Norway

In Norway, oral medicine as a separate dental discipline was put on the agenda in the late 1950s. Sophus Lossius, with degrees in both medicine and dentistry, was appointed professor of dental surgery at the Norwegian Dental College in 1948. Under his leadership at the University of Oslo, the first professorship in odontology with a special duty to teach both oral surgery and oral medicine was announced in 1960. Later, in 1964, the doctor and dentist Eigil Aas was appointed this position. These two professors with backgrounds in both dentistry and medicine gave oral medicine a focus on systemic diseases and their oral manifestations as well as medically complex patients. Manifestations of oral mucosal diseases were taught by oral surgeons and oral pathologists. Professor Jens Jørgen Pindborg (1921–1995) from the University of Copenhagen also played a major role in the development of oral medicine as a separate dental discipline in Norway. He was later awarded an honorary doctorate at the University of Oslo for his efforts. The Department of Dental Surgery at the University of Oslo changed its name in 1966 to the Department of Oral Surgery and Oral Medicine. At the University of Bergen, oral medicine was placed under the Department of Oral Surgery in 1978, and the department was then named the same as in Oslo, Department of Oral Surgery and Oral Medicine.

Sweden

In Sweden, the introduction of oral medicine/hospital dentistry began with the foundation of The Society for Hospital Dentists in 1941, an organization gathering both traditional hospital dentists and oral surgeons. However, in 1976, this society was divided into the Swedish Society for Maxillofacial Surgery and the Swedish Society for Hospital Dentists (SSHD). Furthermore, in 1990, the Swedish Society for Oral Medicine (SOMS) was established. Thus, there were now two societies with a slightly different focus but overlapping areas. While SSHD organized colleagues involved with traditional hospital dentistry, SOMS focused on oral mucosal diseases with or without systemic causes. During the 1990s, an emerging need for specialist education was identified, and authorities were approached in this matter. Therefore, discussions between SSHD and SOMS were initiated, which led to a merger of the two societies in 2010 and the foundation of the Swedish Society for Orofacial Medicine (SOM). During the 2010 decade, a new attempt was planned and carried out to establish the subject as a formal specialty in dentistry. After implementation of a 3-year trial education in orofacial medicine in several regions in Sweden, structured as the other specialist training programmes, the Swedish National Board of Health and Welfare in 2018 finally recognized orofacial medicine as a specialty in dentistry. Professor Emeritus Tony Axéll and Professor Emeritus Mats Jontell have had a great impact on introducing oral medicine nationally and placing Sweden at the front edge internationally.

Finland

In Finland, oral medicine is not available as its own specialty. Instead, patients are diagnosed and treated within several dental and medical disciplines. However, there have been professors in oral medicine at the University of Helsinki, Maria Malmström and Yrjö Konttinen and at the University of Eastern Finland, Arja Kullaa. Currently, there is no professor in oral medicine at any of the Finnish universities. In 2019, the division of oral pathology and oral medicine, under the Finnish Dental Association, proposed introducing this discipline as its own specialty. This work was delayed by the COVID-19 pandemic, but in March 2023, a formal proposal was written by a specific work group and is currently (since April 2023) under consideration at the Ministry of Social Affairs and Health in Finland.

Denmark

In Denmark, the focus on oral mucosal diseases and their association with lifestyle factors such as smoking and alcohol or systemic diseases can largely be attributed to efforts by the famous professor J.J. Pindborg. He was appointed professor in oral histopathology in 1959 at the Royal Dental College in Copenhagen and performed numerous studies on precursors to oral cancer. This led to the World Health Organization (WHO) setting up an international centre for oral precancer in Copenhagen and offering J.J. Pindborg a visiting professorship in India in 1963. He planned and coordinated large-scale population studies together with Professor Fali S. Mehta to determine the prevalence and causes of oral cancer in India. More than 35 000 individuals underwent repeated examinations during a period of 10 years. They concluded that the prevalence of leukoplakia and oral cancer varied between different areas, depending on tobacco habits. Based on 20 years of research, J.J. Pindborg and F.S. Mehta were able to present the Indian authorities with two methods for combating oral cancer: primary prophylaxis (reducing the incidence of leukoplakia and cancer through behavioral changes) and secondary prophylaxis (detecting precursors to oral cancer and preventing further development of the disease through regular oral examinations). Their research was published in the Lancet and other scientific journals [8]. In later years, work has been done to acknowledge oral medicine and oral pathology as a specific specialty in Denmark. However, until now, negotiations with health authorities have been in vain. Currently, patients are referred to oral medicine clinics at the two schools of dentistry at the universities or to oral and maxillofacial departments at the university hospitals.

