review article

Role of Oral Physician in Tertiary Care Centre

Afaque Sarah1, Misra Neeta2, Srivastava Saurabh3, Umapathy Deepak4, Singh Priya5, Rai Puja6
ABSTRACT :
Tertiary prevention refers to the person to optimum function or maintenance of life skills through long-term
treatment and rehabilitation. This form of prevention involves treatment, rehabilitation, prompt treatment, as well as
patient education. When the disability or disease cannot be reversed or is permanent, then tertiary treatment is used.
This level of prevention is involved more with treatment rather than any preventive measures. Since the disease has
already been established, the focus will be to minimize the harmful effects of the disease process and maintain
optimum health. In tertiary treatment, the focus turns toward reducing any further complications once the disease
process has already progressed. Oral medicine is the Junction between medicine and dentistry and essential in
diagnostic and treatment planning for medical practitioners. Oral health is the foremost part of overall health. The
main objective is to highlight the role of oral physicians in the tertiary care centers and how they can reduce
complications caused by severe diseases.

KEYWORDS: Oral health, oral physicians, tertiary care, preventive health strategies, tertiary dental care,
healthcare professional
INTRODUCTION : technology, keeping on par with the utmost treatment
A Swiss psychiatrist and psychoanalyst, Carl Jung, modalities to the patient. The primary role of an Oral
once said that "Medicine cures diseases, but only physician that is concerned with dealing with the oral
doctors can cure patients." With the advancements in health management of medically complex patients,
modern medicines to cure diseases, it is equally including the diagnosis and management of medical
important to create a holistic environment. The conditions that affect the oral and maxillofacial region,
potential reintegration of dentistry with medicines tends to play a significant role in succeeding with the
enables us to acknowledge the paradox of change1. tertiary care for the patient.
Building awareness of common oral problems and the LITERATURE REVIEW :
risk factors for dental issues is critical as physicians The search terms used were "tertiary care" and "oral
know what to look for and make proper referrals. "If physicians." The original purpose of the search was to
you know how to do an oral exam, it does not take establish the role and importance of oral physicians in
much time to concentrate on the mouth. It is a part of the tertiary care centers and what possible outcomes
the entire body, and one should consider doing a good could be drawn. For prioritizing the prevention of head
oral exam." During an excellent oral examination, it is and neck cancers, different articles were searched
imperative to go through the minutest of changes that using the terms "Early detection in head and neck
could be visible in the oral cavity. Oral health is the cancer," and two related studies were also included in
foremost part of the overall health, and oral physicians the literature.
should update themselves to the latest medical ROLE OF AN ORAL PHYSICIAN :
An oral physician is identified by the medical
Corresponding Author : Dr. Afaque Sarah
community as a dentist who is adequately trained in
PG Student, 2Professor & Head, 3-5Reader, 4Professor,
1

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Senior Lecturer
the field of Medicine, Radiology and Applied Oral
Dept. of Oral Medicine & Radiology, BBDCDS, Babu Banarasi Das pathology in order to manage variety of
University, Lucknow stomatological diseases that fall outside the scope of
routine dentistry. An oral physician is expected to

