Study sheet: Oral Medicine Foundations and History Taking

📋 Course Outline

1. Scope of Oral Medicine
2. Clinical Roles and Conditions
3. History Taking Principles
4. Questioning Techniques
5. Age and Sex Assessment
6. Presenting Complaint Analysis
7. Medication and Steroid Safety
8. Family Social and System Review

📖 1. Scope of Oral Medicine

🔑 Key Concepts & Definitions

• Oral medicine : the dental specialty at the interface between medicine and dentistry that diagnoses and manages non-dental pathology affecting the oral and maxillofacial region
• Oral medicine doctor : trained to diagnose and manage disorders of the orofacial region and functions essentially as a physician of the mouth

★ Must-know

• Oral medicine specialists manage oral mucosal diseases, orofacial pain syndromes, salivary gland disorders, and oral manifestations of systemic diseases.

Further detail

• Specialized training includes: oral mucosal growths, ulcers, infections, allergies, immune-mediated and autoimmune disorders, cancers, taste and smell disorders, oral manifestations of systemic and infectious diseases

💡 Memory Hook

Oral medicine stands between dentistry and medicine, treating non-dental orofacial pathology.

📖 2. Clinical Roles and Conditions

🔑 Key Concepts & Definitions

• Biopsy : the surgical removal of a tissue or bone specimen for analysis to obtain a diagnosis

★ Must-know

• The practical aspects of oral medicine include:

  • biopsies
  • ordering and interpreting tests
  • medical management
  • specialized injections

• Examples of conditions managed in oral medicine include: lichen planus, Behçet's disease, pemphigus vulgaris, leukoplakia, erythroplakia, oral mucositis, bisphosphonate-related osteonecrosis of the jaws, Sjögren's syndrome, burning mouth syndrome, trigeminal neuralgia

Further detail

• Investigations include:
  • X-rays
  • CT scans
  • MRIs
  • salivary tests
  • blood tests
  • microbiological investigations

💡 Memory Hook

B-T-M-I: Biopsies, Tests, Medical management, Injections.

📖 3. History Taking Principles

📝 Essential Points

• The first step in dealing with a patient is history taking based on good communication between the dentist and patient.

• A good history reveals the patient's ideas, concerns, expectations, and any accompanying diagnosis, and the history alone can sometimes establish the diagnosis.

• A complete history includes:

  • the current medical problem
  • preexisting medical conditions
  • current medications
  • family history
  • social and psychosocial circumstances
  • environmental factors
  • familial factors
  • occupational factors
  • personal habits

💡 Memory Hook

Good communication → patient ideas, concerns, expectations → more accurate diagnosis.

📖 4. Questioning Techniques

🔑 Key Concepts & Definitions

• Open questions : do not suggest a right answer and allow patients to express what is on their mind freely

★ Must-know

📌 Open questions are the gold standard for historical inquiry and can be used to explore specific symptoms, such as by asking the patient to describe the pain.

📌 Leading questions should be avoided because they direct the patient along an avenue framed by the dentist's assumptions.

Further detail

📌 Questions with options may be used to clarify an unclear statement, but they must be used carefully because they can produce the answer expected by the dentist rather than the patient's true meaning.

💡 Memory Hook

Open questions reveal the patient's account; leading questions impose the dentist's assumptions.

📖 5. Age and Sex Assessment

★ Must-know

• Patient age is important because older patients may have degeneration of bone and joints, chronic brain syndrome, malnutrition, mental disorders, medication-related pharmacokinetic and pharmacodynamic changes, and drug-drug or drug-food interactions.

• Malignant melanoma and squamous cell carcinoma are more common in males, while mucous membrane pemphigoid, cicatricial pemphigoid, pregnancy epulis, and mucocele are more common in females.

Further detail

• Age-related oral changes include:

  • reduced dentin
  • gingival retraction
  • bone-density loss
  • reduced tongue papillae
  • increased salt and sugar taste thresholds
  • reduced salivary secretion
  • potential tooth loss

• Immunological changes include:

  • declining secretory IgA
  • thymus involvement
  • decreased thymopoietin
  • decreased lymphoid tissue
  • impaired antibody production
  • decreased T lymphocytes
  • increased autoantibodies

💡 Memory Hook

Age → sex → presenting complaint → history of presenting complaint.

📖 6. Presenting Complaint Analysis

★ Must-know

• The presenting complaint is the patient's reason for the visit, and the history of the presenting complaint gathers detailed information about that specific problem.

• Pain assessment covers:

  • site
  • onset
  • character
  • radiation
  • associations
  • time course
  • exacerbating or relieving factors
  • severity

Further detail

• Pain severity may be assessed using a 1–10 scale.

💡 Memory Hook

SOCRATES: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating or relieving factors, Severity.

📖 7. Medication and Steroid Safety

★ Must-know

• Corticosteroids are used for oral and maxillofacial lesions because of their anti-inflammatory and immunosuppressive effects.

• Corticosteroid contraindications include:

  • gastric ulcer
  • diabetes mellitus
  • hypertension
  • pregnancy
  • tuberculosis
  • fungal infections
  • herpes simplex infections
  • psychosis
  • epilepsy
  • congestive heart disease

📌 Antifungal, macrolide antibiotic, and antiviral drugs increase corticosteroid levels and toxicity, whereas rifampin reduces corticosteroid effectiveness and levels.

📌 Corticosteroid treatment lasting less than 10 days can be stopped abruptly regardless of dose and type, whereas treatment lasting 10–30 days should be discontinued over two weeks with dose reduction every four days.

Further detail

• Corticosteroids are classified as:

  • short-acting: hydrocortisone and cortisone
  • intermediate-acting: prednisone, prednisolone, methylprednisolone, and triamcinolone
  • long-acting: betamethasone, dexamethasone, and paramethasone

• Long-term treatment should be managed by: changing to a short- or intermediate-acting corticosteroid, reducing administration to once daily in the morning, gradually reducing the dose

• Colchicine may cause diarrhea, nausea, vomiting, liver, kidney or muscle damage, low blood cell counts, and dangerous interactions with other medications.

💡 Memory Hook

Short-term stop abruptly; intermediate-term taper over two weeks; long-term change, reduce frequency, then taper.

📖 8. Family Social and System Review

★ Must-know

• A family medical history is a compilation of relevant medical conditions affecting the patient and close family members and should extend back at least three generations.

📌 Any child of an affected individual with an autosomal dominant inherited disease has a 50% chance of being affected.

• The review of systems covers:

  • cardiovascular
  • respiratory
  • gastrointestinal
  • neurological
  • genitourinary or renal
  • musculoskeletal
  • psychiatric

• After history taking, the dentist should summarize the patient's account to confirm understanding of the oral complaint and its possible relationship to systemic disease.

Further detail

• Autosomal recessive conditions in the family history include sickle cell anemia and alpha thalassemia, while autosomal dominant conditions include neurofibromatosis, myotonic dystrophy, and Huntington's disease.

• Smoking is associated with leukoplakia and nicotinic stomatitis, while alcohol use may be suggested by increased mean corpuscular volume without vitamin B12 or folate deficiency or by unexplained abnormal liver function tests.

💡 Memory Hook

Family → social → systems → summary.

📊 Synthesis Tables

Types of Patient Questions

Question type	Main function	Main risk
Open questions	Allow the patient to describe concerns freely	May not obtain every discriminating feature
Questions with options	Clarify an unclear statement	May suggest the answer expected by the dentist
Leading questions	Direct the patient toward a framed assumption	Can distort the patient's true account