Join Dr. Nirainila Joseph from MedBound Times in this edition of DocScopy as she discusses the expansive field of oral medicine with Dr. Lokapriya Manickam. Dr. Lokapriya completed her BDS degree at Tamil Nadu Government Dental College and Hospital, Chennai, India and MDS degree in Oral Medicine & Radiology at Vokkalingara Sangha Dental College and Hospital, Bangalore, India. She has also completed an Executive MBA in Health care from the Indian Institute of Management (IIM), Calcutta, India.
Dr. Lokapriya shares her expertise on the diverse and critical roles within oral medicine. She explores the field's responsibilities beyond the diagnosis of tooth problems, emphasizing their critical roles in systemic diseases, cancer, forensic investigations, physical abuse cases, and even the battle against COVID-19. She also discusses the importance of understanding antimicrobial resistance and medication-related oral side effects.
Dr. Nirainila Joseph: Please introduce yourself to our readers
Dr. Lokapriya Manickam: I am Dr Lokapriya. BDS was my choice since 9th grade. I graduated from GDC Chennai and MDS in Oral Medicine & Radiology from VS Dental College, Bangalore. I completed a fellowship in Forensic Odontology from IDA, and am a fellow in Facial eAsthetics and Cosmetology. I also graduated with an Executive MBA in Health care from IIM Calcutta. Right now, I am working as the Clinical Operations Manager at Clove Dental and managing the operations of 100+ clinics.
Dr. Nirainila Joseph: For someone unfamiliar with the field, how would you explain what oral medicine is and why it's an important specialty within dentistry?
Dr. Lokapriya Manickam: Oral medicine is equivalent to general medicine, where a basic diagnosis is done to choose a speciality for further treatment. It is a bridge between general health and oral health.
Dr. Nirainila Joseph: Many people associate oral medicine with treating cavities and gum disease. Can you highlight some areas where oral medicine plays a crucial role that may surprise the public? How does oral medicine integrate with other medical specialties to provide comprehensive patient care?
Dr. Lokapriya Manickam: Diagnosis is the major part of oral medicine. Arriving at a diagnosis can’t be done just by looking into the oral cavity for all diseases. Comprehensive analysis of general health for the disease seen in oral cavity is very crucial and that’s what an oral physician does. Oral cavity is beyond teeth, tongue and gums.
Also, it is always important to consider oral cavity and whole body as a single unit. There are a lot of skin lesions that can start from the oral cavity. Intestinal and colon diseases can show early- onset symptoms in the oral cavity. Diseases of almost every organ can show symptoms in the oral cavity.
Dr. Nirainila Joseph: Given this interconnectedness, how does oral medicine bridge the gap with general medicine and contribute to a patient's well-being?
Dr. Lokapriya Manickam: As mentioned earlier, a simple routine oral check up can help diagnose many health issue. Common being diabetes, anemia. A simple dental full mouth radiograph can help us diagnose osteoporosis to oral health in pregnancy can prevent premature birth and low birth weight.
Dr. Nirainila Joseph: Let's discuss the role of oral medicine specialists in conditions beyond the teeth and gums, starting with oral cancer. While it is a serious concern, public awareness is often low. How do oral medicine specialists play a role in early detection and management of oral cancer?
Dr. Lokapriya Manickam: There are certain lesions called pre-cancerous lesions, which are often neglected in a routine check-up. The oral check-up should include all the structures and not just the teeth and gums. Identifying these conditions at an early stage can prevent complications. A sound knowledge of what are normal structures and what are abnormal is better with an oral physician.
Dr. Nirainila Joseph: Diagnosing orofacial pain is often complicated due to its diverse causes, ranging from dental issues to neurological conditions. Can you explain how an oral medicine specialist's understanding of the orofacial complex contributes to their ability to diagnose and manage orofacial pain?
Dr. Lokapriya Manickam: All the structures like TMJ, lymph nodes and muscles of the jaw must be a part of examination. Similarly, reviewing all the structures in the radiograph is also important, the chance of seeing an asymptomatic elongated styloid process is very common. How many of the dentists have seen it!