Iceland

In Iceland, oral medicine has been available as its own specialty for many years. Primarily because of Professor W Peter Holbrook, who received his education and doctorate in Scotland. He became a professor at the University of Iceland, Faculty of Odontology in 1992, where he taught oral medicine and pathology until he retired a few years ago. Dr. Stefán Pálmason, a specialist in oral medicine, then took over responsibility for the training. Since Island merely has two specialists in oral medicine and there is a great demand for expertise within the field from hospitals and general practitioners, the workload is high, implying that patients with oral mucosal lesions are also treated by specialists in other areas as well as general dentists. Furthermore, there is no established specialty training in oral medicine in Iceland, resulting in training being pursued at universities abroad.

Norway

By the end of 2022, the total number of inhabitants in Norway was 5 488 984. The population has increased by 61% from 1953 to 2021, largely because of rising life expectancy and, more recently, due to an increase in net immigration. The size is expected to reach 6 million in 2050, and the elderly will represent an increasing proportion of the population over the next decade. The proportion of persons 70 years or older will increase from 12% in 2020 to 21% in 2050. First-generation immigrants consist of persons from more than 200 countries, and by 1st of January 2021, they comprise 14.8% of the total population (800 094). An additional 4.9% of the Norwegian population are second-generation immigrants (Cancer Registry of Norway, https://www.kreftregisteret.no). With a larger proportion of the elderly in the population, more morbidity can be expected both in terms of general diseases as well as diseases in the oral cavity. The incidence rate (per 100 000 population) for lip and oral cavity cancer in 2020 was 2.6 for females and 4.5 for males. (Oral Health Country profile for Norway, WHO 2022, https://www.who.int/publications/m/item/oral-health-nor-2022-country-profile).

Sweden

In January 2023, the number of Swedish citizens was 10 523 709 compared to 7 041 829 in 1950 and an estimated 11 835 808 in 2050 (Statistiska centralbyrån, www.scb.se). In 2021, approximately 56% of the population was of working age (20–64 years). The number of people aged >65 years today averages 20% and will increase to approximately 28% in 2070 (Statistiska centralbyrån, www.scb.se). In 2022, 102 436 immigrants came to Sweden from India, Syria, Germany, Pakistan, Polen, Iran, Iraq, Turkey and China, and immigrants now make up approximately 20% of the Swedish population (Statistiska centralbyrån, http://www.scb.se).

Finland

The number of Finnish citizens was 5 566 812 in January 2023. The share of working-age people in the population is slightly over 60%. By 2060, both Finland’s population and the number of people of working age are estimated to decrease significantly. According to Statistics Finland’s population structure statistics, at the end of 2019, there were 874 314 people aged 70 or over in Finland. The number of people over 70 years of age has increased by 100 000 people in three years (Statistics Finland, http://www.stat.fi). Furthermore, Finnish citizenship was granted in 2020 to 7 816 foreign citizens permanently resident in Finland. In 2021, 8.5% of Finland’s population had a foreign background. Of them, 83% had a first-generation foreign background, and 17% had a second-generation foreign background. In 2021, the most common country of origin of these people with a foreign background was the former Soviet Union. The next largest background country groups included Estonia, Iraq, Somalia, and the former Yugoslavia (Statistics Finland, http://www.stat.fi).

Denmark

In Denmark, the number of citizens was 5 932 654 in the first quarter of 2023. In 1950, the number was 4 281 000. By January 1st 2023, the number of immigrants and descendants was 910,898 (15.4% of the total Danish population). In Denmark, the number of persons above 65 years of age is expected to increase by 35.8% until 2060, from 1.18 million in 2021 to 1.60 million in 2060. The largest increase occurs among persons above 80 years of age, where the number is expected to rise by 130.6%, whereas the increase among persons 65-79 years of age comprises 5.3% (https://www.dst.dk/da/Statistik/emner/borgere/befolkning/).

