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American Academy of Oral Medicine: 75 years of bringing medicine and dentistry back together

2019; Elsevier BV; Volume: 129; Issue: 2 Linguagem: Inglês

10.1016/j.oooo.2019.11.002

2212-4411

Martin T. Tyler, Craig S. Miller, Peter B. Lockhart, Lauren L. Patton,

Primary Care and Health Outcomes

The historical separation of medicine and dentistry in the United States is derived from the original unregulated dentist–barber surgeon trade and its interaction with the burgeoning profession of medicine.1Gies W.J. Dental Education in the United States and Canada. A Report to the Carnegie Foundation for the Advancement of Teaching. The Carnegie Foundation for the Advancement of Teaching, New York1926Google Scholar With the passing of time, the Baltimore College of Dental Surgery, chartered in 1840 under the vision of Horace H. Hayden and Chapin A. Harris, offered the first formal dental education curriculum and introduced dentistry as a separate profession in the United States.1Gies W.J. Dental Education in the United States and Canada. A Report to the Carnegie Foundation for the Advancement of Teaching. The Carnegie Foundation for the Advancement of Teaching, New York1926Google Scholar Disparate systems for funding medical and dental care continued to promote a divide between medicine and dentistry. In 1932, the Federal Committee on the Costs of Medical Care, overseen by the Secretary of the Interior, envisioned including dentistry in publicly funded comprehensive health services. Organized medicine, however, opposed including dental coverage under the new privately funded medical insurance model, led by Blue Cross and Blue Shield in 1938.2Simon L. Overcoming historical separation between oral and general health care: interprofessional collaboration for promoting health equity.AMA J Ethics. 2016; 18: 941-949Crossref PubMed Scopus (7) Google Scholar In 1965, when Medicare was established to publicly fund health insurance for the elderly and disabled, this general exclusion of dentistry continued through effective lobbying on the part of the American Dental Association (ADA). The exclusion of dental coverage under Medicare still exists today, with minor exceptions for a very limited scope of medically necessary dental care, despite lobbying on the part of oral health advocates and interested organizations. Advocates made some progress in 1997, convincing Congress to call on the National Academy of Sciences' Institute of Medicine to consider the effectiveness and costs of extending Medicare coverage to an expanded scope of dental services for patients with specific medical conditions.3Patton L.L. White B.A. Field M.J. State of the evidence base for medically necessary oral health care.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92: 272-275Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar With the introduction of the Medicare Dental Benefit Act of 2019, and with broad support from medical organizations that see the importance of oral health to the general health of their patient populations,4Families USAClinical consensus on medically necessary dental care. Available at: https://familiesusa.org/wp-content/uploads/2019/08/Attachment_Clinical-Consensus-Review.pdf. Accessed September 29, 2019.Google Scholar we may be on the verge of real change in the funding paradigm. Funding of oral medicine services under the medical model as part of interprofessional health care is essential for the growth of our profession and access to care for our patients.5Pinto A. Mendes R.A. The business model of oral medicine—new market disruption of the practice of dental medicine.Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 127: 89-91Abstract Full Text Full Text PDF Scopus (2) Google Scholar The American Academy of Oral Medicine (AAOM) has a rich history that is deeply imbedded in patient care and dental education. The year 2020 marks the 75th anniversary of the founding of the Academy. Inspired by many forward-thinking educators and dental practitioners, founding members established the organization in 1945 under the leadership of Dr. Samuel Charles Miller, a professor of periodontics at New York University. The position of the Academy has always been at the forefront of inspiring development of oral medicine as a discipline in the United States and globally.6Scully C. Miller C.S. Aguirre Urizar J.M. et al.Oral medicine (stomatology) across the globe: birth, growth, and future.Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 121: 149-157Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar It is generally accepted that in the United States, oral medicine first received public mention in 1926 by Dr. William J. Gies, the noted biochemistry professor at Columbia University, who was interested in dental education, science, and clinical applications. In a well-researched text funded by the Carnegie Foundation, Dr. Gies recommended that oral medicine be one of the major topics covered in the dental school curriculum.1Gies W.J. Dental Education in the United States and Canada. A Report to the Carnegie Foundation for the Advancement of Teaching. The Carnegie Foundation for the Advancement of Teaching, New York1926Google Scholar Dr. Samuel Charles Miller was one of the first in modern times to recognize and promote the oral–systemic health connection, as evidenced by his early study of the relationship between gingival and systemic blood glucose and the effect of periodontal disease on them.7Miller S.C. Seidler B.B. Local microdeterminations of glucose in periodontal disease.J Dent Res. 1941; : 483-488Crossref Scopus (1) Google Scholar He also was one of the first dentists in the United States to emphasize the importance of oral medicine in the practice of dentistry and the first to establish and lead an organization to increase the awareness of "bringing medicine to dentistry." Through these efforts, the Academy was formally organized in 1945 with the name "American Academy of Dental Medicine," incorporated in the state of New York on February 2, 1946. The first professional annual meeting was held in New York City in 1947. The mission of the Academy was to meet the needs of health care professionals interested in furthering their knowledge of total patient care under the leadership of skilled clinicians and recognized educators. Graduate programs in oral medicine were subsequently started at several leading academic institutions. Each generation of members of the Academy included remarkable individuals who dedicated much of their careers to the Academy and were responsible for significant growth and leadership in the field. The AAOM has matured over the past 75 years and continues to seek to improve the quality of life of patients with nonsurgical conditions and disorders of the oral and maxillofacial region and to work with the ADA, other dental specialties, and the public to promote better understanding of this interface between dentistry and medicine. The AAOM is currently defined as offering "credentialing, resources, and a professional community for oral medicine practitioners." Oral Medicine is "the discipline of dentistry concerned with the oral health care of medically complex patients—including the diagnosis and management of medical conditions that affect the oral and maxillofacial region."8The American Academy of Oral Medicine (AAOM): representing the Discipline of Oral Medicine. Available at: https://www.aaom.com/. Accessed September 29, 2019.Google Scholar Academy members care for patients whose underlying medical conditions affect oral health and the delivery of dental care, and the Academy advocates for optimal oral health and health care for everyone with medically complex conditions in general. A recent survey of members indicated that 31.4% were employed by a University or medical center, approximately 25% of practice time was spent managing oral mucosal lesions, and there was a high degree of job satisfaction.9Villa A. Stoopler E.T. Napenas J. Employment type and career satisfaction among oral medicine specialists.J Dent Educ. 2018; 82: 630-635Crossref Scopus (3) Google Scholar Since 1946, the AAOM has held a robust annual meeting each Spring with high-quality scientific sessions given by authorities from medicine and dentistry, to include members at all stages of their careers. Prior joint meetings have been held with the American Academy of Orofacial Pain and the American Academy of Oral and Maxillofacial Pathology. Each Fall, the Academy holds a continuing education meeting for the local community of dentists. The 2020 Fall meeting will be held at the University of Pennsylvania, home to one of the oldest training programs in oral medicine, established over 50 years ago.10Stoopler E.T. De Rossi S.S. Greenberg M.S. Sollecito T.P. The global footprint of oral medicine specialists: the University of Pennsylvania experience.J Dent Educ. 2016; 80: 1464-1467Google Scholar The Academy's annual and semiannual meetings support continuing competence in oral medicine practice and outreach to the broader dental and medical community. The AAOM and its membership has long produced Clinicians Guides to help health care professionals understand and practice principles of oral medicine; the most popular publication is the Clinician's Guide to Treatment of Common Oral Conditions.11American Academy of Oral Medicine Clinician's Guide to Treatment of Common Oral Conditions.in: Siegel M.A. Sollecito T.P. Stoopler E.T. American Academy of Oral Medicine Clinician's Guide to Treatment of Common Oral Conditions. 