oral medicine (stomatology) in Brazil based on the records of the Brazilian Society of Stomatology and Oral Pathology (SOBEP) and the Brazilian Federal Dental Council as well as expert evidence input from academic leaders from 3 different generations of Brazilian oral medicine specialists. The beginning of oral medicine in Brazil dates to 1969, followed by the organization of SOBEP in 1974; however, official recognition as an independent specialty was achieved more recently within the Brazilian Federal Dental Council in 1992. After a 50-year maturation period of oral medicine in Brazil in terms of specialty crystallization across dentistry, medicine, and research, it is now time to follow the historical trends of the specialty internationally and establish a standard curriculum at a post-graduate level that will lead to uniformity of training for oral medicine in Brazil.

Referral Patterns in Oral Medicine: A Retrospective Analysis of an Oral Medicine University Center in Southern Italy

Referral of a patient from one healthcare provider to another is an important part of the medical practice. The aim of this study was to analyze the referral process to the Oral Medicine Unit in a university-based tertiary center in Southern Italy. A chart review of new referrals to the Oral Medicine Unit during a 24-month period was conducted. The following data were recorded: demographic characteristics, medical history, number of physicians seen prior to Oral Medicine assessment, referral source, diagnostic procedures ordered by referrals, reason for referral, site of lesion/condition, final diagnosis. Then, the rates of correct identification for health-care professionals and the appropriateness of the reference diagnosis based on the disease were calculated with descriptive statistic indicators. There were 583 new first consultations. A total of 62.9% of patients were referred by general dental practitioners, 27.4% by physicians, and 9.7% did not have a referral. The most common diseases for referral were immune-mediated diseases (39.6%) and oro-facial pain disorders (25.2%). Only 28.5% of patients had a correct provisional diagnosis. The results of this study show the need to implement curricula in the field of oral medicine among dentistry and medical students, and to support the continuing education among healthcare providers to reduce diagnostic delay for oral diseases.

Job Satisfaction and Perceived Importance of Oral Medicine Amongst Dentists

Background

Compounded by the needs of an aging society, interactions between oral condition and systemic diseases may require that dentists pursue additional training in oral medicine beyond that received in dental school. The purpose of this study was to investigate whether pursuing oral medicine professional education is recognised by dental practitioners as an important factor regarding job satisfaction.

Methods

A questionnaire was mailed to 1,379 dental practitioners in Japan, along with a follow-up survey to assess repeatability, in 2017. The questionnaire consisted of 19 items/questions related to the respondents’ attributes and job satisfaction (5 items), willingness to learn oral medicine (4 items), willingness to learn more about dentistry (4 items), and willingness to contribute to society (6 items). Representative questions were extracted via binomial logistic regression analysis. Multivariable logistic regression analysis was performed to assess the relationships between job satisfaction and the explanatory variables.

Results

Amongst 337 respondents, multivariable logistic regression analysis showed an association between strong job satisfaction (n = 126, 37%) and willingness to learn more about oral medicine and dentistry and contribute to society, with odds ratios (95% confidence interval) of 4.22 (1.84-9.68), 3.16 (1.16-8.62), and 7.32 (3.14-17.06) and κ values of 0.38, 0.58, and 0.51, respectively.

Conclusions

Our results from dental practitioners suggest additional benefits of oral medicine professional education for future job satisfaction.

Analysis of referrals to the stomatology service in a Southern Brazilian hospital: a retrospective study

This paper intends to describe the demand for referrals to the stomatology service requested by the medical teams for inpatients in a reference hospital in the south of Brazil. This research is a retrospective cross-sectional descriptive study focusing on data collection and assessment of information about referrals to the stomatology unit carried out from January 2008 to December 2018. All information was obtained from the hospital management software database, then transferred and analyzed individually for descriptive statistics. A total of 4433 cases were referred to the stomatology team, with an average of 403 cases by year. Hematology/hemato-oncology (37.3%) was the specialty asking for the majority of the referrals, followed by Oncology (20.4%) and Pneumology (8.2%). The mean patients' profile was males (55.5%), receiving a diagnosis of oral mucositis (43.5%), and with the first and second decades of life being the most prevalent ones (34.9%), with a mean age of 34.8±22.3 years. The most common treatment performed by the stomatology team was the photobiomodulation therapy (44.8%). This retrospective study demonstrated the important profile of the stomatological care in hospitalized patients from a specific hospital, especially referred by the hematology/hemato-oncology team. These results evidenced the importance of the stomatology specialty in the hospital environment.

