Letters to the Editor  |   February 2012
Oral Health Awareness for Osteopathic Medical Students—A Medical and Dental Collaborative Effort
Author Affiliations
  • Arnold H. Rosenheck, DMD
    Assistant Dean, Acting Chair, Department of Community Health, New Jersey Dental School
  • George J. Scott, DO, DPM
    Assistant Professor, Department of Family Medicine, School of Osteopathic Medicine
  • H. Timothy Dombrowski, DO, MPH
    Associate Professor, Chair, Department of Internal Medicine, School of Osteopathic Medicine
  • Harold V. Cohen, DDS
    Professor, Department of Diagnostic Sciences, New Jersey Dental School
  • Jill A. York, DDS, MAS
    Associate Professor, Department of Community Health, New Jersey Dental School
  • Alan Kleiman, DMD
    Clinical Instructor, Department of Oral and Maxillofacial Surgery, Department of Community Health, New Jersey Dental School
  • Joshua S. Coren, DO, MBA
    Acting Chair, Associate Professor, Department of Family Medicine, School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey
Article Information
Medical Education
Letters to the Editor   |   February 2012
Oral Health Awareness for Osteopathic Medical Students—A Medical and Dental Collaborative Effort
The Journal of the American Osteopathic Association, February 2012, Vol. 112, 80-82. doi:
The Journal of the American Osteopathic Association, February 2012, Vol. 112, 80-82. doi:
To the Editor: 
Ever since then–US Surgeon General David Satcher, MD, PhD, released Oral Health in America: A Report of the Surgeon General in May 2000,1 subsequent surgeon generals have echoed the report's theme that one cannot be healthy without having good oral health. Dr Satcher's report brought to the attention of the US public—for the first time—the importance of oral health to the well-being of individuals and to the effectiveness of health care management systems. 
The oral cavity, mouth, and associated structures are often a mirror of total body health. The image of the 19th-century physician asking his patient to stick out his tongue is a classic representation of the medical profession's understanding of this concept in simpler times. It is now known that hundreds of diseases affect and manifest themselves in the oral cavity, and a developing area of knowledge and research concerns the connection between oral and systemic health. Oral conditions, such as periodontal disease, may impact such systemic conditions as cardiovascular disease and diabetes mellitus. Conversely, systemic disease can adversely impact the oral cavity. 
In regard to oral health, head and neck cancers make up an area of particular concern. In 2010, approximately 36,500 individuals in the United States were diagnosed as having cancer of the oral cavity or pharynx.2 About 8000 of these people are expected to eventually succumb to their disease.2 In many patients, diagnosis of these cancers is not made until the disease has spread locally or metastasized to other parts of the body.2,3 The 5-year survival rate for patients with oral cancer has remained at only about 50% as a result of the fact that two-thirds of the lesions are detected at later stages of progression.3 
These statistics mandate a growing need for early detection of oral lesions. By expanding awareness among physicians of the clinical appearance of oral, head, and neck cancers, more precancerous lesions and early cancerous lesions could be detected—vastly improving the cure rate.3 The implementation of comprehensive oral, head, and neck examinations of patients will allow physicians to observe adverse oral health conditions, leading to appropriate diagnoses and referrals for treatment. In addition, multiple diseases that have oral manifestations diagnostic of the diseases will be diagnosed in a more accurate and timely manner, improving the treatment of patients. 
It is important to keep in mind that physicians are held accountable for standards of medical care that require them to conduct thorough physical examinations of their patients and to detect any lesions of the oral cavity that exist. 
These concepts of oral health were deemed important by the deans of the University of Medicine and Dentistry of New Jersey-New Jersey Dental School (UMDNJ-NJDS) in Newark and the UMDNJ-School of Osteopathic Medicine (UMDNJ-SOM) in Stratford, resulting in the development of a unique curriculum on oral health for osteopathic medical students at UMDNJ-SOM. In August 1989, UMDNJ-SOM Dean Frederick J. Humphrey II, DO, received the UMDNJ Board of Trustees' approval to create a Department of Dental Medicine. This department was to be directed by, and contain faculty from, UMDNJ-NJDS. The dental school faculty developed a curriculum in conjunction with the faculty at UMDNJ-SOM, and this curriculum was designed to be taught throughout the 4 years of predoctoral training at UMDNJ-SOM. Subsequent to the 2005 retirement of the Department of Dental Medicine's first chair, George Mardirossian, DMD, the UMDNJ-SOM's dean, Thomas A. Cavalieri, DO, collaborated with the NJDS's dean, Cecile A. Feldman, DMD, to arrange for 1 of us (A.H.R.) to direct the Department of Dental Medicine and to expand the curriculum. All faculty involved in writing the present letter have been integral to the success of this curriculum. 