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have a thorough knowledge in the field of oral management of behavioral disorders and the oral and
diagnosis and be competent to handle any disease dental treatment of medically compromised patients.
condition contributing to sore mouth, oral cancer, and Oral physicians strive to maintain a holistic
orofacial pain. To be a successful oral physician, in relationship between the patient and the required
depth knowledge in stomatology, general medicine, tertiary care facilities. Since they are the first to get
pharmacological science, environmental allergens conversant with the patient's dental needs and
etc., are mandatory. A clear understanding of requirements, it enables them to get in kindlier terms
hypersensitivity / idiosyncratic reactions to various with the patients, enabling them to get on board with
drugs and the effects of environmental /dietary factors the patient's oral diseases and their systemic
on oral mucosa distinguishes him from his allied ailments.
specialists.2 The stomatological diseases fall under SCOPE OF ORAL MEDICINE :
the grey areas of Medicine and Dentistry. The general Oral medicine acts as a fulcrum between dental and
physician often fails to understand the dental and the medical fields, giving the platform for oral physicians
oral concepts contributing to oral diseases. The or researcher in local, national, and international
dentist falls very much short of knowledge regarding arenas.5 Oral medicine practice depends on good
the systemic, environmental, food, and drug diagnostic ability in-depth knowledge in identifying
influences on oral lesions.3 A physician should discuss and removing the underlying cause from local,
with his patient in detail good oral hygiene and how it systemic, genetic, and environmental factors. Oral
can impact their systemic health as well. Patients will physicians should adapt the demographic changes
be referred frequently from smaller hospitals to and medical advancements with academic and
tertiary hospitals for major operations, consultations research orientation to expand oral medicine and
with sub-specialists, and sophisticated intensive care radiology and shoulder being part of the patient's
facilities. In this way, an oral physician may tend to overall health care team. Nevertheless, a time has
become a bridge between the required and the come where oral medicine specialists have
preferred treatment. revolutionized oral diagnosis with the help of the
CREATING A HOLISTIC ENVIRONMENT : l a t e st n o n i n va s i ve i m a g i n g a n d d i a g n o st i c
An oral physician should create an educational techniques. Also, diagnosis is a pivotal step against
strategy that will take an initial step to regenerate any pathology, and the scope of the oral physician is
dentistry into medicine and the more extensive health diverse. With the triad of rational thinking,
care system. He should work hand in hand with the professional knowledge, and judicious approach,
physicians to retain and cross-train, thus increasing which today glows with various technological
the flexibility for both professions. Oral medicine dimensions, it is easier to come across better
practice helps in the early diagnosis and monitoring of treatment modalities.
mucosal lesions and potentially malignant disorders DELVING INTO TERTIARY CARE :
for a better prognosis. Correct diagnosis and timely The term tertiary care came into hospital parlance a
treatment of Premalignant disorders may help few decades ago, but only in 2013 was it integrated
prevent malignant transformation in oral lesions.[4] It into the US National Library of Medicine's Medical
includes principles of medicine that are concerning Subject Headings thesaurus, when it was defined as
the mouth, as well as research in biological, "care of a highly technical and specialized nature,
pathological, and clinical spheres. It includes the provided in a medical center, usually one affiliated
medical management of diseases specific to the with a university, for patients with unusually severe,
orofacial tissues and oral manifestations of the complex, or uncommon health problems.6 A patient is
systemic diseases. It moreover includes the referred to tertiary care once he is hospitalized and

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needs a higher level of specialty care within the regional centers equipped with diagnostic and
hospital. Tertiary care entails highly specialized treatment facilities, which are not generally available
equipment and expertise. A positive approach to in local hospitals. Here often, dentists work together in
tertiary care for the patient will not only resolve his a cross-disciplinary way with other medical specialist
current oral complaints, but it will also increase the groups in multi-professional teams. An oral physician
patient's ability to reduce further risk factors, is the first dental professional who comes to direct
therefore reduced morbidity, and mortality rates. At terms with the patient addressing his dental needs,
the tertiary care level, the patient will receive highly enabling the formation of the bond between the oral
specialized, high-technology care and treatment physician and the patient before heading to any other
procedures. Often, care at this level is accessible only departments for the necessary treatment required.
if the patient enters a hospital with the necessities and So, the patient is very well acquainted with the oral
specialty facilities. Of the various tertiary care physician, and it would further enable him to lay down
institutions, three vital ones are hospitals specializing all his health status while taking a case history.
in a certain kind of disease or a group of diseases, Practicing empathy towards patients can help
hospitals associated with medical schools, and large connect with them on a personal level by making them
regional referral centers, including the means of feel understood. For the patient to proceed with the
diagnostic aids such as magnetic resonance testing treatment, it is essential to develop a bond with the
and CT scanning. patient, and this will not only improve the easy flow of
ORAL PHYSICIANS IN TERTIARY CARE CENTERS : the treatment procedure but also would enable the
The main aim of an Oral physician in tertiary care patient to approach the oral physician for his further
should be trying to improve the patient's quality of life requirements and would effortlessly agree to tertiary
and reduce the symptoms of the disease they already care. As part of treatment-resistant cases, many
have. An oral physician's responsibility in a tertiary chronic pathologies, including those of the oral and
care center should focus on people who are already maxillofacial region, are a treatment challenge to
affected by a disease, improving the quality of life by dental professionals. Such chronic pathologies may
reducing disability, limiting, or delaying complications, sometimes lead to behavioral disorders such as
and restoring function. Tertiary prevention targets depression, prompting the oral physician to seek
both the clinical and outcome stages of a disease. It is additional medical assistance affirming their major
implemented in symptomatic patients and aims to role in advancing tertiary care to the patients.
reduce the severity of the disease as well as of any AMALGAMATION OF DENTISTRY AND TERTIARY
associated sequelae. It aims to reduce the effects of CARE :
the disease once established in an individual. Forms of Dental health care is a two-person endeavor, not
tertiary prevention are commonly rehabilitation something that one person does to another.[8] While
efforts.7 To minimize the negative impact of an dentists think of dental symptoms in physical terms,
already-established disease by restoring function and and patients experience those symptoms in their own
reducing disease-related complications should be the psychological and social context, understanding this
goal of tertiary prevention along with improving the allows more effective help to be given to the patient.
quality of life for people with the disease. He should An appropriate health care delivery system should
not only aim at treating the patient visiting his clinic acknowledge the unique and vital role of health for all
but also look for possibilities to make him aware of his aspects of the human organism. The research of
systemic diseases and how they can impact oral preventive health strategies around the world shows
health overall. Tertiary dental care services are that USA has in 2011 laid down a health prevention
provided by specialist hospitals, universities, or strategy for the nation and shows us the importance,

