Burket's Oral Medicine

Michael Glick, Martin S. Greenberg, Peter B. Lockhart, Stephen J. Challacombe, Michael Glick, Martin S. Greenberg, Peter B. Lockhart, Stephen J. Challacombe

• Publisher: Wiley-Blackwell
• Year: 2021
• Print ISBN: 9781119597742
• eBook ISBN: 9781119597810
• Edition: 13
• Topic: Medicine
• Subtopic: Dentistry

This thoroughly revised Thirteenth Edition of Burket's Oral Medicine reflects the scope of modern Oral Medicine with updated content written by 80 contributing oral medicine and medical experts from across the globe.

The textemphasizes the diagnosis and management of diseases of the mouth and maxillofacial region as well as safe dental management for patients with complex medical disorders such as cardiovascular disease, cancer, infectious diseases, bleeding disorders, renal diseases, and many more.

In addition to comprehensively expanded chapters on oral mucosal diseases, including those on ulcers, blisters, red, white and pigmented lesions, readers will also find detailed discussions on:

• orofacial pain, temporomandibular disorders, headache and salivary gland disease;
• oral and oropharyngeal cancers, including the management of oral complications of cancer therapy;
• genetics, laboratory medicine and transplantation medicine;
• pediatric and geriatric oral medicine;
• psychiatry and psychology;
• clinical research; and
• interpreting the biomedical literature

The Thirteenth Edition of Burket's Oral Medicine is an authoritative reference valuable to students, residents, oral medicine specialists, teachers, and researchers as well as dental and medical specialists.

1
Introduction to Oral Medicine and Oral Diagnosis: Patient Evaluation

Michael Glick, DMD, FDS RCSEd

Martin S. Greenberg, DDS, FDS RCSEd

Peter B. Lockhart, DDS, FDS RCSEd, FDS RCPS

Stephen J. Challacombe, PhD, FDS RCSEd FRCPath, FDSRCS

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1. INFORMATION GATHERING
   • Medical History
   • Patient Examination
   • Consultations
2. ESTABLISHING A DIFFERENTIAL AND FINAL DIAGNOSIS
3. FORMULATING A PLAN OF ACTION
   • Medical Risk Assessment
   • Modification of Dental Care for Medically Complex Patients
   • Monitoring and Evaluating Underlying Medical Conditions
4. CLINICAL OUTCOMES AND ORAL DISEASE SEVERITY SCORING
   • Oral Disease Severity Scoring
   • Patient‐Reported Outcome Measures and Oral Mucosal Disease
5. THE DENTAL AND MEDICAL RECORD
   • Problem‐Oriented Record
   • SOAP Note
   • Confidentiality
   • Informed Consent
6. TELEHEALTH/TELEDENTISTRY

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Oral medicine, as defined by the American Academy of Oral Medicine, is “the specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of medically related disorders or conditions affecting the oral and maxillofacial region.” Definitions vary in different parts of the world, but most include the diagnosis and nonsurgical management of oral mucosal and salivary gland disease, orofacial pain, and dental treatment of patients with medical disorders.

The overall goal for all oral healthcare professionals is to deliver and maintain optimal health for their patients. A recent definition was approved by the World Dental Parliament in 2016, which expanded the definition to include three different domains: disease and condition status, psychosocial status, and physiologic function.¹ The inclusion of a psychosocial status and physiologic function deviates from traditional definitions that mainly focused on the presence or absence of disease, and, further, it promotes the inclusion of patient values and preferences, as well as elevates the importance of subjective findings. This approach is more aligned with a person‐centered care approach that emphasizes a patient’s problem in the context of behavioral, socioeconomic, and environmental aspects, and their impact on the patient and on the care that needs to be delivered.^2–4 This definition has also been the underlying framework to establish outcomes that can be used to measure the oral status of an individual.⁵

Given the nature, complexity, and potential systemic implications for some oral conditions, coupled with an aging population with multimorbidities (multimorbidities do not identify an index disease, while comorbidities focus on an index disease and other diseases) and individuals taking numerous medications, all oral healthcare clinicians are required to enhance their knowledge of many aspects of medicine. Therefore, what previously was considered the purview of oral healthcare professionals with hospital‐based training has become increasingly more important in general and specialty dental practice.