It has previously been shown that the prevalence of oral mucosal lesions among persons above the age of 65 years is high (75 %) [9]. In addition, xerostomia and hyposalivation are prevalent conditions often related to the intake of certain medications and polypharmacy [10][11][12]. Additionally, neurogenerative diseases or early stages of impaired cognition can affect oral health and functions [13][14]. Furthermore, the risk of developing cancer increases with increasing age, and the cancer treatment (chemotherapy, radiation therapy to the head and neck region, immunotherapy and endocrine therapy) itself may also affect the oral mucosa and functions directly or indirectly [15]. The increasing use of biologicals in the treatment of inflammatory autoimmune diseases raises additional concerns in relation to oral side effects and odontological treatment planning. Moreover, with the increased immigration influx, specific health issues need to be addressed. Thus, the discipline of oral medicine needs to be dynamic and adapt to changes in demography, changing disease profiles and therapeutic approaches.

Iceland

The population in Iceland was 387 758 by 1st January 2023, which is an increase of 3.1% (11 501 inhabitants) from 1st January 2022, making this the largest increase since 1734. Statistics Iceland published a population forecast in December 2022, according to which the country’s population was expected to reach 393 000 by 2026. However, this increase has already been reached mainly due to a greater immigrant workforce. Approximately 63% of the population lives in the Greater Reykjavík area. Immigrants in Iceland were 61 148 or 16.3% of the population by 1st January 2022, compared to 1.9% in 1995 and 7.4% in 2015. This percentage increases continuously, showing the same trend as in the other Nordic countries. Although the population is aging and population growth will slow down, Icelanders are now and will continue to be much younger than most European nations. In 2060, more than a third of Europeans will be over 65, compared to 25% of Icelanders. It is expected that Icelanders will reach the current percentage within the EU (19%) in 2031. On 1st January 2018, 16% of the population of the European Union was under 15 years of age, and the oldest age group (65 years and older) accounted for 20%. The corresponding figures for the Icelandic population were 19% and 14%, respectively. By 2059, the younger age group is expected to reach 16%, and the oldest age group is expected to reach 20% by 2038 (https://statice.is/statistics/population/inhabitants/).

Norway

In Norway, oral medicine is taught at the universities in Oslo, Bergen and Tromsø as part of the undergraduate curriculum in oral surgery and oral medicine and partly in collaboration with oral pathologists. At the University of Oslo and University of Bergen, oral medicine is taught in the 4th and 5th years with lectures and interdisciplinary courses, including otorhinolaryngology. Clinical training is given at the Department of Oral Surgery and Oral Medicine on patients referred from dental practitioners, physicians, otorhinolaryngologists, oncologists, hematologists, rheumatologists, dermatologists, and others. There is no specific research training in oral medicine, but several of the PhD theses from the Norwegian dental schools are related to this field. Furthermore, a separate oral medicine course of 20 hours has also been established for the faculty’s various specialist training programmes. In the Norwegian Dental Association’s systematic continuing education program “TSE” (est. 1999), oral medicine was developed as the first module. This course has been conducted in all the country’s counties several times. The module is based on problem-based learning and lasts for 3-4 months with two physical day sessions and distance learning in the interim period.

Sweden

In Sweden, education in oral medicine is offered at four different universities, Umeå, Stockholm, Gothenburg, and Malmö, as part of the undergraduate curriculum in oral medicine and partly in collaboration with oral and maxillofacial surgery and oral pathology. When during the programme, it is taught varies between the universities but for all begins during the 3rd semester and is reintroduced for certain universities in semesters 4, 5, 8 and/or 9. Focus lies on oral medicine in the diagnostic process based on obtaining a medical history, clinical examination, laboratory analyses and establishing a treatment plan. Research training in oral medicine has been offered for many years at all four universities. For general dentists, various courses in oral medicine are accessible throughout the year, and currently, an extension training of one year for specialists in oral medicine is offered.

