Vol. 134 No.

1 July 2022

Oral medicine (stomatology) in Brazil: the first 50 years

and counting
Alan Roger Santos-Silva, DDS, MSc, PhD,a Marcio Ajudarte Lopes, DDS, MSc, PhD,b
Caique Mariano Pedroso, DDS,c Ana Carolina Prado Ribeiro, DDS, MSc, PhD,d
Felipe Paiva Fonseca, DDS, MSc, PhD,e Tha
ıs Bianca Brand~ao, DDS, MSc, PhD,f
Luiz Alcino Monteiro Gueiros, DDS, MSc, PhD,g Andr
e Caroli Rocha, DDS, MSc, PhD,h
Fabio Ram^

oa Pires, DDS, MSc, PhD,i,j Aguida Aguiar Miranda, DDS, MSc, PhD,k
unior, DDS, MSc, PhD, Fabio de Abreu Alves, DDS, MSc, PhD,n,o
Herc
ılio Martelli J
l,m

Marcelo Marcucci, DDS, MSc, PhD,p Celso Augusto Lemos, DDS, MSc, PhD,o
Norberto Nobuo Sugaya, DDS, MSc, PhD,o Gilberto Marcucci, DDS, PhD,q
Vin
ıcius Coelho Carrard, DDS, MSc, PhD,r Manoela Domingues Martins, DDS, PhD,r
Abel Silveira Cardoso, DDS, PhD,s,* and Cesar Augusto Migliorati, DDS, MSc, PhDt,*
TagedP

This review outlines the historical perspective, status, and future challenges of oral medicine (stomatology) in Brazil based on the
records of the Brazilian Society of Stomatology and Oral Pathology (SOBEP) and the Brazilian Federal Dental Council as well as
expert evidence input from academic leaders from 3 different generations of Brazilian oral medicine specialists. The beginning of
oral medicine in Brazil dates to 1969, followed by the organization of SOBEP in 1974; however, official recognition as an inde-
pendent specialty was achieved more recently within the Brazilian Federal Dental Council in 1992. After a 50-year maturation
period of oral medicine in Brazil in terms of specialty crystallization across dentistry, medicine, and research, it is now time to fol-
low the historical trends of the specialty internationally and establish a standard curriculum at a post-graduate level that will lead
to uniformity of training for oral medicine in Brazil. (Oral Surg Oral Med Oral Pathol Oral Radiol 2022;134:57 64)

Oral medicine is considered a “young” specialty of
dentistry. It is recognized around the world as the spe-
cialty of dentistry that interacts with medicine.1 In
Southern Europe and Ibero-American countries, such
as Brazil, the term “Stomatology” is used to define the
specialty.1 Oral medicine aims to diagnose and to pro-
vide (mostly nonsurgical) treatment for primary dis-
eases of oral mucosa and the jaws, as well as salivary
gland disorders, orofacial pain, and maxillofacial mani-
festations of systemic diseases and their treatment.

*Shared senior authors.

a
Associate Professor, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba, S~ao Paulo, Brazil.
b
Professor, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba, S~ao Paulo, Brazil.
c
MSc Student, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba, S~ao Paulo, Brazil.
d
Oral Medicine Specialist, Serviço de Odontologia Oncol
ogica, Instituto do C^ancer do Estado de S~ao Paulo, Faculdade de Medicina da Universi-
dade de S~ao Paulo, S~ao Paulo, Brazil.
e
Associate Professor, Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais.
f
Head of Service, Serviço de Odontologia Oncol
ogica, Instituto do C^ancer do Estado de S~ao Paulo, Faculdade de Medicina da Universidade de
S~ao Paulo, S~ao Paulo, Brazil.
g
Associate Professor, Oral Medicine Unit, Department of Clinic and Preventive Dentistry, Federal University of Pernambuco, Recife, Brazil.
h
Oral Surgeon and Oral Medicine Specialist, Divis~ao de Odontologia, Hospital das Cl
ınicas da Faculdade de Medicina da Universidade de S~ao
Paulo, S~ao Paulo, Brazil.
i
Professor, Oral Pathology, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil.
j
Post-graduation Program in Dentistry, Est
acio de S
a University, Rio de Janeiro, Brazil.
