Oral Medicine: Diagnosis and Treatment

By Chitra Priya Emperumal, BDS, MS

Oral medicine deals with clinical diagnosis and management of disorders and diseases affecting the orofacial region.

The Minnesota Head & Neck Pain Clinic offers this service at multiple Twin Cities locations; your specialist can help in pain management and oral lesions.

What is the Oral Medicine Specialty?

Oral medicine is the sphere of healthcare that diagnoses and manages patients with disorders of the orofacial region. It provides comprehensive treatment for all types of mouth, teeth, jaw, and face conditions. It became the 11th American Dental Association (ADA) recognized dental specialty in March 2020.

Oral medicine, according to the American Academy of Oral Medicine (AAOM), is a dental specialty focused on the oral health care of medically complex patients, diagnosing and managing oral and maxillofacial conditions related to systemic diseases, primarily through non-surgical methods like biopsies, topical medications, and minor interventions. ^[1]

What Symptoms Indicate a Need to Visit an Oral Medicine Specialist?

The following symptoms commonly signal a need for oral medicine care:

• Oral mucosal abnormalities, such as lesions, growths, ulcers, infections, allergies, immune-mediated and autoimmune disorders, and cancers.
• Facial pain due to musculoskeletal or neurologic conditions.
• Unusual taste and smell.
• Chronic orofacial pain, defined as pain in and around the face, mouth, and jaw that has lasted for more than three months.
• Musculoskeletal pains associated with the muscles of mastication, temporomandibular joints, and supporting structures.
• Neuropathic pain that may signal conditions like trigeminal neuralgia (TN).

If you experience any of these symptoms, it is crucial to consult an oral medicine doctor for diagnosis and management. They can help determine the underlying cause of your symptoms and recommend appropriate treatment options. ^[2]

What Does an Oral Medicine Doctor Typically Do?

An oral medicine doctor is extensively trained to diagnose and manage mouth, jaw, and face disorders. In simplistic terms, you can think of them as a “physician of the mouth” and orofacial region or ‘oral dermatologist’.

An oral medicine doctor has specialized training in:

1. Management of Osteonecrosis of the Jaw (ONJ)
2. Oral mucosal abnormalities.
3. Salivary gland disorders.
4. Temporomandibular disorders (TMJ/TMD).
5. Oral complications from cancer treatments.
6. Orofacial pain conditions..
7. Orofacial pain conditions.
8. Oral manifestations of systemic diseases.
9. Burning Mouth Syndrome in the absence of obvious findings in the mouth and in the absence of abnormal blood tests. ^[2]

Pain clinics offering oral medicine services may offer a range of treatments. At Minnesota Head & Neck Pain Clinic, every patient is carefully evaluated; you’ll gain your customized treatment plan based on a comprehensive assessment. Our goal is to offer you pain relief.

What are Key Aspects of a First Oral Medicine Appointment?

During an initial visit to an oral medicine expert, expect the following:

• A detailed medical history to understand your overall health and the pain you’re experiencing.
• A comprehensive examination of your mouth, face, and jaw. The examination will likely include checking your teeth, gums, tongue, cheeks, and jaw joints.
• The doctor may order and interpret tests, such as imaging studies (x-rays, CT scans, MRIs), blood tests, and microbiological investigations.
• Based on findings, she/he will discuss potential diagnoses and treatment options with you.

What Percentage of Adults in Minnesota Need Oral Medicine?

There is a dearth of specialists in Oral Medicine, who is board-certified and board eligible with residency training in MN. MHNPC has a board-eligible oral medicine specialist, who can cater to the patients in complex needs.

In 2020, the University of Minnesota School had “more than 2,000 new patients turned to the School of Dentistry’s TMD, Orofacial Pain, and Dental Sleep Medicine Clinic for answers to undiagnosed conditions and relief from life altering pain.” This suggests a significant number of people experience facial pain, prompting them to seek specialized care. Dr. Eric Schiffman’s research improved understanding of pain-related dental treatment outcomes and the risk factors for developing severe postoperative pain. Patient long-term outcomes (e.g. why pain persists, how it affects chronic pain experiences, and on-going needs for oral medicine were part of Untangling the Mysteries of Facial Pain March 5, 2020 report.

Regarding oral cancer, one source highlights the expanded access to the Straticyte™ test, a predictive diagnostic tool for assessing oral cancer risk. This development signals a growing need for early detection and risk assessment for oral cancer. ^[3]

While specific statistical data on these conditions might be limited within the provided sources, the emphasis on specialized clinics, diagnostic tools, and the high patient volume at pain clinics suggests that facial pain and oral cancer are significant concerns. You may wish to consult medical journals or public health databases for more comprehensive statistics on these conditions.