In keeping with the model originally designed by Dr Mardirossian, the dental medicine curriculum is taught within existing medical disciplines as modules to coordinate with, and enhance, the medical education of osteopathic medical students. These modules are currently integrated into the second, third, and fourth years of the osteopathic medical school curriculum. The various modules build upon each other, requiring the student to call upon knowledge gained in other medical classes. 
The second-year program begins with the Comprehensive Oral/Head and Neck Examination. Through a lecture and slide presentation, students are taught a standardized examination protocol along with local anatomic landmarks and standardized nomenclature. Students then participate in a clinical laboratory session in which small groups practice the examination protocol while being supervised by a faculty member. This module is incorporated into the physical diagnosis course. 
The next module, Prevention and Early Detection of Oral Cancer, is incorporated into the Department of Internal Medicine's course on disease prevention. Students are first introduced to an array of oral manifestations of diseases other than oral cancer, providing them with the opportunity to recognize the full spectrum of oral diseases of local and systemic origin. This introduction is followed by a discussion of oral cancer, including its risk factors, etiologic characteristics, pathogenic development, epidemiologic factors, and clinical appearance. Finally, students are taught methods of detection, biopsy, and patient referral. 
In the Department of Pathology's course, second-year students are given a series of lectures pertaining to oral pathology. Inflammatory diseases, odontogenic cysts, and tumors of the oral cavity, oropharynx, and salivary glands are among a total of 8 topics in this oral pathology module. 
Toward the end of the sophomore year of training, osteopathic medical students attend a lecture describing the Clinical Pathways Protocol. This protocol was developed at UMDNJ-NJDS several years ago and has been continuously updated. The focus of the protocol is an algorithm for patients who have specific medical diagnoses that may require dental or oral consultation or additional treatment before, during, or after primary medical treatment. The goal of the Clinical Pathways Protocol is to teach students to deal with oral conditions and improve medical treatment outcomes. 
In addition to classroom-based lectures and laboratories, second-year students have an opportunity to rotate through the UMDNJ Dental Center to observe patients being treated for various oral conditions. This rotation enhances the lectures that students previously received by allowing them to observe the clinical application of the knowledge that they have gained. 
Before their rotation at the Dental Center, students receive a copy of the American Dental Association's Definitions of Dentistry and Recognized Dental Specialties, as well as a copy of the Clinical Pathways Protocol. Working in small groups, the students then shadow a senior dental student during routine dental examinations and various dental restorative and surgical procedures. After completing this session, the students participate in a question-and-answer and debriefing period in which they can obtain more information regarding questions they may have about their observations. Dental students and attending faculty answer these questions. If time permits, intraoral local anesthetic techniques are demonstrated and a review of the pharmacologic features of local anesthetics is presented. 
At the end of this session, the osteopathic medical students complete a questionnaire to answer a few basic questions on what they have learned. The questionnaire also allows students to add comments regarding their impressions of the rotation. These comments may aid in improving future rotations. 
In their third year, the students participate in an Enrichment Program as part of their family medicine clerkship. The third-year class is divided into 4 parts, each of which is scheduled at a specific time so that students are presented with a series of case-based scenarios covering the oral-systemic connection and dental medicine in various specialties of medicine. The cases of this module are presented in a PowerPoint-based format. Each student has an opportunity to discuss and present a differential diagnosis of 1 or more cases. To do so, the student must draw upon his or her previous experience in both the medical and dental medical curricula. 
The faculty of the Department of Dental Medicine is also involved in the fourth-year geriatrics program at UMDNJ-SOM. There are plans for further enrichment of the dental medicine curriculum in such areas as head and neck pain and treatment of dental pediatric patients. 
To summarize, both medical and dental professionals need to be aware of the importance of discovering, assessing, managing, and referring patients with oral health problems to maintain the optimal general health of patients. The oral health curriculum for osteopathic medical students at UMDNJ-SOM has proven to be a successful approach toward enhancing skills and raising awareness. 
Office of the Surgeon General. Oral Health in America: A Report of the Surgeon General. Washington, DC: Department of Health and Human Services; May 2000. Accessed January 6, 2012.
Ridge JA, Glisson BS, Lango MN, Feigenberg S, Horowitz EM. Head and neck tumors. In: Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ, eds. Cancer Management: A Multidisciplinary Approach. 11th ed. New York, NY: CMP United Business Media; 2008.
Ephros H, Goldman H, Lederman D, Plaia J, Wilk R. Oral and oropharyngeal cancer. In: Task Force on Cancer Prevention, Early Detection, and Treatment in New Jersey. Comprehensive Cancer Control Plan, Report to the Governor. Trenton, NJ: Department of Health and Senior Services; July 2002:193. Accessed January 6, 2012.