k
Oral Surgeon and Oral Medicine Specialist, Serviço de Odontologia, Cirurgia Bucomaxilofacial, Hospital Municipal Souza Aguiar, Rio de
Janeiro, Brazil.
l
Professor, Department of Oral Diagnosis, Dental School, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil.
m
Professor, Center for Rehabilitation of Craniofacial Anomalies, Dental School, University of Jos
e Rosario Vellano, Alfenas, Minas Gerais, Brazil.
n
Head of Service, Oral Medicine Department, AC Camargo Cancer Center, S~ao Paulo, Brazil.
o
Associate Professor, Stomatology Department, Dentistry School, S~ao Paulo University, S~ao Paulo, Brazil.
p
Head, Department of Stomatology, Hospital Heliopolis, S~ao Paulo, SP, Brazil.
q
Professor, Stomatology Department, Dentistry School, S~ao Paulo University, S~ao Paulo, Brazil.
r
Associate Professor, Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
s
Professor, Departamento de Patologia e Diagn
ostico Oral, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
t
Professor, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.
Corresponding author. E-mail address: Cmigliorati@dental.ufl.edu
Received for publication Nov 20, 2021; returned for revision Jan 19, 2022; accepted for publication Jan 24, 2022.
Ó 2022 Elsevier Inc. All rights reserved.
2212-4403/$-see front matter
https://doi.org/10.1016/j.oooo.2022.01.018

57
ORAL MEDICINE
58 Santos-Silva et al.
Some of these conditions include cancer and oral com-
plications of cancer therapy, infectious diseases, and
autoimmune disorders, among others. Oral medicine
specialists also provide comprehensive dental care for
patients within a range of complex medical scenarios
that impact oral health, including radiation therapy,
chemotherapy, bone marrow and solid organ transplan-
tation, molecular targeted therapy in oncology, bone-
modifying agents and antiresorptive drugs, cardiovas-
cular diseases, acquired immunodeficiency syndrome,
and COVID-19.2 Nevertheless, there are subtle differ-
ences in the definition and scope of practice of this spe-
cialty worldwide. These differences may impact the
way specialists develop clinical and academic skills
and are recognized by patients and peers in dentistry
and medicine.3,4
The growth of oral medicine was marked worldwide
by the development of professional expertise in several
areas, including outpatient services in dental schools
and hospitals settings, public health primary care units,
inpatient services (infirmaries and intensive care units),
private practices, and clinical research facilities.1,4
This narrative review documents the birth, growth,
present status, and future challenges of oral medicine
in Brazil. The chronologic perspective presented was
obtained from the official records of the Brazilian Soci-
ety of Stomatology and Oral Pathology (SOBEP)
(http://www.estomatologia.com.br/) and the Brazilian
Federal Dental Council (https://website.cfo.org.br/).
Additional narrative was provided by academic leaders
from 3 different generations of oral medicine special-
ists, whose efforts resulted in the establishment of the
specialty in Brazil. The work of these experts is funda-
mental for the continued development and future
achievements of the specialty.
HISTORICAL PERSPECTIVE (BIRTH)
The birth of oral medicine in Brazil occurred in the
1960s. Several dental schools, realizing the importance
of oral medicine, started offering disciplines in the den-
tal curriculum, which were called either oral diagnosis
or semiotics. It was at first an uncoordinated effort.
