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The undiagnosed patient: What are you missing?

Oct. 15, 2020
Many patients with chronic oral lesions suffer pain and frustration for years without diagnoses of their conditions, even after seeing multiple doctors.

From how many practices does a patient with a chronic, undiagnosed oral condition usually seek assistance before getting a definitive diagnosis? The answer is sometimes eight different offices. The failure to obtain a definitive diagnosis is stress producing on its own, and the stress may extend for years.

Oral symptoms such as redness, soreness/pain, blistering, or crusting are often reported by patients who have various mucosal diseases. Many skin diseases have oral manifestations as well. Stress related to SARS-COVID-19 is another factor in an already stressful world. Although stress is not often scientifically proven in most cases, we do know that illnesses appear to rise during stressful periods in a patient’s life.

The diagnosis of uncommon types of oral conditions is a frequent occurrence in stomatology clinics and in oral medicine clinics at many dental schools, generally because the person has been to other facilities that have not diagnosed them with a disease or disorder. Referring a patient to these clinics where oral medicine, oral pathology, and medical experts are on faculty is usually the best practice. Many patients who have oral lesions from pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) have searched for many years to find the cause of their suffering.

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This also occurs with oral lichen planus (OLP). Often patients are told that they must “learn to live with it,” and the search for a diagnosis ends until symptoms recur or progress. The International Pemphigus and Pemphigoid Foundation has reported that some patients will see multiple practitioners before securing a diagnosis. Patients report feeling alone and extremely frustrated when they are unable to receive treatment to cure their oral problems. Oral diseases such as OLP, MMP, and PV are very often misdiagnosed or unidentified for long periods of time, adding to tissue destruction and frustration for patients.

Oral medicine-educated dentists treat and diagnose oral diseases that most practices do not see frequently and sometimes not at all. In 2020, oral medicine became a dental specialty with many educational/training programs throughout the United States. The American Academy of Oral Medicine (AAOM) defines oral medicine as: the specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of medically related disorders or conditions affecting the oral and maxillofacial region.