The future of Oral Medicine and Radiology in India

What is the future of Oral Medicine and Radiology in India?

Introduction 

To plan about the future, it is crucial to know thoroughly about the past and the present. Oral Medicine, Diagnosis and Radiology is a vital dental specialty in India, which is often neglected. It can be called a dual specialty as the two specializations, Oral Medicine and Oral & Maxillofoacial radiology are coupled together under a single specialty. 

Oral medicine deals with various pathological conditions of orofacial region, their diagnosis, medical management etc. Almost all the systemic diseases and conditions have oral manifestations and vice versa. Gastrointestinal,  rheumatological, dermatological, haematological diseases have oral manifestations. Autoimmune and immunodeficiency disorders and the manifestations of neurological or psychiatric diseases are often present in the oral cavity. A well trained Oral Medicine specialist plays a crucial role in identifying these and managing them.[1] 

Oral Radiology is the other part of the dual specialization. Imaging and radiodiagnosis pertaining to Radiology too is dealt with by the same specialists, in India. In all the developed parts of the world, Oral Medicine and Maxillofacial Radiology are two different specializations. Its reason and importance will be explained in the remaining part of this write up. 

American Dental Association defines Oral and Maxillofacial Radiology as a specialty of dentistry and  a discipline of radiology dealing with production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region. [2] Essentially, all oral radiology specialists should be well trained in all medical imaging modalities that are available at any point of time. 

History

18th century: Sir Jonathan Hutchinson (23 July 1828 - 23 June 1913), a surgeon at the London Hospital, is regarded as the father of oral medicine. 

1920's:  Oral medicine is set up as a definite field by Dr William Geis (USA).[1]

1895: Wilhelm Conrad Roentgen discovers X-rays.

1895: 14 days after the discovery of X- rays Otto Walkhoff made the first dental radiograph.

1896: In April 1896 William James Morton made the first dental radiograph in the USA.

1999 : ADA recognized Oral and maxillofacial radiology as the 9^th dental specialty. [3]

The History of Oral Medicine Diagnosis and Radiology in India

• Dental Radiology started as a subject merged with conservative dentistry, oral surgery and periodontics .
• 1959 : 2 year Masters Degree in Dental Radiology was initiated by Bombay University. 
• 1970 : 2 years course of MDS in dental radiology was changed to MDS in Oral Medicine, diagnosis and radiology by Bombay University. 
• 1970 : Later in 1970, the WHO gifted an OPG X-ray unit to GDC, Bangalore. 
• 1985 : On 20th June 1985 Indian Academy of Oral Medicine was formed   under the guidance of Dr BK Venkataraman and Dr. Ramachandra Reddy in Bangalore.
• During the Fifth National Conference held in Chennai, the academy was renamed as Indian Academy of Oral Medicine and Radiology. [1]

The first dental college in India to teach oral medicine was Government Dental College Bangalore, with the help of World Health Organisation (WHO). [1]

 The present perspective

Maxillofacial region is more complex than any other part of the human body. Special skills and knowledge are required for the diagnosis and treatment of various lesions and conditions pertaining to this region. 

Bygone era had very less advancements in the area of both oral medicine and maxillofacial radiology. Hence the idea of dual specialty was justified. The present day of cutting edge technologies and advanced imaging and treatment modalities demand a more detailed and thorough study in the specialization. 

 The world

Japan: Advanced imaging modalities including MRI, MDCT, USG, and CBCT are all available in dental schools for the use of the dentomaxillofacial radiology department. 

USA, UK and Australia: Advanced imaging facilities are shared with the medical imaging department.[3]

Discussion

Oral medicine and oral radiology have traveled a long way since their inceptions. In the past this specialization was all about teaching in a dental school and training the students. But the scenario has changed now. The specialists are trained for delivering care for the society. We have numerous primary health centers and hospitals around, where you can't find an oral medicine specialist!

 All developed parts of the world have already recognized their significance in healthcare sector and has provided the fertile ground for the development of both specialties. A postgraduate radiologist and oral physician should be competent to deliver care to patients in any clinical setting, including dental school practice, hospital radiology practice, or private practice.[3] 

In the present scenario, we can see both these specializations suffocating, being pushed together under a single title. Over the past three decades the information pool pertaining to both specializations have multiplied enormously. The three years of simultaneous training of both the specializations are ultimately failing to do justice to both. 

Oral and maxillofacial radiology has evolved into a behemoth starting from the stage of being a modest X-ray room exclusively dedicated for intraoral radiographs. [1]

Most of the oral radiologists are not getting an opportunity to train in advanced modalities like USG, MRI, MDCT etc. Not all dental schools in India have CBCT yet. The lack of awareness about the specialization in the healthcare fraternity is leaving most of the fresh specialists jobless. No hospital hires them. Ultimately the specialists are forced to turn into general practice for making a living. Lot of knowledge, skills and precious time is thus getting wasted. India has numerous patients who still don't get access to specialists. Ironically, a whole clinical specialty is neglected in the same country!

Conclusions 

• The most desirable and productive action is to separate Oral Medicine and Maxillofacial Radiology into two distinct specializations. Dental schools with access to all advanced imaging modalities should teach Oral and Maxillofacial radiology to postgraduate students. But this could be a really cumbersome job. The most practical suggestion is to provide super specialization programs for the present specialists in OMDR. 
• Provisions for doing super specialty in oral medicine and various other imaging modalities including CBCT, MRI, USG etc should be made on a war footing.
• The healthcare ministry should be pressurized to appoint OMDR specialists in all primary healthcare facilities and hospitals. 
• Measures should be taken to increase the awareness about the clinical specialization of OMDR, its applications and significance in healthcare deliverance. 
• Oral medicine and Oral & Maxillofacial radiology are clinical specializations, justice should be done to these specializations. The public deserve their service. [1,2,3]
  

References

1) Shetty SR, Shaik MM, Babu SG. Oral medicine and radiology- the Indian scenario. J Contemp Med Edu 2013; 1(1): 59-61

2) White SC, Pharoah MJ. Oral Radiology Principles and interpretation. 5th edn, 2004, p IX.

3) Babatunde O et al. Current status of oral and maxillofacial radiology in West Africa. J Oral Radiol Apr 2017