There was a lack of consensus about what the content
of those disciplines should be. Remarkably, at that
time, the W.K. Kellogg Foundation, which had spon-
sored several international fellowships for different
areas of dentistry in Brazil, included oral diagnosis in
the scope of their scholarships, granting (in 1967) to
one of our pioneer members (A.S. Cardoso), for the
first time, a fellowship to attend a graduate program in
oral diagnosis and oral medicine at Indiana University/
Purdue University, Indianapolis, USA. The W. K. Kel-
logg Foundation further sponsored a national oral med-
icine training course in 1969 at the University of S~ao
Paulo and at the A.C. Camargo Cancer Center, both in
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July 2022
S~ao Paulo city. Dr. Sol Silverman Jr, from the Univer-
sity of California San Francisco, was one of the invited
speakers who shared his expertise in oral medicine
with Brazilian faculty members of dental schools from
different parts of the country.5
Two important events in 1972 and 1973 were orga-
nized by the S~ao Paulo State Dental Association. They
invited Dr. A.S. Cardoso to teach a 16-hour course in
oral medicine. Originally intended for general practi-
tioners, most of the attendees in both courses were fac-
ulty members of Brazilian dental schools who were
involved with the introduction of oral medicine in the
national dental curriculum. At the end of daily activi-
ties, by initiative of Dr. A.F. Tommasi and Dr. G. Mar-
cucci (both from the University of S~ao Paulo), some
colleagues enrolled in the course met informally to dis-
cuss the difficulties they were encountering and what
could be done to enhance the field of oral medicine in
their respective universities and hospitals.5
Those experts realized that it would be important to
create a professional society to represent oral medicine
in Brazil and to become a forum that would integrate
young leaders interested to practice this emerging spe-
cialty. Oral pathology was already recognized as an
independent and separate dental specialty in Brazil,
and this was another factor that contributed to the birth
of the Brazilian Society of Stomatology.6 Therefore, in
1974, during a dental meeting in S~ao Paulo State, the
same group that met informally in 1972 and 1973,
together with other colleagues with the same ideas,
founded the Brazilian Society of Stomatology (Socie-
dade Brasileira de Estomatologia, SOBE)6 (Figure 1).
This society’s main goal was the dissemination of
knowledge in the field of oral medicine, through con-
gresses and seminars, to foster close collaboration
among its members. Dr. Tommasi was the first presi-
dent of the society, and the first SOBE meeting
occurred in 1975 at the University of S~ao Paulo. As
President, Dr. Tommasi immediately started the pro-
cess for the recognition of oral medicine as a dental
specialty.6 In 1980, a letter was sent by SOBE mem-
bers to the Brazilian Federal Dental Council requesting
the recognition of oral medicine as an independent den-
tal specialty. The recognition process had a long path-
way until the final registration with the Federal
Statement of Clinical Relevance
Oral medicine significantly contributed to Brazil-
ians’ oral health care in the last 50 years, but new
strategies regarding training and clinical practice
are necessary for its continued improvement.
OOOO
Volume 134, Number 1
Fig. 1. Brazilian Society of Oral Medicine (Stomatology) foundation meeting minutes (July 26, 1974).
Council, but not without a strong resistance within the
Council itself.6 After a decade of intense discussion,
the Federal Council changed the name of the oral
pathology specialty to “oral pathology and oral medi-
cine.” However, this resolution was not well accepted
by oral pathologists and by oral medicine practi-
tioners.6 Finally, in 1990, SOBE filed a request again
for the separation of these specialties and for the recog-
nition of oral medicine as an independent specialty,
which finally happened in 1992. On the sixth of July
1992, oral medicine was officially recognized as a den-
tal specialty in Brazil and, in 1995, the Federal Dental
Council granted SOBE the registration.6 The specialty
recognition was a giant leap for the growth and evolu-
tion of oral medicine in Brazil.
GROWTH AND DEVELOPMENT
During the past 50 years, the field of oral medicine in
Brazil has grown through the efforts of dedicated pro-
fessionals teaching, practicing, and conducting
research. Since its foundation, SOBE and its members
have been working continuously to strengthen the spe-
cialty in the country. The oral pathology professional
community, which has always participated as an inte-
gral part of the SOBE meetings, was officially included
REVIEW ARTICLE
Santos-Silva et al. 59
in the Society in 2007, still maintaining its status of
independent specialty. The Society is now named
SOBEP (Brazilian Society of Stomatology and Oral
Pathology). This effort was driven by Dr. Oslei Paes de
Almeida (Piracicaba Dental School, University of
Campinas), the society president at that time. This for-
mal link between both independent specialties in a joint
society increased the educational and research portfolio
of both specialties.6
SOBEP is a nonprofit scientific entity that congregates
dentists from all regions of Brazil and neighboring coun-
tries in Latin America. These professionals dedicate
themselves to the teaching, research, and patient care in
oral diagnosis and oral medicine. Other professionals
from medical-related areas, such as general pathology,
radiology, dermatology, otorhinolaryngology, head and
neck surgery, radiation oncology, hemato-oncology, clin-
ical oncology, infectology, and general practice, are
members of the group. The main mission of SOBEP is
to disseminate scientifically based knowledge in the
areas of oral medicine and oral and maxillofacial pathol-
ogy through national congresses and regional conferen-
ces. Such events are organized in close collaboration of
SOBEP membership. Strategically, SOBEP strives for
the progress of the specialty through the advancement of
ORAL MEDICINE
60 Santos-Silva et al.
qualified education, scientific research, and patient care.
