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Histological, haematological and microbiological investigations are essential in the field of oral medicine and are a crucial adjunct to clinical findings, often being relied on to obtain a definitive diagnosis. Importantly, in some cases, these investigations can help exclude or confirm the presence of malignancy. This project highlighted some problems regarding labelling and recording of specimens in an oral medicine department and a lack of clear specimen management processes. It aimed to improve specimen management by reducing reported incidents surrounding diagnostic tests. Quality improvement methods such as process mapping were key to understanding the journey of specimens and the departments involved at each stage of the system. Initiatives included a recording log book, staff training, information signage around the clinic and delegation of responsibilities, all of which were implemented over multiple plan, do, study, act (PDSA) cycles. The project was extremely successful and since implementation there has been a clear and sustained reduction in reported incidents. The small number of incidents which did occur all involved transportation of specimens and none involved labelling or recording. One can conclude that the change in test management systems in terms of recording and labelling of specimens in the department has been sustained. Ongoing engagement with stakeholders and senior leaders is the priority to ensure further reduction in incidents in the future and that the improvements are maintained. This project demonstrates how simple, realistic, cost-effective, quality improvement initiatives can have a significant positive impact on patient care and hospital management systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The aim of this study was to analyze referral patterns to a university-based oral medicine (OM) clinic and to identify access issues to OM care., Study Design: A retrospective patient chart review on all OM specialists at the University of Alberta (Edmonton, Alberta, Canada) over a 1-year period was performed. Data collected included patient age and gender, referring clinician training and experience, reason and urgency of referral, provisional and final diagnosis, and the referral times. Proportions for data points were collected by using a 95% Wilson Score confidence interval. Two-sided Fisher's exact tests were performed for significant differences., Results: In total, 924 patients were included. Dentists referred 81.4% of the cases, with the remaining cases referred by physicians. Patients traveled, on average, 55.44 km to the OM clinic, with a mean wait time of 105.5 days. White/red lesions were the most common referral reason (38%), with the tongue (21.8%) being the most common site of concern. There was no significant difference in the accuracy of provisional diagnoses between clinician types. Immune-mediated conditions were the most common final diagnosis., Conclusions: The referral patterns of dental and medical practitioners are similar, with mucosal lesions being the most common referral reason. In our study population, access to care was compromised by wait times and travel distances., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Objectives: This study evaluated the extent to which oral chronic graft-versus-host disease (cGVHD) consensus assessments are predictive of management across institutions with and without oral medicine (OM) centers, and whether ancillary care guidelines are followed within clinical practice., Methods: Longitudinal oral cGVHD data were abstracted from the cGVHD Consortium, and additional mouth-specific management data were analyzed across five transplant centers., Results: Seventy-nine patients with 656 visits were observed for a median of 7.1 months with one visit per follow-up month. Ancillary therapies for oral cGVHD were prescribed for 67% of patients for a median of 0.46 months (per follow-up month) at OM centers and 0.78 months at non-OM centers. Patients treated with ancillary therapy were more likely to have an National Institutes of Health (NIH) mouth score of ≥1 (P < 0.001, odds ratio: 5.1) and mouth pain (P = 0.01, odds ratio: 2.6). The odds ratios of receiving ancillary therapy from OM experts were higher than transplant physicians (53%; P = 0.03)., Conclusions: Oral cGVHD consensus assessments corresponding with ancillary therapy use were mouth pain and NIH mouth score, with higher odds ratios of receiving therapy from OM experts. Ancillary care guidelines for oral cGVHD are reflected in academic clinical practice with respect to utilization of recommended prescriptions., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Evidence to address a scientific question is generated through the design of research aiming to answer it. Probably the most often sought design in epidemiologic research is a randomized clinical trial that offers the advantage of controlling for confounders, which may influence the trial outcome. In contrast, observational study designs test hypotheses when clinical trials are difficult to implement. The interest in clinical trials has led to an explosion of manuscripts testing interventions in health care, often yielding interesting results albeit in statistically underpowered samples. Thus, the clinician faces the challenge of making sense of multiple studies that produce results of variable strength when attempting to assess the evidence supporting a treatment. Meta-analytic methods represent an alternative to assess the evidence by pooling the results from multiple studies to increase statistical power. This manuscript describes considerations for planning and implementing meta-analysis in oral medicine., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Mobile telemedicine, which involves the use of cellular phone telecommunications to facilitate exchange of information between parties in different locations to assist in the management of patients, has become increasingly popular, particularly in resource-limited settings. In Botswana, small studies of mobile telemedicine programs suggest access to these services positively affect patients, but these programs' impact is difficult to capture given limitations of baseline and comparative data. Our observational study uses each patient receiving mobile oral telemedicine services in Botswana as his/her own control to assess the impact of these services on his/her diagnosis and management plan. At month 5 of 12 total, preliminary analysis of eligible cases (n = 27) reveals management plan discordance between clinicians submitting cases and the specialist was 68.0% (17/25), suggesting that telemedicine can result in significant changes in management of patients.

