08 • Careers
DENTISTR DENTISTR
WHERE MEETS
Looking for a broad and challenging specialty at the interface of dentistry and medicine? Oral medicine might be for you
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T’S surprising to consider just how much overall health is refl ected in oral health. It has been estimated that 90 per cent of systemic diseases have oral manifestations – be it mouth ulcers in Crohn’s disease, angular cheilitis in iron defi ciency or xerostomia in diabetes. Conversely, signifi cant orofacial pain or disease has a profound eff ect on the wellbeing of any patient. Oral medicine sits at the interface between
dentistry and medicine and can be defi ned as a dental specialty “concerned with the oral healthcare of patients with chronic, recurrent and medically-related disorders of the oral and maxillofacial region, and with their diagnosis and non-surgical management.” Specialists practising oral medicine in the UK must qualify for inclusion on the Oral Medicine Specialist List maintained by the General Dental Council. To achieve a CCST (Certifi cate of Completion of Specialist Training) in Oral Medicine from the GDC requires a training programme normally of fi ve years duration. This may be reduced for those who apply to the programme with additional qualifi cations such as a medical degree.
The job Oral medicine is an out-patient specialty for the most part, with clinics involving referrals from primary dental and medical care. However, increasingly specialists are receiving referrals from other medical specialties in secondary care, including rheumatology, gastroenterology, dermatology, GU medicine, neurology and even psychiatry. An oral medicine specialist is therefore expected to be conversant with colleagues across these
specialties in the management and onward referral of patients. Oral medicine specialists are often involved
in teaching, as the subject is a core component of the undergraduate dental student curriculum in the UK. They also have an important role in delivering postgraduate education for professional examinations and CPD for practising dentists. Specialists in oral medicine are often in demand from postgraduate deaneries to deliver courses on facial pain, soft tissue disease and the management of medically compromised patients in general dental practice. Oral medicine is one of the smallest dental specialties with 16 units across the UK, mainly based within dental teaching hospitals, and around 40 practising consultants. The consensus from the British Society for Oral Medicine is there should be one consultant in place for every one million of the population and the Society is actively working towards securing new posts and increasing trainee numbers.
Entry and training Posts in oral medicine specialty training programmes in the UK can be few and far between and competition is keen. The basic entry requirement is two years of postgraduate foundation training in dentistry, including experience in primary and secondary care settings. A diploma of membership (MFDS) in a dental faculty of a Royal College is not essential but strongly recommended. Previously a second degree in medicine was required and trainees may still choose to pursue this route before entering specialty training.
MEDICIN MEDICIN
Training involves signifi cant time spent in
oral medicine outpatient clinics, seeing new and review patients under the supervision of a consultant. Trainees are encouraged to see hospital in-patient referrals on the wards and there is a notable overlap with the work of colleagues in special care dentistry in managing the most medically-complex patients. Experience of a hospital environment through oral and maxillofacial house jobs, while not essential, gives invaluable insight into the workings of a hospital and can be very useful to dentists aspiring to a training place in oral medicine. Trainees are required to attend additional specialised out-patient clinics, such as dermatology, gastroenterology and rheumatology, and are encouraged to visit other oral medicine units. Another mandatory component of the curriculum is profi ciency in soft tissue biopsies through a dedicated biopsy list.
A new development in specialty training for
oral medicine has been the national Specialty Training Forum organised by the BSOM. The forum brings together trainers and trainees to gain experience with Work-Based Assessment tools in a safe supportive environment and aids preparation for both ARCP and ISFE (see later). As with other specialties there are many opportunities to attend training events and meetings across a number of medical and dental specialties. Trainees should be active in presenting at interdepartmental and regional clinico-pathological case conferences to develop their skills in interpretation and conversing with colleagues in oral pathology. Trainee specialists will be expected to
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