The main goal is the improvement of specialized dental
treatment for patients with diseases of the oral and max-
illofacial complex. Furthermore, the Society is dedicated
to educating health professionals and patients about the
nature of the practice of oral medicine and the health
benefits it provides.
Since its foundation in the 1970s, SOBEP has
expanded to over 300 active members. Annually,
approximately 1000 attendees meet in a national
meeting, which is held every July. The 45 previous
annual meetings were held in 18 out of the 27 Brazil-
ian states (including the federal district of Bras
ılia, the
capital of Brazil), covering all 5 regions of the coun-
try. In the year 2020, owing to the impact of the
COVID-19 pandemic, the SOBEP promoted its first
online meeting. That effort strengthened the digital
media of the Society’s management team and brought
the experience to the registrants who attended the
46th Brazilian Congress of Stomatology and Oral
Pathology 2021. There were >1000 registered partici-
pants, 760 scientific poster presentations, talks from 3
international speakers, and 4 roundtables, 1 of which
was in partnership with the Multinational Association
of Supportive Care in Cancer/International Society of
Oral Oncology (http://www.estomatologia.com.br/con
gresso-sobep2021?ind=en&l=evento-ing).
The promotion of scientific events by SOBEP has
been contributing to the technical and scientific advan-
ces of oral medicine in Brazil. In this context, to sup-
port scientific events in the areas of oral medicine and
oral pathology across the country, the SOBEP created
the National Events Support Program to financially
assist members of the Society to organize regional
events in the scope of oral medicine and oral pathol-
ogy, promoting the formation of strong networks dur-
ing the scientific meetings.
The SOBEP meetings have always supported partici-
pation of international guest speakers from Latin and
North America, Europe, the United Kingdom, and
Asia. This participation was fundamental to the growth
of oral medicine in the past 20 years in Brazil.6 Interna-
tional speakers included colleagues from Argentina,
Australia, Canada, Colombia, Chile, Colombia, Czech
Republic, Finland, Guatemala, Greece, India, Italy,
Japan, Peru, Mexico, South Africa, Spain, United
States of America, the United Kingdom, and Uruguay,
among others. Of note, international joint meetings
also contributed to the internationalization of SOBEP,
including shared conferences with the International
Association of Oral Oncology, the Ibero-American
Academy of Oral Pathology and Oral Medicine, and
the International Association of Oral Pathologists.
These meetings contributed to the enhancement of oral
medicine in Brazil. Future meetings seek to enhance
OOOO
July 2022
international collaborations, the participation of inter-
national attendees, the expansion of the society beyond
the country’s borders, and the recognition of the quality
of work done by the Brazilian oral medicine and oral
pathology groups.1
Owing to the impact of the COVID-19 pandemic on
the possibility of organizing in-person meetings,
SOBEP used a virtual platform to offer continuing edu-
cation conferences to its members. Access to current
information and continuing education activities can be
found on the SOBEP website (www.estomatologia.
com.br). In addition, the society works in connection
with an official YouTube channel (https://www.you
tube.com/channel/UClz7iMVYaAKJ2O1v_8OXmHA).
Furthermore, it has social media profiles on Facebook,
Instagram, and Twitter. These virtual platforms are
available to members to promote educational and scien-
tific activities. The society has its own open-access
journal entitled the Journal of Oral Diagnosis, which is
available at www.jordi.com.br. The Journal of Oral
Diagnosis aims at publishing basic, applied research
papers, clinical cases, and articles reporting new infor-
mation in the fields of oral medicine and oral pathol-
ogy. SOBEP is affiliated with Oral Surgery, Oral
Medicine, Oral Pathology, and Oral Radiology journal
(www.oooojournal.net).
From a historical perspective, even though Brazil is
one of the largest countries on the planet in terms of
territorial extension and population, from the economic
and cultural points of view, it ranks among developing
countries and exhibits a low human development
index. Therefore, access to advanced communication
infrastructure and fast data transmission speed took
place at a slower pace than it would have in the eco-
nomically developed world. Thus, considering that the
birth of oral medicine in Brazil occurred nearly 50 years
ago, the relatively fast development and recognition of
oral medicine as an independent dental specialty is
remarkable given the fact that, for more than 25 years,
oral medicine survived based on face-to-face meetings
and conferences organized by a small group of dedi-
cated professionals.