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especially being a developing country with poor recurrence. The treatment plan revolves around the
healthcare and social indices in India.[9] The effective oral physician making a rightful decision regarding his
use of resources, proper healthcare infrastructure, patient's concerns to proceed with an effective and
dedicated healthcare professionals and IEC campaign holistic treatment planning. The benefits include
can greatly influence preventive strategy in India.[10] higher productivity, lower treatment costs, less
Use of technology should be co-opted to leverage and suffering and premature mortality, and more cohesive
provide preventive health services to the communities families-and, of course, happier, better adjusted, more
at affordable costs.11,12 Tertiary dental care includes successful young people. 17 The outlook of the
trauma centers, burn treatment centers, oro-maxillo- integrated health system has a network of care with
facial surgery, organ transplants, radiation oncology, multiple combinations of dimensions among
etc.13 After all strengthened health system aims at subsystems such as nuclear representation, relating
saving more lives. The tertiary care facility will the clinical aspects and governance to the
combine leading-edge technology and experienced representations and collective values. The normative
staffing in a harmonious blend to provide 'round the integration aims to ensure coherence between the
clock efficient medical services. Most of the cases that system of representations and values of society
the oral physicians may come across, including simultaneously with the interfaces of clinical and
management of oral mucosal abnormalities, oral functional integration.18
cancer, salivary gland disorders, temporomandibular CONCLUSION :
disorders, often lead to the requirement of tertiary The field of medicine and oral medicine is
care. transforming at a tremendous rate, and we have come
EARLY DIAGNOSIS - KEY TO TERTIARY CARE : a long way. With a better understanding of the human
A patient coming with oral cancer needs to be very organism and its pathophysiology, an oral physician
well educated and further referred to an oncologist for with sophisticated diagnostic abilities can better
the desired treatment. Patients with anxiety stress- manage patients' oral and general health. Their
related temporomandibular joint disorder may education and preparation make them uniquely
immediately be needed to simultaneously consult a qualified to treat the oral health of a growing patient
psychiatrist and a physiotherapist. Early diagnosis is population whose management is more complex
the key to improving any chances of head and neck because they are medically or pharmacologically
cancers. The oral cavity and the oropharynx are ideal compromised. Furthermore, they are integrated into
for early detection due to their good accessibility for the healthcare professional team and health care
inspection.14 Thus, it needs to be kept in mind that delivery system, improving the coordination and
diagnosis is not the end but the beginning of integration of medicine and dentistry's patient care
practice.15 It has been found that over five people in program, biomedical research, health services
India die every hour every day because of oral research, and public and professional service.
cancer.16 So early diagnosis is crucial because the Concluding, Oral physicians are moving away from
earlier a head and neck abnormality is detected, treating the hole in the patient towards treating the
diagnosed, and treatment can begin, the better the patient as a whole.
patient can be for the rest of his life. With the scope of REFERENCES :
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