Oral medicine, explained

What an oral medicine specialist does

An oral medicine specialist is a dentist who has completed postgraduate specialist training in the diagnosis and non-surgical management of diseases of the mouth and adjacent structures. The scope, as defined internationally, covers:¹

• Mucosal diseases — conditions of the lining of the mouth, including lichen planus, leukoplakia (white patches), erythroplakia (red patches), aphthous ulceration, autoimmune blistering diseases, and potentially malignant disorders.
• Oral cancer detection and surveillance — clinical screening for oral squamous cell carcinoma and the management of patients with potentially malignant disorders.
• Salivary gland disorders — dry mouth (xerostomia), salivary gland enlargement, and infections of the salivary glands.
• Oro-facial pain that does not originate from a tooth — temporomandibular disorders, atypical facial pain, burning mouth syndrome, trigeminal neuralgia (in collaboration with neurology).
• Oral manifestations of systemic disease — many systemic conditions (autoimmune disease, blood disorders, HIV, diabetes) present with oral signs that are sometimes the first thing a patient notices.
• Medication-related oral side effects — mucosal reactions, salivary changes, gingival overgrowth, medication-related osteonecrosis of the jaw.

Oral medicine sits between dentistry and medicine. Many patients have been to a GP and a dentist before they reach an oral medicine specialist; the specialist is often the practitioner who connects the dots.

When to see one

Symptoms or findings that warrant an oral medicine consultation include:

• A mouth ulcer that has not healed after two weeks.
• A white, red, or mixed-colour patch in the mouth that does not rub off.
• A persistent burning of the tongue or mouth.
• A dry mouth that is interfering with eating, sleeping, or wearing dentures.
• A lump or swelling in the mouth, on the lips, or in the salivary glands that has been present for more than two weeks.
• A diagnosis of lichen planus, leukoplakia, or another mucosal condition by your dentist or doctor that needs specialist confirmation and ongoing care.
• Pain in the face or jaw that does not originate from a tooth and has not responded to general-dental or medical management.

A referral from your dentist or doctor is helpful but not required (see Do I need a referral?).

Why oral medicine is under-recognised

Oral medicine is one of the smaller dental specialties globally; in South Africa, the number of specialists is modest. Several consequences:

1. Patients don't know it exists. A patient with a mouth ulcer that won't heal may see a GP, then a dentist, then perhaps an ENT specialist, before someone suggests an oral medicine specialist.
2. Some general dentists are unfamiliar with the scope. A general dentist trained primarily in restorative care may not feel confident managing a complex mucosal condition and may not know who to refer to.
3. Some symptoms are dismissed. "It's just a small ulcer", "burning mouth is probably anxiety" — these are statements patients sometimes hear. Some are accurate; many are not.

If a symptom in your mouth has been brushed off elsewhere and is bothering you, that is a reasonable reason to seek a specialist opinion directly.

What an oral medicine consultation involves

The structure of the visit is similar to a periodontal consultation, with the focus shifted to the mucosa and soft tissues:

1. Detailed history: when did the problem start, how has it changed, what makes it better or worse, what medications are involved, what other medical conditions, what lifestyle factors (smoking, alcohol, betel nut, recreational drug use, sexual history if relevant for HPV-associated lesions).
2. Systematic examination: lips, labial mucosa, buccal mucosa, tongue (dorsum, ventral surface, lateral borders), floor of mouth, palate, oropharynx. Palpation of lymph nodes in the head and neck.
3. Photographs of any clinically significant lesion, recorded for comparison at follow-up.
4. Adjunctive investigations where indicated: salivary flow testing, swabs, blood tests (sometimes requested via the patient's GP), referral for imaging.
5. Biopsy where the lesion warrants histopathological diagnosis. Many oral medicine conditions are diagnosed clinically; some require tissue diagnosis.
6. Discussion of findings and plan.

A written report is sent to you and to the referring practitioner (dentist or GP) typically within a few working days.

A word on oral cancer

Cancer of the lip and oral cavity (predominantly oral squamous cell carcinoma) accounted for an estimated 377,713 new cases worldwide in 2020 (GLOBOCAN), with the burden concentrated in tobacco- and alcohol-using populations.² In South Africa it is a recognised health burden, with risk concentrated in tobacco (smoked and smokeless) and alcohol users.

Many oral cancers arise from potentially malignant disorders — visible lesions that carry a heightened risk of transformation. Leukoplakia (white patches), erythroplakia (red patches), oral submucous fibrosis, lichen planus, and others are recognised in this category by the WHO Collaborating Centre for Oral Cancer (consensus, 2021).^{5 4} Early detection of these lesions, and ongoing surveillance, is one of the highest-impact things oral medicine does.

If you have any persistent lesion in the mouth — white, red, ulcerated, raised, or simply different from the surrounding tissue — and it has been present for more than two weeks, please book a consultation. The vast majority of such lesions are benign. Of the ones that are not, early detection materially changes outcomes: oral-cavity cancer found at a localised stage has a 5-year relative survival of about 89%, falling to about 38% once it has spread to distant sites (NCI SEER).³

This pillar links to seven L3 pages covering specific oral medicine conditions and questions: what oral medicine is, oral medicine vs oral surgery, white patch in the mouth, burning mouth syndrome, lichen planus, a mouth ulcer that won't heal, and oral cancer screening.

This pillar is general educational content. The specific cause of any symptom in your mouth can only be established by a clinical examination by a registered specialist.