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Oral Medicine Curriculum across EAOM member countries 
The contribution of Cristina Bez in the preparation of the manuscript is acknowledged

Introduction
Even though there is a general, world-wide consensus defining Oral Medicine (OM) as the branch of dentistry related to the “oral health care of patients suffering from chronic recurrent and medically related disorders of the mouth and with their diagnosis and non surgical management” (Baum&Scully, 2015), severe discrepancies in OM curricula among member countries are glaring.
 
Aim
During 2015 Professor Alexandra Sklavounou, President of the European Association of Oral Medicine (EAOM), proposed and coordinated a working group consisting of six EAOM Board Regional representatives, in order to describe accurately the similarities and differences among the educational and training programmes in countries represented within the Association.  
 
Methods
The following six EAOM Board Regional Representatives in 2015, Roddy McMillan, Stina Syrjanen, Arjan Vissink, Cristina Bez, Noam Yarom, Douglas E. Peterson were enrolled.. The members were asked to obtain information for each country included in their Region and to present it in a tabulated format. The information was classified according to the questionnaire reported in Table 1. Each member was able to choose freely the procedure to retrieve information within his/ her Region. In some countries, such as in the United Kingdom, India or the United States, all the information had already been officially published by a regulatory authority (e.g. the General Dental Council in United Kingdom) whereas in other countries the source was represented either by personal contacts with colleagues involved in teaching OM in Universities or by members of national OM Associations (when available).  
 
Results 
It was possible to retrieve information from the following 34 countries out of 48: United Kingdom, Denmark, Estonia, Finland, Iceland, Norway, Sweden, Austria, Belgium, Czech Republic, Germany, Hungary, Luxemburg, Netherlands, Poland, Slovakia, Switzerland, Italy, Malta, Spain, Portugal, Albania, Bosnia and Herzegovina, Croatia, Greece, Israel, Romania, Slovenia, Turkey, Brazil, India, South Korea, Thailand, United States.
It was not possible to recover any information about the OM curricula for the following 14 countries: Ireland, Latvia, Lithuania, France, Bulgaria, Cyprus, Russia, Serbia, Ukraine, Indonesia, Japan, Australia, Kingdom of Saudi Arabia, New Zealand.
In 5 out of 34 countries, OM is an officially recognized specialty: United Kingdom, Estonia, Croatia (recognized specialty since 1997), Israel, Brazil. The duration of the post-graduate programmes ranges from 2 years (at least 750 hours) in Brazil to 5 years in the United Kingdom. In Croatia the specialty programme lasts 3 years, in Israel 4 years.
In 3 out of 34 countries, OM is incorporated into other specialty programmes: Bosnia and Herzegovina (since 1992 integrated with Periodontology and Oral Medicine), Turkey (Oral Surgery and Oral Medicine), India (Oral Medicine combined with Oral Radiology). It is of note that in Slovenia a 3-year combined specialty programme of Oral Diseases, Periodontology and Dental Diseases started in 1973 and ended in 2000. In this programme 1 year was exclusively dedicated to oral diseases.
In some countries OM training is combined with Oral Surgery (Denmark, Germany, Netherlands, Norway, Malta, Turkey) or Oral and Maxillo-Facial Surgery (Belgium, Germany, Netherlands, Slovenia). In Portugal the specialty in Stomatology refers to Medical Doctors only, which allows them to practice OM exclusively in hospitals. Collegues with a degree in Dentistry do not have the right to attend an OM specialization programme and therefore they can not practice OM in hospitals.
Post-Graduate (PG) courses in OM operate in the following 20 countries: United Kingdom, Czech Republic, Hungary, Netherlands, Poland, Slovakia, Italy, Malta, Spain, Portugal, Bosnia and Herzegovina, Croatia, Greece, Israel, Romania, Brazil, India, South Korea, Thailand, Unites States.
Greece presents a well-structured PG course completely dedicated to OM. However OM is still not officially recognized as a specialty in this country. It lasts 3 years with 2.5 years fully dedicated to Oral Medicine and Pathology and the remaining time to Internal Medicine, Dermatology, Rheumatology, Eye Nose Throat (ENT) and General Pathology.
Even if dental treatment for medically complex patients is included within the scope of oral medicine practice in many areas of the world as reported by Stoopler and co-workers in 2011, in the United Kingdom the General Dental Council has defined a new specialty of Special Care Dentistry.
Within OM programmes there is a general consensus regarding main topics, which include the following: history taking, clinical examination, laboratory investigations, clinical management of chronic, recurrent and medically related disorders of the oral and maxillofacial region.
However, as underlined in the United Kingdom, United States and Brazil, a specialist in OM is also expected to function effectively and efficiently in multiple health care environments and within interdisciplinary health care teams. He or she should apply scientific principles to learn and to provide oral health care: critical thinking, evidence or outcomes-based clinical decision-making and technology-based information retrieval system. Practitioners must utilize the values of professional ethics, lifelong learning, patient-centered care, adaptability and acceptance of cultural diversity in professional practice. They must understand the oral health needs of communities and engage community service. Therefore management and health care delivery, time management, patient safety, team working and quality improvement should be part of the OM care provider curriculum.
 
Discussion
While the present investigation attempts to analyse the structure of educational and training programmes of oral medicine mainly in Europe, it also includes some global data. It is evident from the results reported that the scenario is far from uniform and this variability most likely reflects differences in history, culture and economic policies among countries. As already highlighted by Stoopler and coworkers (2011), the diversity of oral medicine practice is not surprising in view of the heterogeneity of settings and systems of health care across the world. In certain countries such as the United Kingdom, United States and Brazil, OM curricula are more detailed and standardized compared to others.
This manuscript provides a starting point for a constructive discussion among members of the EAOM to work towards harmonization and uniformity of OM curricula and to eventually provide guidelines for an OM specialty recognition. It is important to agree on a minimum standard curriculum and define what an OM clinician or researcher should know. Without this, it will remain difficult to overcome local divergence and to participate in an international scientific Association.
 
References
1. Baum BJ, Scully C. Training specialists in oral medicine. Oral Dis. 2015 Sep; 21(6): 681-4. doi:10.1111/odi.12351.
2. Stoopler ET, Shirlaw P, Arvind M, Lo Russo L, Bez C et al. An international survey of oral medicine practice: proceedings from the 5th World WOrkshop in Oral Medicine. Oral Dis. 2011 Apr; 17 Suppl 1:99-104. doi: 10.1111/j.1601-0825.2011.01795.x.
 
Table 1 - Descriptors to summarize the Oral Medicine Curriculum in each country
 

Descriptors
Is Oral Medicine a recognized Specialty?
Are there Oral Medicine Post-Graduate courses?
How long do they last?
Which are the main topics covered in each course?
 
 
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