Background: The authors conducted a study to ascertain participants' perceptions of and confidence in their responses regarding the definition and diagnosis of burning mouth syndrome (BMS)., Methods: The authors developed an eight-question questionaire with input from several experienced clinicians in the fields of oral medicine (OM) and orofacial pain (OFP) and sent it to directors (n = 20; OM = 10; OFP = 10) of accredited postgraduate training programs in North America. They used descriptive statistics to analyze the results., Results: The response rate was 65 percent (n = 13; OM = 6; OFP = 7). Participants reported a mean of 7.3 cases of BMS in any given three-month period, with 89 percent of these cases managed within the programs. They identified, with a high degree of confidence, overall criteria for establishing a definition and definitive diagnosis of BMS., Conclusions: There were multiple similarities among participants' responses regarding the elements to be included in the definition and diagnosis of BMS., Practical Implications: These data provide information on current status of definitions and diagnostic guidelines and may assist in development of future consensus statements on BMS that incorporate additional geographical representation and appropriate methodology.

This is the first national audit of Fellows of the British Association of Oral and Maxillofacial Surgeon with the specific purpose of supporting consultant revalidation. The audit was performed online. There were 127 responses from 275 email invitations. The audit reflects the range of activity by consultants with over 90% being involved in dento-alveolar, trauma and oral medicine. 78% of consultants performing head and neck oncology had a database and 75% of cleft lip and palate surgeons. Contributions to audits in the last 3 years were least common in oral medicine (7%), skull base (7%), aesthetic surgery (8%), and paediatric maxillofacial surgery (12%). There were many different audits reflected in consultants responses and there is merit in focusing on specific audits suitable for national comparison and benchmarking., (Copyright © 2010. Published by Elsevier Ltd.)

We investigated the current provision of oral medicine in oral and maxillofacial (OMF) departments in the UK. We examined the number of specialists in oral medicine in OMF departments, the training given to OMF consultants in oral medicine, and the estimated time dedicated to treating patients with oral medical conditions in outpatient clinics. We also examined the pattern and reasons for onward referrals to departments of oral medicine. A postal questionnaire was sent to 300 OMF consultants and was returned by 183 (61%). Sixteen (9%) of the responding consultants had a registered specialist qualification in oral medicine with the General Dental Council (GDC), 15 (8%) had a degree in oral medicine, and 4 (2%) had a diploma. One hundred and eighteen (64%) consultants had been given formal training in oral medicine during their training as registrars. Time dedicated to oral medicine in outpatient clinics varied between less than 20% and more than 40% of total outpatient time. Sixteen surgeons (9%) referred 1-2 patients/week to departments of oral medicine, and 19 (10%) referred 2-4/month. Reasons for referral included need for specialist expertise, failure of treatment, and lack of time in outpatients. The proposal for a dentally qualified consultant-led oral medicine service was supported by 70 responding surgeons (38%)., (Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objectives: (i) To define the current state of oral medicine clinical practice internationally, and (ii) to make recommendations for future modeling of the practice of oral medicine., Materials and Methods: A survey was designed by an international panel of oral medicine experts to assess the current state of oral medicine practice internationally. The survey was sent to oral medicine experts across the world, and responses were electronically stored and analyzed using descriptive statistics., Results: Two hundred respondents completed the survey representing 40 countries from six continents. The two most common settings for an oral medicine practice were in a hospital and a dental school. More than 88% of respondents considered management of oral mucosal disease, salivary dysfunction, oral manifestations of systemic diseases, and facial pain in the definition of oral medicine., Conclusions: (i) Oral medicine clinicians diagnose and manage a wide variety of orofacial conditions; (ii) There are significant differences in the definition of oral medicine clinical practice from country to country; (iii) India has the largest expansion of oral medicine services as defined by escalating numbers of clinicians within the specialty as compared with other countries; (iv) oral medicine practitioners have a wide range of professional responsibilities., (© 2011 John Wiley & Sons A/S.)

Objectives: The aims of this study were firstly to examine patient demographics, lesion types and referral sources to Cork University Dental School and Hospital (CUDSH) for oral medicine services and secondly, to indicate factors that could improve the efficiency of the service provided., Methods: A retrospective analysis of the clinical records for all new patients, both public and private, seen in the CUDSH oral medicine unit (n = 412) in the calendar year 2007 was undertaken. For each patient the following parameters were recorded: age, gender, residence, referral source and the reason for referral including site of lesion., Results: The majority of patients were females and the majority of referrals came from general dental practitioners. The most common reason for referral was due to concern about white lesions. Raised soft tissue lesions including epuli and mucocoeles were second and ulceration, including recurrent aphthous and traumatic ulceration, was the third most common reason for referral., Conclusions: To our knowledge this is the first study to investigate factors influencing referrals to oral medicine clinics in Ireland. Based on the results presented there appears to be a considerable demand for an oral medicine service dealing with oral lesions and conditions which other practitioners consider to be outside the scope of their practice. Studies of this nature should prove to be valuable in maximising hospital resources at a time when economic factors are leading to increased financial pressure in health care funding.

