Oral medicine is basically concerned with the patients with chronic medical disorders related to dentistry and with their diagnosis and management. These disorders include salivary gland disease,
oral mucosal infections, oral swellings and ulceration, connective tissue disorders, oro-facial pain and neurological disorders, oro-facial musculoskeletal disorders, potentially malignant and malignant oral diseases and oral manifestations and complications of systemic diseases.
Despite the immense importance of this specialty, having its origin in academia, research and clinical practice, it has evolved from an optional subject to a main one in just the last few years in Pakistan. Unfortunately, it still requires a lot of acceptance from the academia to uphold its importance in dental colleges.
Similarly, establishing an oral medicine clinical practice takes a lot of effort, mostly without fruitful results. This poses many challenges to existence of oral medicine discipline and practice.
PATIENT RELATED CHALLENGES
Starting with the beneficiaries, no one knows much about the existence of oral medicine clinics.
Then trends of free dental consultation also hinder the progress of oral medicine.
First and foremost, the patients’ attitude towards diagnosis and treatment is a main issue in both medical and dental field in Pakistan, as they are mostly reluctant to pay for investigations, which are part and parcel of a definitive diagnosis.
Patient compliance issue leads to a lack of follow-up visits, which are necessary for the adequate treatment of the disease. Unawareness regarding the course of diagnosis and treatment in general public results in a lack of understanding that oral medicine is a multidisciplinary field and final diagnosis will be provided after microscopic examination by oral pathologist and in some cases by an oral surgeon.
Mostly patients go for second opinions from non-experts and doctor shopping for their satisfaction, representing the mindset of an average patient in Pakistan.
COLLEAGUES RELATED CHALLENGES
In Pakistan referral system is very poor, mostly because the doctors feel ashamed of referring the patient, so resistance to referral-based practice decreases the patient inflow in oral medicine clinics. This leads to misdiagnosis and maltreatment of patients.
Secondly, oral and maxillofacial surgery holding the fort due to overlapping oral diseases, doesn’t allow the specialty to grow and develop.
A lack of encouragement from fellow dentists also add to the obstacles for oral medicine department.
GENERAL DENTAL BOARD RELATED CHALLENGES
Moreover, recognition by PMDC/PMC is also an issue in Pakistan as master graduates from abroad also face difficulty in getting themselves registered and recognised with the one-year degree. Oral medicine is still considered a nice-to-know subject in academia in dental colleges and teaching hospitals, which decreases its importance in the eyes of students and patients equally.
ORAL MEDICINE FIELD RELATED CHALLENGES
The field of oral medicine is itself challenging with some shortcomings of its own as there is
a limited scope of practice, it’s usually limited to academic settings and therefore the general practice is more appealing for oral medicine experts as that is more rewarding.
For some rare oral conditions the process of diagnosis and treatment may become exhausting and difficult as it is hard to explain to the patients that even an expert needs time and sometime more research to know about their condition.
PHARMACEUTICALS’ CHALLENGES
Pakistan is still developing and progressing in terms of new avenues in therapeutic medicine. This impedes following the general protocols of treatment in oral medicine. The medications are either expensive or unavailable in the market, resulting in a lack of evidence-based optimum treatment.
Furthermore, there is no support from pharmaceutical companies to facilitate patients by producing low-cost drugs or importing newer drugs.
There is no denying the fact that oral medicine is a fundamentally important area of dentistry. The interaction of oral and general health of an individual, as exemplified by oral medicine, emphasizes that dentistry is not simply a technological and surgical niche, but so much more. So, oral medicine future in Pakistan requires support from the senior dental professionals.