The efforts of these colleagues made them pioneers
in the development and dissemination of oral medi-
cine-related knowledge in a country of continental
dimensions.
TRAINING AND CLINICAL PRACTICE
(PRESENT-DAY)
The definition of oral medicine clinical practice in Bra-
zil7 differs from other areas across the globe. In Brazil,
oral medicine is currently defined as the dental area
working on prevention, diagnosis, and treatment of
oral maxillofacial diseases.8 Clinical practice empha-
sizes prevention and early diagnosis of oral potentially
OOOO REVIEW ARTICLE
Volume 134, Number 1 Santos-Silva et al. 61

malignant diseases and malignant tumors, because of Table I. Distribution of dentists and oral medicine spe-
the alarmingly high incidence and mortality rates of cialists (absolute numbers) in Brazil across
oral cavity and oropharyngeal cancer. This information federal administrative regions and states in
was recently documented by the Global Cancer 2021
Observatory.9,10 Thus, oral medicine specialists work-
Region/State Dentists Oral medicine specialists
ing in Brazil often focus their clinical practices and
research initiatives on the early diagnosis of oral cancer North
Acre 1713 1
and the mitigation of cancer treatment-related oral Amap
a 1873 3
complications. Nonetheless, within the scope of current Amazonas 8369 4
oral medicine training and clinical practice, the focus is Par
a 10461 10
on diagnosing and managing primary oral diseases and Rond^onia 4239 7
oral manifestations of systemic diseases.7 Moreover, Roraima 1513 4
Tocantins 4030 5
dental treatment of patients with complex medical con- Subtotal 32198 34
ditions such as cancer, acquired immunodeficiency Northeast
syndrome, cardiovascular diseases, and now COVID- Alagoas 5337 7
19, are also within the scope of oral medicine.1 Bahia 22586 32
Oral medicine is considered a growing specialty. Cear
a 13118 7
Maranh~ao 8253 4
The Brazilian Federal Dental Council reports that there Piau
ı 5343 4
are 932 registered specialists (410 male and 522 Pernambuco 15890 22
female), which corresponds to <0.18% of all Brazilian Sergipe 3654 5
dentists.11 Most of these specialists are concentrated in Para
ıba 8711 20
the Southeast region, including S~ao Paulo, Rio de Rio Grande do Norte 6742 3
Subtotal 89634 104
Janeiro, and Minas Gerais states11 (Table I) Midwest
(Figure 2A), whereas Rio de Janeiro represents the Distrito Federal 14283 13
state with the highest proportion of oral medicine spe- Goi
as 19285 18
cialists per 100,000 inhabitants (Figure 2B) and with Mato Grosso 9720 4
the highest number of oral medicine specialists among Mato Grosso do Sul 7789 13
Subtotal 51077 48
the overall number of dentists registered in the Federal Southeast
Dental Council (Figure 2C). Consequently, with oral Esp
ırito Santo 19285 16
medicine specialists in Brazil concentrated in large Minas Gerais 14283 84
metropolitan areas, patients have a difficult time Rio de Janeiro 9720 177
accessing providers who diagnose and manage oral dis- S~ao Paulo 7789 316
Subtotal 51077 593
eases and lesions. Future studies could focus on the dis- South
tribution of oral medicine specialists across the country Paran
a 32789 42
and stimulate the migration of these professionals to Rio Grande do Sul 29454 70
underserved areas. This action would improve oral Santa Catarina 20570 41
health literacy and the promotion of health around the Subtotal 82813 153
Total 524,453 932
country. One way to improve this situation is the use of
telemedicine platforms for facilitating remote oral Source: The Brazilian Federal Dental Council. Data taken from
medicine consultations and patient management. Such https://website.cfo.org.br/ on September 20, 2021.
