{"id":4215,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmedicine\/"},"modified":"2026-01-28T09:11:41","modified_gmt":"2026-01-28T09:11:41","slug":"oralmedicine","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/oralmedicine\/","title":{"rendered":"Oral Medicine"},"content":{"rendered":"\n<title>Oral Medicine<\/title>\n\n\n\n<p class=\"has-alert-red-color has-text-color wp-block-paragraph\">All those suspected of having cancer must be referred to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Maxillofacial Surgery<\/a> at St Johns. The <a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/head-and-neck-and-thyroid-cancers\/\" target=\"_blank\" rel=\"noreferrer noopener\">head and neck section<\/a> of the Scottish Referral Guidelines for Suspected Cancer outlines that this includes anyone with 3 or more weeks of unexplained:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-b742fa7253ad4716122c9abbd0b5be6f\">Red or mixed red and white patches of the oral mucosa (not oral thrush)<\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-d392c7c26c824357a5fa414b211d75d4\">Ulceration or swelling\/induration of the oral mucosa<\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-76a1fe2766d7332a0faf59e5964c681c\">Neck or parotid lump.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color wp-block-paragraph\">Red flag throat symptoms require referral to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/neck-lump-and-throat-cancer-risk-assessment\/\" target=\"_blank\" rel=\"noreferrer noopener\">ENT<\/a>.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-28a369dfd0c546232bc9960a5a2f7c4b wp-block-paragraph\"><strong>Patients with lesions in their mouth considered urgent suspicious of cancer should be referred directly to the OMFS service at St John\u2019s Hospital using the specific SCI Gateway pathway. They should not be referred to oral medicine or oral surgery.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>The specialty of Oral Medicine deals with the diagnosis and non-surgical management of patients with chronic \/ recurrent, benign conditions of the oral mucosa and facial pain. These conditions are often intractable and related to systemic disease requiring multi-disciplinary care.<\/span><br><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Referrals for children, adolescents and adults are accepted from primary and secondary care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration:underline\"><strong>The Oral Medicine service is delivered on two sites within NHS Lothian<\/strong><\/span>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Edinburgh, Mid- and East Lothian patients<\/strong> &#8211; Oral Medicine at the Edinburgh Dental Institute. On SCI Gateway access is via Lauriston (Oral Health).<\/li>\n\n\n\n<li><strong>West Lothian patients<\/strong> \u2013 refer to Oral Medicine at St John&#8217;s Hospital, Livingston, where patients are managed by the Oral &amp; Maxillofacial Surgical team.<br><br><span style=\"text-decoration:underline\"><strong>The conditions managed include<\/strong><\/span>:<\/li>\n\n\n\n<li>Recurrent oral ulceration<\/li>\n\n\n\n<li>Herpes labialis<\/li>\n\n\n\n<li>Angular cheilitis<\/li>\n\n\n\n<li>Chronic Oral candidiasis<\/li>\n\n\n\n<li>Geographic tongue<\/li>\n\n\n\n<li>Oral white patches <\/li>\n\n\n\n<li>White sponge naevus<\/li>\n\n\n\n<li>Vesiculobullous disorders<\/li>\n\n\n\n<li>Suspected drug reactions<\/li>\n\n\n\n<li>Temporomandibular joint (TMJ) disorders<\/li>\n\n\n\n<li>Acute or chronic facial pain of non-odontogenic origin<\/li>\n\n\n\n<li>Burning mouth syndrome<\/li>\n\n\n\n<li>Medical Salivary disorders, including dry mouth, Sj\u00f6gren&#8217;s syndrome and excess salivation<\/li>\n\n\n\n<li>Oral facial granulomatosis<\/li>\n\n\n\n<li>Suspected orofacial allergic disorders<\/li>\n\n\n\n<li>Oral lesions in immunocompromised patients.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration:underline\"><strong>Associated specialties are<\/strong><\/span><strong>:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralSurgery\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralSurgery\/\" target=\"_blank\">ORAL SURGERY<\/a><\/strong>&#8211; deals with the diagnosis and management of pathology of the mouth and jaws that&nbsp;requires surgical intervention, but where cancer is not suspected.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralMaxillofacialSurgery\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralMaxillofacialSurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">ORAL &amp; MAXILLOFACIAL SURGERY (OMFS)<\/a><\/strong> &#8211; the diagnosis and management of benign and malignant diseases affecting the mouth, jaws, face and neck. The team at St John&#8217;s Hospital delivers the only&nbsp;OMFS service for NHS Lothian and does so for patients of all ages, including children.&nbsp;<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Please see above for details of conditions managed.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Anyone suspected of having oral cancer &#8211; who should be referred to Oral and Maxillofacial Surgery at St John&#8217;s, Livingston. For further details please see&nbsp;<a href=\"\/refhelp\/guidelines\/OralMaxillofacialSurgery\" target=\"_blank\" rel=\"noreferrer noopener\">OralMaxillofacialSurgery.aspx<\/a><\/li>\n\n\n\n<li>Those requiring surgical treatment, or likely to need a biopsy<strong>.<\/strong><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Urgent Suspicion of Cancer<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All such referrals should be directed to Oral and Maxillofacial Surgery, St John&#8217;s Hospital via SCI Gateway.