by Leif Kullman
"Am I to be part of a potential move to the sub-specialty of Oral Radiology within Medical Radiology?."
This month I would like to tell you about my current viewpoint on our profession specialty, Oral Radiology. A profession which has changed a lot recently. I am not mainly thinking of our future with the new digital imaging systems, but of all the new professional contacts and potential within the medical side of radiology. I think there are many oral radiologists currently experiencing these changes to a greater or lesser extent.
Of course, these comments will contain a lot of my own thoughts and they will depend upon the environmental situation I am in. My own situation is also strongly influenced by our ever changing society and its structure today. As a matter of fact the question as raised above is relevant to all dentists. From an International viewpoint, we know that in some countries dental education is becoming more firmly connected to medical education than currently in Sweden at present.
Firstly, my own worktime structure in my position today requires me to be working 80% in a Dental School and 20% in a Specialist position in the county of Uppsala.
There are great differences in tasks and responsibilities between theses two working positions. In the Dental School a substantial lot of my time is devoted to student education. I have to make the planning for their fourth semester in our Radiology department and am responsible for many lectures, seminars, and other forms of theoretical (didactic) education. At the same time also guiding them when they perform their first intraoral fullmouth radiographic investigations. This is a time consuming work and usually I have too little time for supervising a lot of patient investigations, which are always interesting if one is clinically inclined. In a dental School there is also often limited opportunities to see and treat patients with all kinds of conditions, especially in Stockholm where a lot of specialists are available. Furthermore, the requirements for research activities also takes a lot of time, much of which has to be in one's own personal time.
However, our work conditions have changed a little this past year. In Sweden we must reduce the number of graduating dentists, since we have a surplus of dentists. This is likely to produce some restructuring of teaching faculty in the future.
Our specialist colleagues within maxillofacial surgery are closely associated with the nearby located Hudinge Hospital and do some work in association with ear, nose and throat physicians. This fact might in the foreseeable future open a possibility for us to develop our oral radiology contact with the Radiological department at the Hospital. As a matter of fact, we have already started some cooperative activity. As a consequence of this too, we will in the future see and use more of the advanced imaging equipment such as the newer CT (computed tomography), Magnetic Resonance Imaging and Ultrasound.
When I have been in my working field at the Academic Hospital within the department of maxillofacial surgery and our radiological unit, my working day is mainly occupied with writing patient radiology reports and performing some specific patient investigations. The investigations which we dental radiologists supervise are mainly CT and MR investigations upon our dental patients. It can be to investigate any kind of pathology (tumors, cysts, developmental defects, joint pain and so on) within the maxillofacial region where we have found our usual "plain" radiographs insufficient. Besides managing patients from the maxillofacial surgeons and the hospital dentists, we also perform some of the radiographic investigations for the physicians form different departments, but mostly the ear, nose and throat physicians. I think that this situation is very common for most specialists in oral radiology, working in the Public Dental Service in Sweden today. They have a good contact and collaboration with their colleagues in the hospital and usually have an opportunity to see and diagnose many pathological lesions. Obviously, they have access to CT and MRI facilities, methods with a greater potential to establish a more accurately structured differential diagnosis. At the same time many oral radiologists today work closely with these referring clinicians and have the possibility to observe and share in joint consultations, with their patients. Our contribution is also appreciated in the explanation and interpretation of radiolographs in the clinic environment .For me it has been very useful to assume both this roles.
What interest or benefit does a general private dental practitioner have in the above depicted description of an oral radiologist? Well certainly I think that the described transformation of the role of oral radiologists is a positive advantage for all concerned. Since the general practitioner probably will become more medical orientated (at least in Sweden and some other countries), he/she will expect the same directions in the envolving qualifications for his radiologist. In particular, within Sweden we will also have the opportunity to clinically examine or observe, and follow the management of patients up to the final diagnosis, which is really only complete when the pathological report has been written.
Leif Kullman