a program was created by a Federal Program called
“Telesa
ude” and developed by the Graduation Program
in Epidemiology at the Federal University of Rio minimum of 750 hours, certified by the Brazilian Fed-
Grande do Sul (UFRGS) School of Medicine.12,13 This eral Dental Council. Another route for specialty train-
initiative, funded by the Brazilian Ministry of Health, ing is clinical training combined with a Master of
was led by oral medicine and oral pathology professors Science or a Doctor of Philosophy program, certified
from the UFRGS Dental School. This teleconsultation by the Coordination for the Improvement of Higher
service demonstrated a remarkable potential to induce Education Personnel (CAPES) (https://www.gov.br/
a higher use of the primary health care services. This capes/pt-br). CAPES is a Brazilian federal government
same group further created a distant e-learning course agency within the Ministry of Education responsible
in oral medicine as a continuing education activity to for quality assurance in postgraduate institutions. Also,
improve the diagnostic abilities of Brazilian general there are other training programs recognized by a
dentists and dental students.14 licensing body that must follow a process of accredita-
To become an oral medicine specialist, dentists must tion regulated and funded through government agen-
complete a 2-year clinical training program with a cies, such as the National Council for Scientific and
ORAL MEDICINE
62 Santos-Silva et al.
Fig. 2. Heatmap showing the geographical distribution of oral medicine specialists (data from September 2021). Darker hues of
color on the map represent higher concentrations of oral medicine specialists. (A) Distribution across Brazilian states. (B) Distri-
bution per 100,000 habitants in Brazil. (C) Distribution per overall dentists registered in the Brazilian Federal Dental Council.
Technological Development (https://www.gov.br/cnpq/
pt-br) and CAPES. Note that, until 2010, dentists who
had completed a master’s or doctorate course in oral
medicine in Brazil could request the validation of their
diplomas for the certificate of specialist by means of a
curriculum analysis carried out by a group of specialists
linked to the Federal Council of Dentistry. Those pro-
fessionals approved by this diploma validation process
were recognized as specialists in oral medicine.
Unfortunately, in general, there are no official res-
idency programs or examining boards for most den-
tal specialties in Brazil, including oral medicine.
During the last decade, there was a shift in clinical
training with a significant increase in hospital-based
training programs and a proportional decrease in pro-
grams conducted traditionally in dental schools.
Since the 1970s, but with more emphasis in the last
decade, multiprofessional residency programs were
created in hospitals with a focus on the supportive
care for cancer patients and medically complex
patients. The residency, as in other countries, has a
curriculum and advanced clinical training compati-
ble with the training in oral medicine. To date, few
integrated or multiprofessional residencies in oral
health programs, including those at UFRGS Clinical
Hospital, and AC Camargo Cancer Center, have spe-
cific oral medicine training sites in Brazil allowing
graduates to have their residency completion certifi-
cates recognized by the Federal Council as special-
ists in oral medicine.
Similar to many other countries, oral medicine as a
specialty is mostly clinically practiced in dental
schools and teaching hospitals.6 Oral medicine and
oral pathology have been traditionally offered as part
of the predoctoral academic dental curriculum and
form the basis of the oral diagnosis departments in
many dental schools. This scenario, in turn, helped the
establishment of graduate programs in these areas,
mostly in public universities. An overview of the
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July 2022
practice locations of oral medicine specialists has
shown that most professionals (42%) work at universi-
ties (including dental schools and university hospitals),
followed by those who work in public institutions
(26%) (including military forces and public health
services) vs private health services and dental offices
(15%) (H. Martelli J
unior, personal communication,
unpublished data). Note that most oral medicine spe-
cialists in private practice work usually in combination
with other dental specialties, including oral surgery,
periodontics, and oral rehabilitation. A small but grow-
ing group of oral medicine specialists works in
private practice or in a combination of public and pri-
vate clinics.
Oral medicine specialists work in association with
other medical and dental specialists. Thus, they need to
have knowledge and skills for the elaboration of com-
plex diagnoses and treatments. Furthermore, they need
to remain updated with the ever-changing protocols of
patient management in hospitals and health reference
centers.
