Title: Improving Oral Medicine Treatment in Primary Care: Clinical Tips and Recommendations
Subtitle: Collaboration between Dentists and General Practitioners Leads to Effective Outcomes and Reduced Pressure on Specialized Services
Many patients with oral medicine problems can be successfully treated in primary care without the need for referral to secondary care, thanks to the specialty of dentistry known as oral medicine. Oral medicine focuses on the oral health care of patients with chronic, recurrent, and medically related disorders of the oral and maxillofacial region, offering diagnosis and non-surgical management.
Operating at the intersection of dentistry and medicine, the field of oral medicine plays a crucial role in ensuring patients receive appropriate care. Effective collaboration between dental practitioners and general practitioners (GMPs) allows for more effective treatment of oral medicine problems in primary care, reducing the burden on specialized services and enabling them to handle the most complex cases.
Assessment of Orofacial Tissues:
When examining orofacial tissues, visual assessment is usually the first step in detecting abnormalities. However, manual palpation is also important and can reveal changes in the tissues. Basic principles dictate that sinister conditions, such as carcinoma, tend to feel firm to touch (indurated), while non-sinister abnormalities, such as cysts, usually feel soft. All visual and palpable findings should be carefully documented in the patient’s clinical notes. It is essential to use descriptive terms such as ulcer, red spot, or swelling, rather than ambiguous terms like “injury,” which lacks precise meaning. This approach proves particularly valuable in patient referrals, as it helps determine the urgency and level of investigation required in secondary care. Additionally, the use of clinical photography aids in monitoring abnormalities and can be added to a patient’s record to enhance communication between professionals.
Special Investigations:
When diagnosing orofacial diseases, a wide range of special investigations can assist in the process. For oral mucosal diseases, hematologic investigations, including a complete blood count (CBC), folate, vitamin B12, and ferritin, prove especially helpful. In certain cases, HbA1c is the most reliable indicator of diabetic status in patients with conditions such as dry mouth or oral candidiasis.
Prescribing:
The British National Formulary (BNF), which includes the Dental Practitioner Formulary (DPF), serves as a comprehensive source of advice on all aspects of prescribing, including adverse drug reactions and interactions. However, for concise information specifically tailored to dental practice, dentists can refer to the Scottish Dental Clinical Efficacy Program (SDCEP) guidelines for dental prescribing. To ensure clarity and avoid potential misinterpretation, it is advisable to eschew the use of abbreviations in prescription instructions and case records. Instead, write out frequency instructions like “every 8 hours” or “three times a day.”
Pain Management:
Differentiating between various orofacial pain conditions often requires a detailed evaluation of symptoms rather than relying solely on clinical signs. When assessing pain severity, using a 0 to 10 scale, where 0 signifies “without pain” and 10 represents “the worst pain ever experienced,” can provide a standardized measure. Patients should be encouraged to describe the nature of their pain without suggesting specific words. Common descriptions may involve terms like “shoot,” “burn,” or “grab.” For example, a shooting pain at a level of 10 out of 10 lasting for seconds is likely to be trigeminal neuralgia, while a burning sensation at 8 out of 10 that persists throughout the day suggests burning mouth syndrome. Consistent pain at a level of 7 out of 10 is indicative of persistent idiopathic facial pain.
Conclusion:
Collaboration between dental practitioners and general practitioners is crucial in successfully treating many patients with oral medicine problems in primary care. By adhering to recommended clinical tips, including thorough visual and manual assessment, appropriate use of special investigations, informed prescribing practices, and effective pain management strategies, patients can receive comprehensive care within a primary care setting. This multi-professional approach not only benefits patients but also reduces the strain on specialized services, allowing them to focus on complex cases.