COMMENTARY

Oral Medicine in the 21st Century

Eric T. Stoopler, DMD

Disclosures

June 11, 2015

The Practice of Oral Medicine in the United States in the Twenty-First Century: An Update

Pinto A, Khalaf M, Miller CS
Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:408-415

Study Summary

The discipline of oral medicine is critical to dental education and the clinical practice of dentistry.[1,2] A cornerstone of modern healthcare is the connection between oral and systemic health, which is a fundamental principle of oral medicine.[3] Studies have observed that both general and specialist dentists readily refer patients to oral medicine practitioners (OMPs) for evaluation and management of oral mucosal diseases and facial pain disorders.[4,5,6] Many patients with these conditions will consult several healthcare providers and receive various treatments for their complaints without benefit before they are managed effectively by OMPs.[7] The study conducted by Pinto and colleagues attempted to identify clinical services provided by OMPs and to characterize the current practice of oral medicine in the United States.

Members of the American Academy of Oral Medicine (AAOM) served as the cohort in this prospective study, and information was obtained over a period of 15 months. The investigators distributed the study protocol electronically to active members of the AAOM. Participants were asked to document specific patient data for patients seen during a 5-day clinical practice week. The recorded patient data included:

  • Demographic characteristics;

  • Visit diagnosis (International Classification of Diseases, ninth revision [ICD-9]);

  • Presenting symptoms or reason for consultation;

  • Anatomic location;

  • Procedures (current procedural terminology [CPT]);

  • Referral source;

  • Number of practitioners seen before consultation;

  • Duration of the chief complaint; and

  • Medical comorbid conditions.

Information from 916 patients was provided by 74 practitioners from 20 states, for a return rate of 15%. The results of the study were:

  • Female patients presented to OMPs more frequently than male patients (2:1), with a mean patient age of 57 years.

  • Most patients were white (74%), followed by black (12.8%) and Hispanic (8.8%).

  • The most common oral medicine diagnoses were oral lichen planus (ICD code 697.0) followed by disturbance of salivary secretions (ICD codes 527.7, 527.2, 527.6, and 527.9).

  • The most common presenting symptoms or reasons for consultation were oral lesions (mass, either red or white), followed by orofacial pain, dry mouth, burning mouth, and oral ulcers or sores.

  • The most common anatomic locations affected were the tongue and gingiva.

  • The most common procedures were biopsy of oral soft tissue, mucous membrane, lips, and incisional biopsy (CPT codes 40808, 11100, 40490, and 42405).

  • The referral source pattern was most frequently a general dentist, followed by physician specialists, dental specialists, and primary care physicians.

  • Patients had seen an average of 2.2 practitioners before consulting the current OMP.

  • Patients experienced symptoms related to their oral medicine condition for a mean of 16.8 months.

  • The most common medical comorbidities were: cardiovascular disease, followed by endocrine disease, rheumatologic disease, digestive disease, and, finally, psychiatric disease.

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