Professor Igor Blum, Editor of the Primary Dental Journal (PDJ), introduces the latest issue, which provides an overview and update on oral medicine for the general dental team
The art and science of oral medicine begins with the pioneering work of Sir Jonathan Hutchinson (1828–1900), a surgeon at the London Hospital, who is also regarded in the UK as the Father of Oral Medicine.1 He reported on the dental manifestations of congenital syphilis, intraoral pigmentation and perioral pigmentation associated with intestinal polyposis, later described by Peutz in 1921.2 Subsequently, ten further cases were described by Jeghers, McKusick, and Katz who also reviewed the literature on this topic in 1949.3 Individuals with Peutz-Jeghers syndrome commonly present with an association of gastrointestinal polyps, mucocutaneous pigmentation, a familial incidence, and are at an increased risk of various cancers.
Much of the early description of oral mucosal diseases was found in dermatology textbooks, as documented in the works of the English surgeon and dermatologist Sir William James Erasmus Wilson (1809–1884).4,5 Sir William Osler (1849–1919), a Canadian physician and co-founder of the Medical Library Association of Great Britain and Ireland, recognised the importance of the oral cavity and believed that the tongue and oral mucosa reflect a patient’s overall health.6 This idea, held in various medical and traditional practices, suggests that changes in the appearance or condition of the mouth, including the tongue and soft tissues, can indicate underlying systemic health issues.
In a thoroughly researched and well written article by Professor Crispian Scully in 2016, he described the immense contributions of various stalwarts who were instrumental in the initiation and popularisation of the discipline of oral medicine over a 50-year period, between 1920 and 1970.7 In the UK, the evolution of oral medicine has its origin in oral pathology and resulted in its recognition as a dental specialty by the General Dental Council in 1998, with tribute paid to the founders of the British Society for Oral Medicine (BSOM) – the predecessor organisation of The British & Irish Society for Oral Medicine (BISOM) which was established in 1981.
Although not a substitute by any means for an extensive quality textbook on oral medicine, the editorial team felt it was timely to produce an issue of the Primary Dental Journal devoted to the common and important oral medicine conditions encountered in general dental practice. This themed issue on oral medicine is geared to primary care dental practitioners and dental care professionals as a refresher and an update on oral medicine-related diseases. The articles in this issue provide an overview of current thinking in the more relevant areas of oral medicine. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features, and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.
A major challenge in the diagnosis of oral disease is the need for memorising long lists of oral lesions from oral medicine/oral pathology literature. This is made more difficult because many of these lesions are not frequently encountered by the primary care dental team. This new issue of the journal highlights common oral conditions that may be encountered in the dental practice. Pulpal, periapical, and periodontal diseases are intentionally not discussed in this issue since primary care dental clinicians are experienced in diagnosing and managing those conditions.
I trust that the oral medicine-themed issue of the PDJ will serve as a tabletop reference in General Dental Practice. The discussion of the entire spectrum of oral diseases is beyond the scope of this single issue; instead, we have selected what we believe to be important oral medicine conditions. The introductory article addresses an approach in formulating clinical diagnosis and management of the various types of oral candidosis. This is followed by articles on oral lichen planus and lichenoid lesions, managing a dry mouth in primary care, a review of common oral medicine conditions in children, oral facial pain, burning mouth syndrome, and chronic graft versus host disease (cGvHD). Although the latter is less common, it can occur in the increasing numbers of patients receiving hematopoietic stem cell transplants.8
The information presented is primarily aimed to cover the diagnostic aspects and an overview of patient management, including patient referral. The main objective is to provide readers with a cutting-edge update on the above topics, including raising awareness of the need to diagnose and manage patients with oral medicine conditions in primary care, and when to make a referral to an oral medicine service if available. Alternatively, a referral to a specialist in oral and maxillofacial surgery can be made when appropriate.
It is hoped that this themed issue will help the primary care dental team to integrate the principles of oral medicine and oral pathology into clinically applicable concepts that will enable the practitioner to develop clinical differential diagnoses and participate in definitive diagnosis through a multidisciplinary approach with dental specialty teams. It is my further hope that the reader will not only be provided with updated information as to the multiple facets of oral medicine conditions but will also find new information to further aid them in the diagnosis and management of these occasionally enigmatic disorders.
No issue of the Primary Dental Journal could come to successful fruition without the contributions of well-qualified authors. I am extremely thankful to the guest editor, Dr Emma Hayes, consultant in oral medicine, and to all contributing authors for their invaluable input to this issue. I believe that this edition of the Primary Dental Journal will be an asset and resource to the general dental practice team.
The Primary Dental Journal is the College’s quarterly peer-reviewed journal dedicated to general dental practice. The titles and abstracts of PDJ papers are available to all dental professionals via the searchable PDJ homepage, with full paper access available to College members through the PDJ Library.
Printed copies of the Summer 2025 issue on oral medicine should arrive with College members in the second half of September.
References
1 Spielman AI. History of Oral Diagnosis, Medicine, Pathology and Radiology. In: Illustrated Encyclopedia of the History of Dentistry. [Internet]. New York: History of Dentistry and Medicine; 2023. Available at historyofdentistryandmedicine.com [Accessed Jun 2025]
2Peutz JLA. Over een zeer merkwaardige, gecombineerde familiaire pollyposis van de sligmliezen van den tractus intestinalis met die van de neuskeelholte en gepaard met eigenaardige pigmentaties van huid-en slijmvliezen (Very remarkable case of familial polyposis of the mucous membrane of the intestinal tract and nasopharynx accompanied by peculiar pigmentations of skin and mucous membrane). Nederl Maandschr v Geneesk. 1921;10:134-146. Dutch.
3Jeghers H, McKusick VA, Katz KH. Generalized Intestinal Polyposis and Melanin Spots of the Oral Mucosa, Lips and Digits — A Syndrome of Diagnostic Significance. N Engl J Med. 1949;241(26):1031-1036.
4Wilson E. On The Management of the Skin as a Means of Promoting and Preserving Health (3rd ed.). London: John Churchill; 1849. Retrieved 15 June 2025. Full text at Internet Archive (archive.org)
5Wilson E. On Diseases of the Skin (4th American, from the 4th & enlarged London ed.). Philadelphia: Blanchard & Lea; 1857. Retrieved 15 June 2025. Full text at Internet Archive (archive.org)
6Stone MJ. The wisdom of Sir William Osler. Am J Cardiol. 1995;75(4):269-276.
7Scully C. Oral medicine in academia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(1):111.
8Passweg JR, Baldomero H, Chabannon C, et al. Hematopoietic cell transplantation and cellular therapy survey of the EBMT: monitoring of activities and trends over 30 years. 2021;56(7):1651-1664.