Advances in clinical practice are influencing many aspects of patient care, from our initial contact with a patient, through medical history‐taking, diagnosis, and treatment options. For example, electronic health records (EHRs) allow for sharing health information among multiple clinicians caring for the same patient and can provide point‐of‐care algorithms for eliciting and using health information. Modern imaging techniques, such as computerized tomography scans (CTs) and magnetic resonance imaging (MRI), provide more detailed information and are a means to acquire more sophisticated data, but require enhanced training for accurate interpretation. Nevertheless, one of the most important skills for accurate diagnosis and management remains an experienced clinician with highly developed skills of listening and examination.

The initial encounter with a patient may influence all subsequent care. The skilled, experienced practitioner has learned to elicit the subjective (i.e., history‐taking) and objective (e.g., clinical, laboratory) findings and other necessary information required for an accurate diagnosis. This process is an art, as well as a skill. Although mastering a patient evaluation can be assisted by specific clinical protocols, the experienced practitioner will add their own skills and experience to the diagnostic methodology.

A variety of accessible sources of healthcare information are now readily available to patients, and many will use this information to self‐diagnose, as well as demand specific treatments. As a person‐centered approach is encouraged, where a patient’s preferences and values will influence care, the practitioner must listen to the patient to understand their needs, fears, and wishes and address them to arrive at an appropriate treatment plan that results in informed, scientific, and evidence‐based choices. Furthermore, part of a shared decision‐making approach includes the responsibility of the oral healthcare professional to educate their patient about the implications and consequences of a diagnosis and subsequent treatment. Creating an environment for effective communication between provider and patient has been shown to improve health outcomes.⁶

The process of obtaining, evaluating, and assessing a patient’s oral and overall health status can arbitrarily be divided into seven major, sometimes overlapping, parts:

• History and examination.
• Establishing a differential diagnosis.
• Obtaining necessary consultations, as well as appropriate laboratory tests, such as specific blood investigations, a biopsy, and imaging studies, all based upon the initial differential diagnosis.
• Final diagnosis.
• Formulating a plan of action.
• Initiating treatment.
• Follow‐up assessment of response to treatment.

INFORMATION GATHERING

An appropriate interpretation of the information collected through a medical history and patient examination achieves several important objectives. It affords an opportunity for:

• Gathering the information necessary for establishing a diagnosis for the patient’s chief complaint.
• Assessing the influence of the patient’s systemic health on their oral health.
• Detecting other systemic health conditions of which the patient may not be aware.
• Providing a basis for determining whether dental treatment might impact the patient’s systemic health.
• Giving a basis for determining necessary modifications to routine dental care.
• Monitoring medical conditions of relevance to the maxillofacial condition.

Medical History

Obtaining an appropriate and accurate medical history is a critical first step for all patient care. It begins with a systematic review of the patient’s chief or primary complaint, a detailed history related to this complaint, information about past and present medical conditions, pertinent social and family histories, and a review of symp...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• Dedication Page
• Preface
• List of Contributors
• 1 Introduction to Oral Medicine and Oral Diagnosis: Patient Evaluation
• 2 Overview of Clinical Research
• 3 Ulcerative, Vesicular, and Bullous Lesions
• 4 Red and White Lesions of the Oral Mucosa
• 5 Pigmented Lesions of the Oral Mucosa
• 6 Benign Lesions of the Oral Cavity and the Jaws
• 7 Head and Neck Cancer
• 8 Oral Complications of Nonsurgical Cancer Therapies
• 9 Salivary Gland Diseases
• 10 Temporomandibular Disorders
• 11 Neuropathic Orofacial Pain
• 12 Common Headache Disorders
• 13 Diseases of the Respiratory Tract
• 14 Diseases of the Cardiovascular System
• 15 Diseases of the Gastrointestinal Tract
• 16 Renal Diseases
• 17 Hematologic Diseases
• 18 Bleeding and Clotting Disorders
• 19 Immunologic Diseases
• 20 Transplantation Medicine
• 21 Infectious Diseases
• 22 Disorders of the Endocrine System and of Metabolism
• 23 Neurologic Diseases
• 24 Psychological and Psychiatric Aspects of Oral Health
• 25 Pediatric Oral Medicine
• 26 Geriatric Oral Medicine
• 27 The Role of Genetics in Oral Medicine
• 28 Laboratory Medicine and Diagnostic Pathology
• 29 How to Identify, Interpret and Apply the Scientific Literature to Practice
• Index
• End User License Agreement