8th ed. AAOM, Seattle, WA2018Google Scholar In addition, AAOM position papers, parameters of care, scientific monographs, and clinical practice statements focusing on oral medicine conditions and other issues have contributed to the dissemination of the science of oral medicine. The Academy also has provided regular membership and leadership to the ADA's Council on Scientific Affairs and many experts who serve on evidence-based dentistry panels. The AAOM has established, sponsored, and edited the Oral Medicine section of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and formerly published the Journal of Oral Medicine from 1946 to 1987. Understanding the importance of the Academy's growth and to serve its young members, the Academy supports graduate student research grants and assists in a Board review course; in 2019, the Academy initiated a formal Mentorship Program, based on the recognition of the importance of guiding young members through their careers. Recognition of contributions to the field of oral medicine are awarded annually by the Academy through the Jonathan Ship Lecture, Sol Silverman Lecture, the Samuel Charles Miller Award for outstanding scientific contributions in the field of oral medicine, and the James Little and Don Falace Award for outstanding scientific contributions to the sponsored journal. Distinguished contributions to the Academy are acknowledged annually through the Diamond Pin Award and Herschfus Award for lifetime achievements in oral medicine. Looking back, there are 3 particularly significant accomplishments in the past 75 years:1.In 1955, the AAOM helped establish the American Board of Oral Medicine (ABOM). The ABOM vetted oral medicine providers and created the framework for accrediting training programs in oral medicine. In 2002, adapting the ABOM standards to the Commission format, the Academy submitted an application to the Commission on Dental Accreditation (CODA) for consideration for approval of Accreditation Standards for Advanced General Dentistry Education Programs in Oral Medicine. Approval was provided in 2007, and subsequently all 6 current graduate programs in oral medicine have received CODA accreditation. This allowed for well-trained graduates from CODA-accredited advanced education programs in oral medicine. These programs have trained many specialists engaged in scientific inquiry, including federally funded studies and clinical trials, and those who have advanced the science and practice of oral medicine. In the past 10 years, AAOM members have contributed to more than 30 textbooks and more than 1000 scientific publications, resulting in thousands of citations.2.Beginning in 1988, Dr. Dean Millard (University of Michigan) and Professor Sir David Mason (Glasgow Dental College) created the first World Workshop on Oral Medicine (WWOM).12Peterson D.E. Lodi G. Beier Jensen S. et al.Report on World Workshops on Oral Medicine (WWOM) IV and V: research themes and citation impact: WWOM VI steering committee.Oral Dis. 2015; 21: 409-416Crossref PubMed Scopus (6) Google Scholar The first 2 workshops were held in Chicago at the ADA headquarters. Subsequent workshops have been held in other national and international locations and have convened experts from around the world about every 5 years, resulting in 7 WWOMs and numerous highly cited publications to date. Using a collegial and mentorship model, international experts and rising scholars discuss research advances, knowledge gaps in science, and changing clinical practice protocols related to critical and controversial issues in oral medicine. These workshops have furthered the science of oral medicine from a global perspective and benefited from critical supporting partnership from the AAOM. Leaders from the Academy (Drs. Peter B. Lockhart, Doug E. Peterson, A. Ross Kerr, and Martin Greenberg) have served on the WWOM Steering Committee and guided the past 4 workshops, which have had a significant impact on the careers of young oral medicine specialists worldwide and the specialty in general.3.An international survey found that 33 (89%) of 37 countries reported oral medicine as a recognized specialty, a distinct field of study, or an actively developing specialty.13Rogers H. Sollecito T.P. Felix D.H. et al.An international survey in postgraduate training in Oral Medicine.Oral Dis. 2011; 17: 95-98Crossref PubMed Scopus (19) Google Scholar The AAOM has long dedicated intense effort to achieving its place among the dental specialties in the United States. This effort intensified in the 1980s with the pursuit of official recognition by the ADA, and this continues to the present time. In 2014, Oral Medicine became recognized as a dental specialty by the American Board of Dental Specialties.14American Board of Dental