Talk:Oral medicine

Sources

This needs work so moving here. (Doc James)

Comments: This article discussed oral medicine as a specialty. I feel much of the added content would be more at home on the page oral and maxillofacial pathology. Complaint of halitosis would more be managed by a general dentist. Subjective halitosis (where there is no genuine breath malodor) might be more managed in oral medicine setting. Lumps and swelling in the neck is more on the surgical side, i.e. oral surgery / oral and maxillofacial surgery. Same with odontogenic tumors. Oral medicine is a non surgical specialty. The section under "Scope" is far more representative of this area than the new content added imo. Matthew Ferguson (talk) 21:06, 11 February 2019 (UTC)

Dry mouth and disorders of Salivation.

Saliva plays an integral role in our mouths. Roles such as chewing/lubricating food, taste, speaking, allowing the food bolus to be swallowed easily, and wash away debris and bacteria. It has a number of particular properties that allow it to carry out its role. When there is a decrease in the flow rate of saliva, the aforementioned functions are compromised.

The production of saliva from the major and minor salivary glands is mainly under neural control (autonomic nervous system). The most common complaint a patient would present with is dry mouth/xerostomia. This is not a diagnosis as such, rather a subjective feeling, which can develop caries or other infections such as candidiasis and acute bacterial sialadenitis. There are many causes attributed to this, such as anxiety, medication, asthma, mouth breathing. The diagnosis of dry mouth related disorder is usually made clinically. Saliva flow rates (sialometry) are carried out to measure the amount of saliva secreted by the patient at rest over a certain period of time (usually 15minutes) and compared to average data. Other diagnostic aids include blood tests, labial gland biopsies (in suspicion of Sjogrens Disease) and imagine techniques

The management of salivation disorders is such that the first line is to identify and control/remove any underlying factors. Then supplementary aids such as sprays, lozenges or gels can be prescribed to further stimulate salivary flow rate.

Halitosis

Halitosis, or often known as bad breath/malodour is a state in which the individual feels there is abnormal smell coming from their mouths. The causes are usually psychological but can have some physiological basis. Patients may also complain of bad taste.

Apart from the usual and common morning bad breath, a consequence of reduced saliva flow overnight/or mouth breathing is normally associated with malodour. Another more common cause of bad breath is after eating certain types of foods. Garlic, onions, cabbage, radish, durians are commonly associated with halitosis, Socially, smoking and alcohol intake also cause halitosis.

Physiologically poor oral hygiene can result in halitosis, with gram negative anaerobes being the main culprit. They break down the denuded proteins which then release chemicals such as volatile sulphur compounds, mainly methyl mercaptan, hydrogen sulphide and dimethyl sulphide.

Defined infective processes that can cause halitosis may include periodontal infections, pericoronitis, various oral infections, dry sockets post extractions and ulcers. Occasionally, in the absence of a known cause, the complaint of malodour can be associated with psychogenic reasons.

The diagnosis of halitosis is usually clinical, and via the organoleptic method, which involves the patient exhaling once with their mouth and once with their nose. The dentist then smells this exhaled air and judges if there is a difference in the two exhales. Sometimes a device that measures the VSCs can also be used to note its prevalence in the patients halitosis. The management of halitosis is mainly concentrated in removing any known underlying factor. Whether from the social or dental history. Further than this, a specialist referral to the oral medicine department may be warranted.

Lumps and swellings of the Neck

This primarily refers to the lymphatic system of our bodies. The lymphatic system is the essential basis of immune defences and is thus responsible for filtering tissue fluid which drains into it. A lymphnode’s structure consists of a cortex, paracortex and medulla. It is enclosed by a capsule. Lymphocytes and antigens (if present) pass into the node through the afferent lymphatics, are filtered and pass out from the medulla through the efferent lymphatics. Lymphnode enlargement due to oral infections or local infections in the neck is most common with lesions involving the lymphnodes. A thorough lymphnode examination is important to be carried out by the dentist or medical professional.

Lumps and swellings of the neck fall under 3 broad categories, which are inflammatory, malignant and other (due to drugs example phenytoin). Inflammatory swellings are further divided into infective, possibly infective and non infective. Which all embody either viral or bacterial causative agents. Malignant swellings are categorized as primary (leukaemia’s, lymphoma) and secondary (metastases). For efficient management of a patient who presents with such lumps, a specialist opinion and referral is best advised.

Odontogenic Tumors

These are rare and often asymptomatic. Thus, they are usually discovered incidentally on imaging. They are commonly slow growing and may only show symptoms when a large size, through swelling and pain due to secondary infection or pathological fracture. The majority of these are benign tumors and would require surgical resection or enucleation.

Ameloblastoma is one of the most commonly seen benign odontogenic tumor. Well known to recur or metastasize if surgical resection is not adequate. They predominate in the posterior mandible as slow growing, painless, uni or multilocular masses. Odontogenic keratocyst is the other most common benign odontogenic tumor. It presents with a well corticated uniclocular or multiclocular radiolucency which enlarges through cancellous bone.

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