What Diagnostic Tests Might an Oral Medicine Doctor Perform?

An oral medicine doctor is the right person to perform various procedures to diagnose and treat conditions of the mouth and face.

Typical diagnostic tests may include:

• Biopsies: This involves surgically removing a small sample of tissue or bone for analysis under a microscope. Biopsies are often necessary to diagnose oral mucosal abnormalities, such as growths, ulcers, or suspicious lesions.
• Ordering and Interpretation of Tests: Oral medicine doctors can order and interpret a range of tests, including:
  • Imaging studies (x-rays, CT scans, MRIs) to assess the structure of bones and soft tissues in the mouth and face.
  • Blood tests to detect underlying medical conditions or to monitor the effectiveness of medications.
  • Salivary tests to analyze the quantity and flow of saliva and identify potential problems with salivary gland function.
• Medical Management: Oral medicine doctors use a variety of topical and systemic medications to treat a wide range of conditions. This may include:
  • Prescription medications for symptomatic management including topical medications, such as creams, gels, and rinses, to treat oral lesions and infections.
  • Intralesional steroid injections for painful ulcers/non responsive to topicals or conventional treatment

How do Oral Medicine Doctors Merge Dental Care with General Health Needs?

An oral medicine doctor merges dental care with facial medical care needs by bridging the gap between dentistry and medicine. They have the expertise to diagnose and manage a wide range of conditions that affect the mouth and face, extending beyond traditional dental care.

How patients benefit from integrating pain management in clinical practice:

• Recognizing Oral Manifestations of Systemic Diseases: Oral medicine doctors are trained to identify oral signs that may indicate underlying medical conditions like autoimmune disorders, infections, or even cancer. This helps in early detection and prompt referral to other medical specialists if needed.
• Managing Complex Medical Needs in Dental Patients: Your oral medicine care giver provides specialized care to dental patients with complex medical conditions. They can also advise other dentists on the best ways to treat these patients safely and effectively. Their understanding of both dental and medical aspects ensures safe and effective integrated care. The introduction is often made through a referral from your dentist or primary physician.
• Collaborative Approach: Oral medicine doctors frequently work in partnership with other healthcare professionals, such as dentists, primary care physicians, ENTs, oncologists, and dermatologists. Our collaborative, evidence-based approach to pain treatment ensures that you receive comprehensive care tailored to your individual needs.

Essentially, oral medicine doctors blend their dental expertise with a deep understanding of medicine, allowing them to provide comprehensive care for patients with complex oral and facial health needs. They are particularly valuable for individuals experiencing chronic oral diseases, as they can address the interconnectedness of oral health with overall well-being.

Oral Disease Prevention is Your Best Defense

Gain professional help to establish good oral health preventative routines.

Oral diseases are both common and can be expensive to treat. Early diagnosis and care can prevent higher levels of oral disease. Treatment costs worldwide (public and private) are estimated at US $356.80 billion each year. The potential cost of oral medicine treatment varies depending on the specific medication, the severity of the condition being treated, location, and how quickly conditions are diagnosed and treated. ^[4]

Dr. Chitra Priya Emperumal has extensive training and experience treating conditions needing specialized oral care and surgery. By receiving a more comprehensive assessment and treatment plan, the Minnesota Head & Neck Pain Clinic addresses potential underlying causes of oral conditions.

Call 651-32-7474 to Schedule Your Oral Medicine Appointment

About the author

Chitra Priya Emperumal, BDS, MS is the only dual dental specialist in Minnesota in Orofacial Pain and Oral Medicine. She has gained board certification from the American Board of Orofacial Pain, attained Diplomate status, and is a board-eligible Oral Medicine specialist.

Resources:

[1] American Academy of Oral Medicine, “Oral Medicine Patient Resources,” https://www.aaom.com/patients

[2] Dr. Kentaro Ikeda, et al, “Oral Medicine Condition Information,” https://www.aaom.com/oral-medicine-condition-information

[3] Proteocyte Diagnostics Inc., “United Healthcare Expands Access to Straticyte™ Test for Oral Cancer Risk Assessment,” Oct 2024, https://proteocyte.com/united-healthcare-now-reimbursing-straticyte-test/

[4] Rebecca Harris, “The Cost of Oral Disease Prevention Versus Treatment,” June 2024, https://www.nature.com/articles/s41415-024-7556-8