Specialties website. Available at: https://dentalspecialties.org/. Accessed October 3, 2019.Google Scholar Soon thereafter, a legal case in Texas confirmed the authority of "oral medicinists" to claim specialty status in the state of Texas.15In the United States Court of Appeals for the Fifth Circuit. No. 16-50157. Available at: http://www.ca5.uscourts.gov/opinions/pub/16/16-50157-CV0.pdf. Accessed October 3, 2019.Google Scholar Progress continues to be made, most recently, in 2019, with the submission of an application for dental specialty recognition with the ADA-sponsored National Commission on Recognition of Dental Specialties and Certifying Boards, and it appears to be on track for approval. After 75 years, it is not only important to reflect on the past, but it is also important to examine the future. Memories may not do service to the many activities, advances, accomplishments, and friendships produced by our Academy, especially because only a few are highlighted above. An academy at age 75 years must demonstrate the maturity to have a forward vision for the next generation—one that incorporates adaptive modeling to yield a strong academy. This process requires a new set of leaders who have a strong foundation from a new educational and patient care paradigm—with a curriculum built on medical principles, scientific inquiry, and a sound evidence base that leads to oral health in the context of smart technology, preventive medicine, nutrition, social determinants, genetic and biologic risks, integrative health care, interprofessional practice, and patient empowerment. Our future must consist of clinicians who are well trained to provide novel biologic therapies, regardless of whether the delivery of these therapies is currently practiced. Innovation dictates the training of practitioners who have expertise to treat oral cancer; who are involved in wellness management; whose clinics employ nurse practitioners; whose practices have strong referral linkages to primary care providers, pharmacists, physicians, physical therapists, and alternative medicine providers; and who endorse alternative practice models, including telemedicine and integrated care models. Our new leaders must ask important questions, such as: How is oral medicine transforming lives differently now compared with a few decades ago? How are new medical, technologic, and aggregate data advances being incorporated into the practice of oral medicine? Where do we focus our financial investments to build scientific repositories and clinicians who support future oral medicine trends? And, what are the qualities required of future oral medicinists from clinical, professional, regulatory, and consumer points of view? As Drs. Bruce Baum and Crispian Scully elucidated in their 201516Baum B.J. Scully C. Training specialists in oral medicine.Oral Dis. 2015; 21: 681-684Crossref PubMed Scopus (11) Google Scholar editorial, "what is important is that those who have responsibility for oral health care have training in human medicine such that they can integrate, and work cooperatively, with physicians, nurses, and others, speaking a common language about the patients for whom they all provide care."17Nash D.A. Envisioning an oral healthcare workforce for the future.Community Dent Oral Epidemiol. 2012; 40: 141-147Crossref Scopus (18) Google Scholar, 18Berwick D.M. Reshaping US health care: from competition and confiscation to cooperation and mobilization.JAMA. 2014; 312: 2099-2100Crossref PubMed Scopus (8) Google Scholar, 19Quock R.L. Al-Sabbagh M. Mason M.K. Sfeir C.S. Bennett J.D. The dentist as doctor: a rallying call for the future.Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 118: 637-641Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 20Wilder R.S. Bell K.P. Phillips C. Paquette D.W. Offenbacher S. Dentists' practice behaviors and perceived barriers regarding oral-systemic evidence: implications for education.J Dent Educ. 2014; 78: 1252-1262PubMed Google Scholar It is the Academy's responsibility to provide the foundation, framework, and vision for integrating oral health into overall health and, therefore, seek to support graduate programs that can provide their graduates with the knowledge base and clinical skills to address the oral problems of individuals who have medically related disorders and return these patients to oral health by using the best medical principles. Doing this properly will evolve over the next 75 years, but the effort will be firmly planted at the interface among dentistry, medicine, and evolving technology. Over the next 75 years, the Academy must continue its leadership role in the field, pursuit of evidence-based practice, mentorship of trainees and early career Academy members, and assurance of high-quality care for patients.