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Routine and Urgent referrals via SCI Gateway:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Edinburgh, Mid and East Lothian patients \u2013 refer to Lauriston, Oral Health Oral Medicine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">West Lothian patients \u2013 refer to Oral Medicine, St John&#8217;s Hospital, Livingston.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Emergency referral to Oral Medicine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If a GP or a dentist needs to access an emergency referral for a patient, please contact: &nbsp;&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Edinburgh, East- or Midlothian: &nbsp;Oral Medicine at the Edinburgh Dental Institute &#8211; 0131 536 4566 (same route as Oral Surgery).<\/li>\n\n\n\n<li>West Lothian: Oral and Maxillofacial Surgery &#8211; via St John&#8217;s Hospital switchboard.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"http:\/\/www.healthcareimprovementscotland.org\/our_work\/cancer_care_improvement\/programme_resources\/scottish_referral_guidelines.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish referral guidelines for suspected cancer (Healthcare Improvement Scotland)<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/medication-related-osteonecrosis-of-the-jaw\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/anticoagulants-and-antiplatelets\/\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Dental Patients taking Anticoagulants or Antiplatelet Drugs (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/antibiotic-prophylaxis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Antibiotic Prophylaxis (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.baoms.org.uk\/#MainForm\">British Association of Oral and Maxillofacial Surgeons<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.baos.org.uk\/\">British Association of Oral Surgeons<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.bsom.org.uk\/home\/\" target=\"_blank\" rel=\"noreferrer noopener\">The British Society for Oral Medicine (BSOM)<\/a>: this website has produced patient information leaflets for a number of oral conditions.<\/li>\n\n\n\n<li><a href=\"http:\/\/www.bad.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">British Association of Dermatologists<\/a>: patient information leaflets available.<\/li>\n\n\n\n<li><a>International Association for the Study of Pain: <\/a><a href=\"https:\/\/www.iasp-pain.org\/resources\/\">patient resources available<\/a>.<\/li>\n\n\n\n<li><a href=\"https:\/\/www.england.nhs.uk\/commissioning\/wp-content\/uploads\/sites\/12\/2015\/09\/guid-comms-oral.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Guide for Commissioning Oral Surgery and Oral Medicine (NHS England)<\/a><br><br><strong>Primarily for dentists:<\/strong><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.rcseng.ac.uk\/dental-faculties\/fds\/publications-guidelines\/clinical-guidelines\/\" target=\"_blank\" rel=\"noreferrer noopener\">Guidelines for Selecting Appropriate Patients to Receive Treatment with Dental Implants: Priorities for the NHS (Royal College of Surgeons)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/sedation\/\" target=\"_blank\" rel=\"noreferrer noopener\">Conscious Sedation in Dentistry (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.baos.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">British Association of Oral Surgeons (BAOS)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/management-of-acute-dental-problems-madp\/\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Acute Dental Problems (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.england.nhs.uk\/commissioning\/wp-content\/uploads\/sites\/12\/2015\/09\/guid-comms-oral.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Guide for Commissioning Oral Surgery and Oral Medicine (NHS England)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.bsperio.org.uk\/news\/dementia-friendly-dentistry-good-practice-guidelines\">Dementia friendly dentistry: good practice guidelines<\/a>.<\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/management-of-acute-dental-problems-madp\/\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Acute Dental Problems (SDCEP)<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Oral Medicine All those suspected of having cancer must be referred to Oral Maxillofacial Surgery at St Johns. The head and neck section of the Scottish Referral Guidelines for Suspected Cancer outlines that this includes anyone with 3 or more weeks of unexplained: Red flag throat symptoms require referral to ENT. Patients with lesions in<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3839,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[83],"class_list":["post-4215","page","type-page","status-publish","hentry","category-oral-medicine"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dentistry-oral-health-service\/oral-medicine\/\" rel=\"tag\">Oral Medicine<\/a>","rttpg_excerpt":"Oral Medicine All those suspected of having cancer must be referred to Oral Maxillofacial Surgery at St Johns. The head and neck section of the Scottish Referral Guidelines for Suspected Cancer outlines that this includes anyone with 3 or more weeks of unexplained: Red flag throat symptoms require referral to ENT. Patients with lesions in","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4215","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4215"}],"version-history":[{"count":11,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4215\/revisions"}],"predecessor-version":[{"id":26322,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4215\/revisions\/26322"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3839"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4215"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4215"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}