The article deals with the results of sociological survey of patients concerning the motivation of their appealability to private stomatology institutions for the orthopedic stomatological care. The survey data includes the information needed for planning functioning and management of orthopedic stomatological service.

Background: Biopsy procedures and diagnostic histopathology are rarely used by general dental practitioners (GDPs) compared with dental specialists. The aim of this study was to investigate the usage patterns and views of GDPs and specialists in Brisbane on these procedures., Methods: An analysis was carried out on 1027 oral biopsy accessions at a private pathology laboratory. A survey was distributed to 200 GDPs and dental specialists inquiring about their use of and views on biopsy and diagnostic histopathology. An analysis was carried out on 327 and 95 biopsies performed at a private oral medicine practice and at the University of Queensland School of Dentistry, respectively., Results: The majority (76.2%) of GDPs surveyed referred all oral lesions requiring biopsy to a specialist, rather than undertaking biopsy themselves. Although most GDPs recognized the importance of biopsy, a large proportion (58.1%) did not feel competent in undertaking the procedure due to concerns of inadequate experience and practical skills., Conclusions: Many dental practitioners believe that GDPs should be able to undertake simple biopsies of benign lesions, however more undergraduate and postgraduate training in biopsy and diagnostic histopathology is necessary to promote a greater use of these procedures.

Aim: The purpose of this study was to examine the scope of practice, lesion occurrence and utilisation of referral-based hospital and private practice oral medicine and oral pathology (OMP) services in Australia., Materials and Methods: Clinical records of patients referred to a hospital (n=500) and private (nbequals;1104) OMP clinic were audited. For each patient, the following parameters were recorded: age, gender, source of referral, reason for referral, site of lesion/condition if applicable, medical and drug history, diagnostic services utilised, clinical and histopathological diagnoses rendered, medications prescribed and further treatment required., Results: A majority of the referrals were generated by general dental practitioners. The most commonly seen problems were epithelial hyperplasia/hyperkeratosis, oral candidosis, oral lichen planus, xerostomia, recurrent aphthous ulcers and burning mouth syndrome. OMP specialists requested diagnostic imaging for 13% of hospital and 9.42% of private patients, diagnostic biopsies were required for 18.4% of hospital and 19.3% of private patients, blood tests were ordered for 14.4% of hospital and 12.13% of private patients, while medications were prescribed for approximately 36% of hospital and 51% of private patients., Conclusions: This study is the first to detail the scope of practice, lesion occurrence and utilisation of services offered by OMP specialists in Australia. The demand for OMP services is strong.

The need and demand for oral medicine services in the United States and Canada was determined by a prospective survey of American Academy of Oral Medicine practitioners who attended the Academy's 1996 annual meeting. Of the 50 surveys returned from 149 eligible registrants, it was determined that, on the average, oral medicine practitioner respondents practiced 2.3 days per week and treated 8.7 patients per day; this amounts to more than 40,000 patient-care visits per year. Almost 90% of patients were treated because of medically compromising conditions, oral mucocutaneous disease, or chronic orofacial pain. Most of the care (52%) was provided in non-university settings. Most treatment involved the comprehensive evaluation of complex oral problems (36.7%), the prescription of medications (24.2%), or comprehensive dental treatment (21.8%) for patients with severe and life-threatening medical conditions. These results suggest that oral medicine services are needed and that demand for these services is high.

The aim of this project was to determine the oral and dental research output in South African dental schools over a 5-year period. All refereed research articles emanating from South African dental schools which appeared in peer-reviewed journals during the 5 year period, 1990-1994, and which could be traced, were recorded, scrutinized and classified according to the thrust of the research. During this period the 5 schools published 494 articles, 176 from the University of the Witwatersrand, 145 from the University of Stellenbosch, 85 from the University of Pretoria, 54 from the Medical University of Southern Africa and 34 from the University of the Western Cape. Papers were classified into 22 categories. The majority were produced in oral biology, oral pathology and microbiology and dental materials, followed by pharmacology and anaesthetics, epidemiology, community dentistry, preventive dentistry and prosthetic dentistry. A number of articles featured in the rest of the categories. Fifty-five per cent of manuscripts appeared in overseas journals while the bulk of locally published contributions featured in the Journal of the Dental Association of South Africa. The output of research remained constant over the 5 year period with a slight increase of articles in dental materials. The findings indicate that the South African dental schools may have reached a limit in their capacity to produce peer-reviewed research.

The authors demonstrate the potentialities of multidimensional analysis methods: component, cluster, and discriminant as exemplified by clinico-laboratory examinations of 26 patients with medium-severe periodontitis and concomitant diseases. A two-stage modification of multidimensional grouping of biomedical objects is suggested. The first stage implies detection of the principal components and their estimation for each examinee. The second stage consists in realization of multidimensional grouping method according to G. S. Kil'dishev and Iu. I. Abolentsev in relation to individual component values. Different typologically homogeneous groups of patients with a specific microbiologic and biochemical status evidently requiring a differentiated approach to treatment may be singled out within the frames of a current classification of periodontal diseases basing on clinical and laboratory data.