Finland

In Finland, oral medicine is not available as its own discipline. Therefore, all four universities, Helsinki, Turku, Kuopio, and Oulu, have undergraduate dental programmes in their curriculum offering their own slightly differing schedules in oral medicine. The subject is taught as part of other disciplines, primarily within oral pathology and oral and maxillofacial surgery. The teaching is focused on the clinical setting, mainly during the fourth and fifth years of dental studies, on patients with oral mucosal diseases. Similarly, there has not been a postgraduate speciality of oral medicine in Finland. Therefore, the treatment of acute and chronic oral mucosal diseases and diseases, changes and conditions of the mouth and jaws related to general diseases and developmental disorders has varied depending on the competence of individual dentists. Again, the main specialists consulting and treating these patients have been oral pathologists and oral and maxillofacial surgeons as well as periodontologists. Currently, there is an on-going proposal in Finland to establish a specialty of oral medicine. Likewise, there is no specific research training in oral medicine, but several PhD theses of varying specialties are oral medicine related.

Denmark

In Denmark, the curriculum for oral medicine at the School of Dentistry/Department of Odontology, University of Copenhagen, includes teaching of dental students during semesters 8, 9 and 10. Teaching includes clinical training at the Clinic for Oral Medicine. Approximately 500 hundred patients (children and adults) are referred to this clinic annually from dental practitioners, physicians, rheumatologists, otorhinolaryngologists, dermatologists and others. The patients present with a broad panoply of oral diseases and manifestations of systemic diseases. Until recently, the section had its own lab for oral pathology, where biopsies were handled and diagnosed. Biopsies are now sent to the Department for general pathology at the regional hospital. The teachers are faculty VIP/researchers with a dental degree (DDS) at the professor level, associate professor level, assistant professor level and PhD students. They also teach at the postgraduate level, including teaching at courses for otorhinolaryngology, oral surgery, and orthodontics.

Iceland

In Iceland, at the faculty of Odontology, oral medicine is taught mainly as a separate subject area but is also included within the subject of diagnostics, allowing patients to be examined at the faculty. The subject is primarily taught during the 6th year, and the patients present with a broad spectrum of oral diseases and manifestations of systemic diseases. For many years, the section had its own lab for oral pathology, but biopsies are now sent to the Department of Pathology, Landspítali, University Hospital or other labs.

Norway

In Norway, there is collaboration in oral medicine with all dental disciplines and a selection of medical disciplines, such as otorhinolaryngology, rheumatology, internal medicine, dermatology, oncology, plastic surgery, and endocrinology. Additionally, the patient’s general practitioner is often involved.

Sweden

In Sweden, many patients are referred to orofacial medicine clinics by physicians both in outpatient and inpatient settings. This results in the treatment often being part of the overall medical treatment plan. Furthermore, with regard to education, many orofacial medicine clinics in Sweden collaborate where national web seminars are organized on a regular basis as part of the specialist training programme. Additionally, the Swedish Oral Medicine Network (SOMNET) provides monthly seminars where oral medicine cases are discussed nationally among general dentists and specialists in orofacial medicine. There are also ongoing collaborations for international, national, and regional scientific studies.

Finland

In Finland, patients are diagnosed and treated within several dental and medical disciplines, mainly at the departments of oral and maxillofacial surgery at universities and central hospitals by oral pathologists, oral and maxillofacial surgeons, and periodontologists. This can sometimes cause problems concerning who has the overall responsibility for the patient. In addition, as oral medicine is not coordinated within Finland, the quality of diagnostics and treatment vary greatly depending on the competence of individual dentists and medical doctors.

Denmark

In the section for Oral Medicine and Pathology, Department of Odontology, University of Copenhagen, national and international cross-disciplinary collaboration is highly prioritized, as many of the patients display a complex medical profile. Currently, there are collaborations with dermatologists, pathologists, ophthalmologists, otorhinolaryngologists, rheumatologists, oncologists, endocrinologists, and universities in Scandinavia and the U.S.

Iceland

In Iceland, patients are treated at a dental department or a private clinic by a specialist in oral medicine. There is also cooperation with other medical disciplines, as many patients display a complex medical profile.