Oral Medicine Residency

Dentistry originated as a subspecialty of medicine, but it evolved into a separate healthcare profession in the middle of the 19th century. The subsequent isolation from the profession of medicine has resulted in voids in the training of both physicians and dentists, with an impact on healthcare delivery in this country as well. The faculty of the Department of Oral Medicine feels that the discipline of oral medicine as we define it - to include its role in dental education, practice and research-is the primary interface of medicine and dentistry. As such it is as challenging as any area of dental practice, and that it requires formal and extensive training in the hospital setting.

The general population in the United States includes an increasing number of people with medical conditions that require special consideration by the dental practitioner. Among these are patients receiving cancer chemotherapy and /or radiotherapy, heart valves or organ transplants and those taking a variety of medications. Our new, hospital-based oral medicine residency stresses the interrelationship between oral disease and systemic health, the recognition and management of oral conditions and disease, and the dental management of medically compromised people. Our goal is to develop the resident's clinical competence, such that participants can manage patients with systemic implications for dental treatment, to include those who must be managed in nontraditional dental healthcare settings (e.g., operating room, bedside).

The Field Of Oral Medicine

Oral medicine is defined by the American Academy of Oral Medicine as
"The specialty of dentistry concerned with the oral health of medically compromised patients and with the diagnosis and nonsurgical management of medically-related disorders or conditions affecting the oral and maxillofacial region."

This definition implies that oral medicine has two distinct activities in the US:

1. The dental management of medically compromised patients and
2. The diagnosis and management of a wide variety of nonsurgical conditions of the intraoral hard and soft tissues, to include facial pain, salivary gland disorders, vesiculobullous diseases, and other oral soft tissue lesions that may be either primary in origin or oral manifestations of systemic disease. Although both of these activities are described in the formal AAOM definition, we feel that the training necessary to approach a level of competence in both areas requires hospital-based training.

Program Overview

Carolinas Medical Center (CMC) is the flagship hospital of the largest healthcare system in the Carolinas, and one of the largest public systems in the nation that includes the facilities, patient population, faculty, and the other essentials to support our clinical, educational, and research activities, and to provide a unique and innovative training program in oral medicine. The oral medicine residency program includes 2 additional years of training after a one year GPR. Residents must complete at least one year of our general practice residency (GPR) program, another North American GPR, or the equivalent, during which they continue to develop a didactic background and the clinical skills in a wide spectrum of relevant activities. This approach ensures that recent dental graduates not loose their newly acquired clinical skills without additional months of general dental training.

Research Program

Clinical research is an integral part of the mission of our department, and a critical element in the training of clinicians who must keep up with and interpret the important literature in their field. Our department has active clinical and basic science research focusing on problems in the field of oral medicine. Some of our faculty members have a heavy commitment to research and they are involved in several important studies at any given time. In addition to the many publications, textbook chapters, and research grants produced by the department, this commitment also provides for solid clinical research training for oral medicine residents.

Early on in their training, oral medicine residents will identify one or more areas of clinical research to pursue on a longitudinal basis with faculty supervision. Training includes exposure to grant, abstract, and manuscript writing, as well as the development and implementation of clinical and/or basic science research studies.

Examples of current research initiatives:

* Examine the overall health effects of bacteremia (bacteria in the blood stream) from dental disease. Our department will soon complete a three year, 1.7 million dollar grant from the National Institutes of Health to study the issue of bacteremia and the relationship to heart valve infections.
* Establish the mechanism for the development of hospital-acquired pneumonia, which has a high incidence, morbidity and mortality rate, and results in major cost to the healthcare system.
* Develop new treatments for patients with oral complications of Sjögren's syndrome, an autoimmune disease that affects as many a 4 million Americans.
* Evaluate the pathophysiology and treatment of cancer treatment related alimentary mucositis.
* Examine the role of liver disease and medications in bleeding complications from invasive dental procedures.

To see the curriculums:
CURRICULUM YEAR 1
CURRICULUM YEAR 2

This article is reposted with thanks to Carolinas Medical Center.