Dr. Nirainila Joseph: That's interesting! One area where oral medicine specialists have played a crucial role in recent times is in the diagnosis of COVID-19. Loss of smell and tastebecame a widely recognized symptom while some people also experienced mouth and oral mucosal lesions as signs of COVID-19 infection. Can you explain why oral medicine specialists play a crucial role in identifying and differentiating these symptoms from other underlying conditions?
Dr. Lokapriya Manickam: The most important was psychological evaluation. An oral physician deals with psychosomatic disorders, the basic difference of it is the person is just feeling it or there is an actual loss that was critical during the COVID. Apart from that the duration and other symptoms were considered to differentiate. Also, every symptom should be considered in 360 view.
Dr. Nirainila Joseph: Since oral medicine specialists prescribe various antibiotics for different oral infections, they are at the forefront of addressing the challenge of antimicrobial resistance which is a growing public health concern. How does oral medicine address the challenge of ensuring effective treatment options for oral infections while minimizing resistance?
Dr. Lokapriya Manickam:
1. Judicial utilization of antibiotics
2. Understanding and diagnosis of disease - can avoid prescribing Amox & Metrogyl in all oral conditions
3. Knowledge of the right dosage and duration
4. Google information
Dr. Nirainila Joseph: Not everyone realizes oral medicine specialists are involved in managing medication-related side effects in the oral cavity. How do you address these issues of medications impacting oral health?
Dr. Lokapriya Manickam: That's where the detailed history of medication, drug combination, dosage and duration is important. And a sound knowledge on adverse drug effects and alternate medication is helpful.
Dr. Nirainila Joseph: What is the role of oral medicine specialists in conducting pretreatment dental evaluations for patients about to undergo other medical treatments?
Dr. Lokapriya Manickam: Any invasive surgery requires intubation of the patient and hence oral hygiene is crucial. A complete check up and not missing any finding or potential disease that is anticipated should be diagnosed and treated.
Dr. Nirainila Joseph: Given that the role of oral medicine specialists extends beyond just addressing medical issues, how do they play a crucial part in identifying individuals who may be experiencing abuse?
Dr. Lokapriya Manickam: The first dentist to examine any patient is an Oral Physician. The cocktail knowledge of oral health/oral injury, general health and psychology of the child/patient makes identification of the issue on the right time.
Dr. Nirainila Joseph: Another intriguing area in your expertise is forensic odontology. Can you discuss the role of oral medicine specialists in this field, which extends beyond routine diagnosis and treatment ?
Dr. Lokapriya Manickam: Identifying the duration of a disease/injury from the signs and it and correlation of it with the scenario becomes easy with comprehensive thinking capacity of an oral physician.
Dr. Nirainila Joseph: Understanding that oral health problems can affect a patient's mental well-being, how do you incorporate psychological support into your treatment approach?
Dr. Lokapriya Manickam: The psychological aspect of evaluation starts as soon as the individual enters the clinic, the way they start talking to us, the way they respond to the questions till the way they respond to the diagnosis and the treatment. These can give us an idea about the patient's psychology. Addressing it to the patient is very sensitive. We take time, evaluate the best time, and understand the patient's ability. At times, discussion with the family member will make way. Ultimately, it is very important to address it to patient as it will impact the healing process.
Dr. Nirainila Joseph: That is thoughtful. In your experience, how aware is the general public of the oral medicine specialty? Have you encountered any misconceptions about oral medicine that you find particularly important to address?
Dr. Lokapriya Manickam: Common people including general doctors are not aware of this specialty. But, the more painful truth is some dentists are also not aware of the subject depth of this specialty. The huge misconception about oral medicine is that this is a non clinical specialty. But this is the first department where a patient walks in and the basic diagnosis is done.
Dr. Nirainila Joseph: It’s true that many, including general doctors, are not fully aware of the depth of oral medicine as a specialty. However, on the bright side, can you list the latest advancements or research areas in oral medicine that you find particularly exciting?
Dr. Lokapriya Manickam: Advancement of imaging, AI in imaging as well as laser application in various oral lesions.
Dr. Nirainila Joseph: As someone with comprehensive knowledge and significant expertise in oral medicine, what would you like to say to those dental students who are considering a career in this specialty?
Dr. Lokapriya Manickam: It will be a great choice if you really miss being a general doctor. This is the only specialty where one can have a comprehensive approach within dentistry and outside dentistry, if you are looking to explore more in healthcare sector.
Stay tuned for Part II!