Introduction
Oral Medicine is a unique discipline within dentistry that focuses on the diagnosis and non-surgical management of orofacial disease. The Oral Medicine Department at the University of Washington strives to be a global leader in the diagnosis and management of disorders in the orofacial complex whose treatment may fall between medicine and dentistry. The department has been established for over 50 years any has trained many graduates whom have gone on to become program directors, department chairs or other senior administrators, examiners on the American Board of Oral Medicine, and internationally respected clinicians, researchers and leaders in Oral Medicine.
Training in Oral Medicine combines elements of both dental and medical education to enable graduates to provide holistic care for patients with orofacial disorders, oral manifestations of systemic disease, orofacial complications of medical therapies, and other medical complexities that affect the delivery of traditional dental care.
Program Goals, Objectives, and Competency Assessment
The primary goal of the post-graduate program is to develop oral medicine specialists with expertise in scientific methodology, clinical diagnosis, and therapeutic management of orofacial disorders who are capable of pursuing careers in academics, research, and specialty practice.
Graduate students successfully completing the Oral Medicine program will be able to:
- Provide patient care for individuals with acute, chronic, and recurrent medically related disorders of the oral and maxillofacial regions at a level and depth beyond the level of predoctoral education. Specifically, this includes:
- Oral mucosal disorders (e.g., lichen planus, aphthous ulcers)
- Salivary disease (e.g., Sjögren’s syndrome, xerostomia, hyposalivation)
- Acute and Chronic orofacial pain and neurosensory disorders (e.g., temporomandibular disorders, burning mouth disorder)
- Oral manifestations of systemic disease and disease therapy
- Provide consultative services to dentists, physicians, and allied health professionals treating patients with acute, chronic, and recurrent diseases of the oral and maxillofacial region outlined above.
- Function effectively and efficiently in multiple health care environments and within interdisciplinary health care teams in both dental and medical settings.
- Apply scientific principles to learning, research, and patient care. This includes applying critical thinking, evidence-based practice, critical appraisal of literature, and use of information technology.
- Conduct oneself in a professional manner upholding ethical principles, engaging in life-long learning, and delivering person-centered care across diverse populations.
- Engage in research and scholarly activity at the level of a Master of Science Degree (MSD) thesis.
- Engage in community service and understand the healthcare needs of the community, serving as an ambassador for the specialty of oral medicine.
Competency Assessment
Student progress is assessed in each domain outlined in the program’s goals and objectives as well as competencies. Graduate students are formally evaluated by the graduate faculty on a quarterly basis. Evaluations take into account items germane to teaching, patient care, and research including critical thinking, communication, professionalism, ethical decision making, physical examination, assessment of signs and symptoms, differential diagnosis, and all aspects of patient management.
Graduate faculty collectively assess student competence based on performance in direct clinical care, clinical oral competency exams, and written examinations.
By the end of the program residents will be competent in the following:
- Be able to detect and diagnose patients with complex medical problems that affect various organ systems and/or the orofacial region according to symptoms and signs (subjective/objective findings) and appropriate diagnostic tests.
- Perform a comprehensive physical evaluation and medical risk assessment on patients who have medically complex conditions and make recommendations for dental treatment plans and modifications.
- Select and provide appropriate diagnostic procedures including bodily fluid studies, cytology, culture, biopsy, trigger point injections, diagnostic nerve blocks, qualitative sensory testing, sialometry for outpatients and inpatients to support or rule out diagnoses of underlying diseases and disorders.
- Must achieve competency to establish a differential diagnosis and formulate an appropriate working diagnosis prognosis, and management plan pertaining but not limited to:
- oral mucosal disorders
- medically complex patients
- salivary gland disorders
- acute and chronic orofacial pain
- orofacial neurosensory disorders
- Be able to employ suitable preventive and/or management strategies (e.g. pharmacotherapeutics) to resolve oral manifestations of medical conditions or orofacial problems.
- To critically evaluate the results and adverse effects of therapy.
- Ameliorate the adverse effects of prescription and over-the-counter products and medical and/or dental therapy.
- To communicate effectively with patients and health care professionals regarding the nature, rationale, advantages, disadvantages, risks and benefits of the recommended treatment.
