Even though there is a general, world-wide consensus defining Oral Medicine (OM) as the branch of dentistry related to the “oral health care of patients suffering from chronic recurrent and medically related disorders of the mouth and with their diagnosis and non surgical management” (Baum&Scully, 2015), severe discrepancies in OM curricula, among member countries, are glaring.
During 2015, Professor Alexandra Sklavounou, President of the European Association of Oral Medicine (EAOM), proposed and coordinated a working group consisting of six EAOM Board Regional Representatives, in order to describe accurately the similarities and differences among the educational and training programmes in countries represented within the Association.
The following six EAOM Board Regional Representatives, Roddy McMillan, Stina Syrjanen, Arjan Vissink, Cristina Bez, Noam Yarom, and Douglas E. Peterson, were enrolled in 2015. These members were asked to collate information from each country included in their region and to present it in a tabulated format. The information was classified according to the questionnaire reported in Table 1. Each member was able to choose the method by which they obtained information within their region. In some countries, such as the United Kingdom, India or the United States, all the information had already been officially published by a regulatory authority (e.g. the General Dental Council in United Kingdom) whereas, in other countries, the source was represented either by personal contacts with colleagues involved in teaching OM in Universities or by members of national OM Associations (when available).
It was possible to retrieve information from 34 countries out of 48: United Kingdom; Denmark; Estonia; Finland; Iceland; Norway; Sweden; Austria; Belgium; Czech Republic; Germany; Hungary; Luxembourg; Netherlands; Poland; Slovakia; Switzerland; Italy; Malta; Spain; Portugal; Albania; Bosnia and Herzegovina; Croatia; Greece; Israel; Romania; Slovenia; Turkey; Brazil; India; South Korea; Thailand; United States.
It was not possible to recover any information about the OM curricula from the following 14 countries: Republic of Ireland; Latvia; Lithuania; France; Bulgaria; Cyprus; Russia; Serbia; Ukraine; Indonesia; Japan; Australia; Saudi Arabia; New Zealand.
In 5 out of 34 countries, OM is an officially recognised specialism - in the United Kingdom, Estonia, Croatia (since 1997), Israel, and Brazil.
The duration of post-graduate programmes ranges from 2 years (at least 750 hours) in Brazil to 5 years in the United Kingdom. In Croatia, the specialism programme lasts 3 years and in Israel, 4 years.
In 3 out of 34 countries, OM is incorporated into other specialism programmes: Bosnia and Herzegovina (since 1992 integrated with Periodontology and Oral Medicine); Turkey (Oral Surgery and Oral Medicine); and India (Oral Medicine combined with Oral Radiology). It is of note that in Slovenia a 3-year combined specialism programme of Oral Diseases, Periodontology and Dental Diseases started in 1973 and ended in 2000. In this programme 1 year was exclusively dedicated to oral diseases.
In some countries, OM training is combined with Oral Surgery (Denmark, Germany, Netherlands, Norway, Malta, Turkey) or Oral and Maxillo-Facial Surgery (Belgium, Germany, Netherlands, Slovenia). In Portugal the specialism in Stomatology refers to Medical Doctors only, which allows them to practice OM exclusively in hospitals. Colleagues with a degree in Dentistry do not have the right to attend an OM specialisation programme and, therefore, they can not practice OM in hospitals.
Post-Graduate (PG) courses in OM operate in the following 20 countries: the United Kingdom; Czech Republic; Hungary; Netherlands; Poland; Slovakia; Italy; Malta; Spain; Portugal; Bosnia and Herzegovina; Croatia; Greece; Israel; Romania; Brazil; India; South Korea; Thailand; the United States.
Greece presents a well-structured PG course completely dedicated to OM. However, OM is still not officially recognised as a specialism there. The course lasts 3 years with 2.5 years fully dedicated to Oral Medicine and Pathology and the remaining time to Internal Medicine, Dermatology, Rheumatology, Eye Nose Throat (ENT) and General Pathology.
Even if dental treatment for medically complex patients is included within the scope of oral medicine practice in many areas of the world as reported by Stoopler and co-workers in 2011, in the United Kingdom the General Dental Council has defined a new specialism of Special Care Dentistry.
Within OM programmes there is a general consensus regarding main topics, which include the following: history taking; clinical examination; laboratory investigations; and clinical management of chronic, recurrent and medically related disorders of the oral and maxillo-facial region.
However, as underlined in the United Kingdom, United States and Brazil, a specialist in OM is also expected to function effectively and efficiently in multiple health care environments and within interdisciplinary health care teams. They should apply scientific principles to learning and to providing oral health care such as critical thinking, evidence or outcomes-based clinical decision-making and technology-based information retrieval system. Practitioners must utilise the values of professional ethics, lifelong learning, patient-centred care, adaptability and acceptance of cultural diversity in professional practice. They must understand the oral health needs of communities and engage community service. Therefore, management and health care delivery, time management, patient safety, team working and quality improvement should be part of the OM care provider curriculum.
While the present investigation attempts to analyse the structure of the educational and training programmes in oral medicine mainly in Europe, it also includes some global data. It is evident from the results reported that the scenario is far from uniform and this variability most likely reflects differences in history, culture and economic policies among countries.
As already highlighted by Stoopler and coworkers (2011), the diversity of oral medicine practice is not surprising in view of the heterogeneity of settings and systems of health care across the world. In certain countries such as the United Kingdom, United States and Brazil, OM curricula are more detailed and standardised compared to others.
This manuscript provides a starting point for a constructive discussion among members of the EAOM to work towards the harmonisation and uniformity of OM curricula and to, eventually, provide guidelines for an OM specialism recognition. It is important to agree on a minimum standard curriculum and define what an OM clinician or researcher should know. Without this, it will remain difficult to overcome local divergence and, thus, to participate in an international scientific Association.
1. Baum BJ, Scully C. Training specialists in oral medicine. Oral Dis. 2015 Sep; 21(6): 681-4. doi:10.1111/odi.12351.
2. Stoopler ET, Shirlaw P, Arvind M, Lo Russo L, Bez C et al. An international survey of oral medicine practice: proceedings from the 5th World WOrkshop in Oral Medicine. Oral Dis. 2011 Apr; 17 Suppl 1:99-104. doi: 10.1111/j.1601-0825.2011.01795.x.
Table 1 - Descriptors to summarise the Oral Medicine Curriculum in each country
|Is Oral Medicine a recognised specialism?|
|Are there Oral Medicine Post-Graduate courses?|
|How long do they last?|
|Which are the main topics covered in each course?|