- INFORMATION GATHERING
- Medical History
- Patient Examination
- Consultations
- ESTABLISHING A DIFFERENTIAL AND FINAL DIAGNOSIS
- FORMULATING A PLAN OF ACTION
- Medical Risk Assessment
- Modification of Dental Care for Medically Complex Patients
- Monitoring and Evaluating Underlying Medical Conditions
- CLINICAL OUTCOMES AND ORAL DISEASE SEVERITY SCORING
- Oral Disease Severity Scoring
- PatientâReported Outcome Measures and Oral Mucosal Disease
- THE DENTAL AND MEDICAL RECORD
- ProblemâOriented Record
- SOAP Note
- Confidentiality
- Informed Consent
- TELEHEALTH/TELEDENTISTRY
Oral medicine, as defined by the American Academy of Oral Medicine, is âthe specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of medically related disorders or conditions affecting the oral and maxillofacial region.â Definitions vary in different parts of the world, but most include the diagnosis and nonsurgical management of oral mucosal and salivary gland disease, orofacial pain, and dental treatment of patients with medical disorders.
The overall goal for all oral healthcare professionals is to deliver and maintain optimal health for their patients. A recent definition was approved by the World Dental Parliament in 2016, which expanded the definition to include three different domains: disease and condition status, psychosocial status, and physiologic function.1 The inclusion of a psychosocial status and physiologic function deviates from traditional definitions that mainly focused on the presence or absence of disease, and, further, it promotes the inclusion of patient values and preferences, as well as elevates the importance of subjective findings. This approach is more aligned with a personâcentered care approach that emphasizes a patientâs problem in the context of behavioral, socioeconomic, and environmental aspects, and their impact on the patient and on the care that needs to be delivered.2â4 This definition has also been the underlying framework to establish outcomes that can be used to measure the oral status of an individual.5
Given the nature, complexity, and potential systemic implications for some oral conditions, coupled with an aging population with multimorbidities (multimorbidities do not identify an index disease, while comorbidities focus on an index disease and other diseases) and individuals taking numerous medications, all oral healthcare clinicians are required to enhance their knowledge of many aspects of medicine. Therefore, what previously was considered the purview of oral healthcare professionals with hospitalâbased training has become increasingly more important in general and specialty dental practice.
Advances in clinical practice are influencing many aspects of patient care, from our initial contact with a patient, through medical historyâtaking, diagnosis, and treatment options. For example, electronic health records (EHRs) allow for sharing health information among multiple clinicians caring for the same patient and can provide pointâofâcare algorithms for eliciting and using health information. Modern imaging techniques, such as computerized tomography scans (CTs) and magnetic resonance imaging (MRI), provide more detailed information and are a means to acquire more sophisticated data, but require enhanced training for accurate interpretation. Nevertheless, one of the most important skills for accurate diagnosis and management remains an experienced clinician with highly developed skills of listening and examination.
The initial encounter with a patient may influence all subsequent care. The skilled, experienced practitioner has learned to elicit the subjective (i.e., historyâtaking) and objective (e.g., clinical, laboratory) findings and other necessary information required for an accurate diagnosis. This process is an art, as well as a skill. Although mastering a patient evaluation can be assisted by specific clinical protocols, the experienced practitioner will add their own skills and experience to the diagnostic methodology.
A variety of accessible sources of healthcare information are now readily available to patients, and many will use this information to selfâdiagnose, as well as demand specific treatments. As a personâcentered approach is encouraged, where a patientâs preferences and values will influence care, the practitioner must listen to the patient to understand their needs, fears, and wishes and address them to arrive at an appropriate treatment plan that results in informed, scientific, and evidenceâbased choices. Furthermore, part of a shared decisionâmaking approach includes the responsibility of the oral healthcare professional to educate their patient about the implications and consequences of a diagnosis and subsequent treatment. Creating an environment for effective communication between provider and patient has been shown to improve health outcomes.6
The process of obtaining, evaluating, and assessing a patientâs oral and overall health status can arbitrarily be divided into seven major, sometimes overlapping, parts:
- History and examination.
- Establishing a differential diagnosis.
- Obtaining necessary consultations, as well as appropriate laboratory tests, such as specific blood investigations, a biopsy, and imaging studies, all based upon the initial differential diagnosis.
- Final diagnosis.
- Formulating a plan of action.
- Initiating treatment.
- Followâup assessment of response to treatment.