- To interpret and document the advice of health care professionals and integrate this information into patient treatment.
- To organize, develop, implement and evaluate disease control and recall programs for patients.
- To select and provide appropriate diagnostic imaging procedures and the sequential interpretation of images to support or rule out the diagnosis of head and neck conditions. (2-14) Including the following:
- The selection of conventional and advanced imaging techniques based on clinical examination and medical/dental history.
- The direct and/or indirect provision of conventional and advanced imaging in the oral and maxillofacial regions.
- The sequential interpretation of conventional radiographs to support or rule out the diagnoses of head/neck, oral and maxillofacial conditions.
Program Overview
The Oral Medicine program is a continuous 24-month Master’s of Science in Dentistry (MSD) program that is accredited by the Commission on Dental Accreditation (CODA) as an Advanced General Dentistry Education Program in Oral Medicine. The program provides extensive training in both clinical Oral Medicine and research methodology.
Oral Medicine specialists require considerable knowledge in the basic health sciences (including but not limited to immunology, physiology, general pathology, pharmacology, and internal medicine) and must be able to apply this knowledge to the clinical management of orofacial diseases. An intimate understanding of the instruments, procedures and techniques used in the diagnosis of all oral diseases and a broad knowledge of treatment planning are also critical.
The clinical and didactic portions of the program are designed to provide extensive training in the diagnosis and management of:
- Temporomandibular joint disorders (TMD)
- Nerve and neurosensory disorders (including burning mouth syndrome, oral and facial neuropathic pain, and trigeminal neuralgia)
- Chronic orofacial pain (including psychosocial aspects of pain management)
- Oral and mandibular movement disorders (including clenching/bruxism, dystonia, and tardive dyskinesia)
- Diseases/conditions affecting the oral mucosa (including aphthous stomatitis. lichen planus, vesiculobullous conditions, and allergic/hypersensitivity reactions)
- Oral dysplasia and other premalignant changes of the oral cavity
- Salivary gland dysfunction (including Sjögren’s syndrome)
- Obstructive sleep apnea/Sleep disordered breathing
- Oral complications of cancer therapies (including chemotherapy and radiation)
Clinical training primarily takes place in Oral Medicine Clinical Services (OMCS) at the University of Washington School of Dentistry (UWSoD), a large clinical service providing care to a variety of complex patients. Additional clinical experience takes place in the Oral Medicine Service at the Fred Hutchinson Cancer Center, the Oral Medicine service at UW Medicine Montlake within the Otolaryngology-Head & Neck Surgery Center, the Dental Urgent Care Clinic (DUCC) at UWSoD, and the Dental Education in the Care of Persons with Disabilities (DECOD) Clinic. An elective rotation in the Dental Education in the Care of Persons with Disabilities (DECOD) clinic is also available. Students complete medical rotations in Dermatology, Hematology, Otolaryngology, and Rheumatology. All rotations are located in Seattle.
In addition to clinical training, the Oral Medicine program is devoted to the development of clinician scientists with a strong basis in research. To this end, all students receive training in critical thinking, research methodology, literature assessment, and biostatistics. All students are required to select an area of interest and complete a Master’s thesis under the guidance of a faculty research committee.
Seminar and didactic training throughout the program also includes case conferences, literature reviews, research seminars, oral pathology, oral radiology, oral medicine topics related to etiology, pathophysiology, anatomy, differential diagnosis, and therapeutics within oral mucosal disease, medically complex, salivary gland disorders, acute and chronic orofacial pain, and neurosensory disorders.
Finally, graduate training also includes clinical and seminar-based teaching of pre-doctoral dental students at UWSoD. Students serve as clinical instructors in DUCC one session per week. Additionally, in Autumn and Winter quarters, graduate students take part in seminar-based instruction one afternoon per week. Teaching responsibilities comprise <10% of total program time and are designed to enhance the education process. Additional opportunities are available based on the interest of the graduate student.
Many of our past graduates have used these skills to pursue careers in academic dentistry as clinicians, researchers, and educators. Others have used their training in private practices in oral medicine and/or the management of medically complex patients.
Please consult the UW School of Dentistry DDS Admissions table for information regarding degree completion and state licensure requirements that may be helpful to potential applicants considering future practice outside of Washington state.