Oral Medicine

 

Oral medicine is the specialty of dentistry concerned with the oral health care of medically compromised patients and with the diagnosis and non-surgical management of medically-related disorders or conditions affecting the oral and maxillofacial region.

I have been active throughout my dental career in treating patients with medical problems that affect how they need to receive dental care, and patients with oral problems including mouth sores, ulceration, growths, tumors, and malignancies.

In 1981, I took and passed the rigorous examination of the American Board of Oral Medicine and received Diplomate status from that board.  According to the American Dental Association (ADA), Oral Medicine is not a dental specialty. In contrast, according to the American Board of Dental Specialties (ABDS), Oral Medicine is a recognized dental specialty, based on approval of the application submitted by the American Board of Oral Medicine in 2015. Many dentists do not have experience or training in the management of Oral Medicine problems. Every dental school and most military bases have oral medicine departments and specialists.

If you have a problem with your mouth or require special consideration in how you receive dental care, I am trained and will seek the best ways to get you that care.

Medical Conditions Which Require Special Considerations:

Artificial Heart Valve Recipients and Certain Congenital Heart Disease Patients — These patients may need to take antibiotics before dental procedures known to create bacteremia. Bacteria that may be forced into the gums during such dental procedures can (but usually don’t) seed out onto the altered valve. This condition is called Subacute Bacterial Endocarditis, or “SBE,” for short. If it is left undiagnosed and untreated, it can destroy the valve and require the need for open heart surgery to replace the valve. If detected in time, antibiotics can treat the condition. It is usually a simple matter to pretreat the patient with a high dose of antibiotics before the dental appointment. This preventive treatment with antibiotics before there is an infection called SBE Prophylaxis or SBE Precautions.

Mitral Valve Prolapse — Patient’s with a heart condition of Mitral Valve Prolapse no longer need appropriate antibiotics before certain types of dental care since the American Heart Association in conjunction with the AMA, the American Dental Association and numerous other groups determined in June 2007 that SBE precautions were no longer indicated.

Heart Murmurs — These are sounds of turbulent blood flow through heart valves and may be either innocent (no need to treat with precautions) or significant enough to need SBE Precautions. Your cardiologist can decide if SBE precautions are required, but in a vast majority of patients with murmurs, no SBE precautions are necessary.

Diabetes — Along with many other changes (such as circulation problems to toes, healing problems, and eyesight problems), patients with diabetes show increased periodontal bone destruction and early tooth loss. Those that take insulin are of particular concern as they need special considerations for dental treatment, depending on their level of diabetic control and the amount and type of dental care that’s planned.

Cancer Patients — Those patients with recent treatment for cancer with chemotherapy require evaluation of their blood profiles to be sure there are suffice factors for proper clotting and healing.

Patients who have received radiation therapy to the head and neck have a whole other group of considerations. They often have xerostomia (dry mouth), which can increase decay markedly and make eating, talking, and speaking difficult. Artificial saliva can be prescribed that help many patients with xerostomia. Also, very high dose fluoride gels are applied in custom mouthguard applicators that are made in our dental lab for xerostomia patients to remineralize the teeth and prevent the devastating root decay that often develops.

Patients who require Bone Marrow Transplantation are another group with special dental needs.

In the 11 years of my being at Memorial Sloan-Kettering, I saw hundreds of patients with each of these cancer-related problems and am trained to render the special care they need.

Head and Neck Cancer Patients — Patients who have part of their jaws or oral structures removed for cancer require special techniques for the reconstruction of the mouth and teeth. I am trained extensively in this special branch of oral rehabilitation, known as Maxillofacial Prosthetics.

Patients who have or are receiving Osteoporosis (Bisphosphonate) Medications -- These patients are at-risk for non-healing jaw infections that sometimes lead to loss of the jaw bone, because these drugs alter how bone is remodeled and how it may fail-to-heal after a tooth is removed or after other oral surgery.