Oral medicine practice in Europe and Australia: Identifying practitioner characteristics and their clinical activity

Oral Medicine is a young dental specialty born almost a century ago and deals with orofacial conditions not directly attributable to the most prevalent tooth pathologies such as dental caries or periodontal diseases. Presentations may reflect local disease or orofacial manifestations of more widespread pathology affecting other parts of the body. Due to its recency as a distinct discipline and to heterogeneous global settings, Oral Medicine has not yet achieved a shared scope and definition, as well as a recognized status across the globe. The current report presents survey data gathered from Oral Medicine practitioners in Europe and Australia and aimed to identify practitioner characteristics including demographics, training, clinical and research activity. As expected, Oral Medicine clinical practice commonly deals with conditions such as immune-mediated disorders, potentially malignant disorders, oral mucosal infections and chronic pain disorders, but geographical heterogeneities are observed. The present data, representative of current clinical practice, are valuable in order to understand the evolution of Oral Medicine as a distinct discipline and should be taken into consideration in order to create or update postgraduate training curricula able to meet the needs of future practitioners and the communities they serve.

Oral Mucosal Injury Caused by Targeted Cancer Therapies

Targeted cancer therapies have fundamentally transformed the treatment of many types of cancers over the past decade, including breast, colorectal, lung, and pancreatic cancers, as well as lymphoma, leukemia, and multiple myeloma. The unique mechanisms of action of these agents have resulted in many patients experiencing enhanced tumor response together with a reduced adverse event profile as well. Toxicities do continue to occur, however, and in selected cases can be clinically challenging to manage. Of particular importance in the context of this monograph is that the pathobiology for oral mucosal lesions caused by targeted cancer therapies has only been preliminarily investigated. There is distinct need for novel basic, translational, and clinical research strategies to enhance design of preventive and therapeutic approaches for patients at risk for development of these lesions. The research modeling can be conceptually enhanced by extrapolating "lessons learned" from selected oral mucosal conditions in patients without cancer as well. This approach may permit determination of the extent to which pathobiology and clinical management are either similar to or uniquely distinct from oral mucosal lesions caused by targeted cancer therapies. Modeling associated with oral mucosal disease in non-oncology patients is thus presented in this context as well. This article addresses this emerging paradigm, with emphasis on current mechanistic modeling and clinical treatment. This approach is in turn designed to foster delineation of new research strategies, with the goal of enhancing cancer patient treatment in the future.

Awareness of oral medicine among medical practitioners, evidence of the unbridged interdisciplinary gap

RATIONALE, AIMS, AND OBJECTIVES

Inadequate awareness of oral health and related disciplines appears to be common among medical practitioners. This study was designed to evaluate the awareness of oral medicine (OM) specialty and its scope of practice among Jordanian medical practitioners and to outline potential strategies for improvement where appropriate.

METHOD

A specially designed questionnaire was electronically distributed to Jordanian medical practitioners and thereafter via personal interviews to improve the response rate. The questionnaire comprised nine questions and covered demographical details and characteristics of participants, in addition to their awareness of OM and agreement to refer a group of common oral and dental conditions to OM specialists. Pearson Chi-square tests were used to examine the significance of association between the variables of respondents and awareness of OM. Significance level was set at P values < 0.05.

RESULTS

A total of 1492 respondents completed the questionnaire, of which 779 (52.2%) were aware of OM as an independent specialty. Age group, higher degrees in medicine, country of graduation, and the specialty type were significant determinants of OM awareness level. Oral ulceration and other mucosal pathology, including fungal infections, were the most likely conditions to be referred to OM specialists while participants had apparent problems separating the scope of practice of OM from other dental disciplines.

CONCLUSION

This study provides evidence on the profound interdisciplinary gap between medicine and dentistry and highlights the importance of more focused education and training in oral health-related disciplines to be provided to clinicians and medical trainees as described.