This clinical requirement has led to the establish-
ment of oral oncology units in several hospitals
throughout the country. Oral medicine specialists are
often among the leading dental providers in these clin-
ics in both the public and private sectors. This scenario
led to the inclusion of photobiomodulation (PBM) ther-
apy in the prevention and treatment of oral mucositis
on the list of obligatory services covered by health
insurance companies. This reality was supported by
Brazil’s leading research in PBM therapy, especially in
supportive care in cancer and oral mucositis. Currently,
the use of PBM in the prevention and management of
oral mucositis in cancer patients is the standard of care
in Brazil. This stimulated research and improved the
clinical care of cancer patients.15,16
The number of professionals working in oral medi-
cine and oral pathology areas and the investigation of
specific research in this field increased in the last
OOOO
Volume 134, Number 1
20 years. Currently, of the 218 Research Fellows in
Dentistry, grantees of the National Council for Scien-
tific and Technological Development, 35 (16%) are in
oral medicine and oral pathology fields, including 8
(23%) fellows in oral medicine, 20 (57%) in oral
pathology, and 7 (20%) working on both areas (https://
www.gov.br/cnpq/pt-br).
INTERNATIONAL ACTIVITIES AND
COLLABORATIONS
Regarding international efforts, several Brazilian spe-
cialists in oral medicine are active members in associa-
tions such as the Ibero-American Academy of Oral
Pathology and Oral Medicine, American Academy of
Oral Medicine (AAOM), European Association of Oral
Medicine, International Academy of Oral Oncology,
Multinational Association of Supportive Care in Can-
cer and International Society of Oral Oncology, and
World Association for Photobiomodulation Therapy.
There are Brazilian members on editorial boards of
leading journals, such as Oral Surgery, Oral Medicine,
Oral Pathology, Oral Medicine; Journal of Oral
Pathology & Medicine; Oral Diseases; Oral Oncology;
and Medicina Oral, Patologia Oral y Cirurgia Bucal.
Although Brazilian scientific articles correspond to
approximately 5% of the overall production of these
journals, local research strategies in oral medicine have
been increasing in past 10 years through international
collaborative studies.17
This international collaboration allowed Brazilian
researchers to join world-class working groups, such as
the World Workshop on Oral Medicine VIII (https://
www.aaom.com/world-workshop-on-oral-medicine-
viii), which includes 2 Brazilian oral medicine special-
ists (A.R. Santos-Silva and L.A.M. Gueiros), and focus
on advancing oral medicine patient care, research, and
health professionals’ education at the international
level.18 The World Workshop on Oral Medicine have
the capacity to promote young oral medicine specialists
to gain expertise and be exposed to seasoned interna-
tional experts, which can enhance their training, expe-
rience, and career development. Note that members of
the AAOM have been supporting SOBEP for many
years. Likewise, this relationship with AAOM opened
the doors for Brazilian PhD students, post-doc
researchers, and mid-career faculty members to be
awarded academic externships in leading North Ameri-
can, British, and European universities.
FUTURE CHALLENGES
Oral medicine in Brazil has contributed to the improve-
ment of the quality of life of the population. However,
the specialty needs to be better recognized for its
importance in the interdisciplinary care of patients.
Current health care professionals and medical
REVIEW ARTICLE
Santos-Silva et al. 63
educators must recognize the benefits that oral medi-
cine specialists bring to our patients. Also, oral medi-
cine practitioners must outline strategies for the new
generation of postgraduate students, specialists, and
clinicians, who will be responsible for the advancement
of this specialty in our country.
The future of oral medicine in Brazil will depend on
the establishment of advanced training programs and
on a better uniformity of clinical practice across the
country, as well as on continued international scientific
collaborations. The SOBEP members should now start
working in partnership with health policymakers to cre-
ate standards for residency programs and examining
boards. Also, despite the previously mentioned spe-
cialty differences worldwide, it is important to better
define the oral medicine practice in Brazil through an
international core curriculum that will determine the
scope of training and practice.3
The practice of oral medicine demands greater visi-
bility among the Brazilian population. A key step
would be to increase marketing and advertisement
related to the impact of oral and maxillofacial diseases,
mainly in diagnosing oral cancer and other regionally
relevant diseases. This scenario became even more evi-
dent during the COVID-19 pandemic, which decreased
oral medicine specialized consultations and reduced
oral biopsies around the country with the potential to
negatively impact the already challenging panorama of
oral cancer mortality in Brazil.19,20 The next generation
of oral medicine specialists will need to better promote
the relevance of oral medicine in patient care. Other
important aspects include the following: recognition of
the value of the specialty by other health care pro-
viders; increasing attention, support, and funding
through collaborative efforts with other dental special-
ties; and fostering interprofessional education/clinical
practice with other medical specialties.21 Likewise, the
maintenance of the historical connections between oral
medicine and oral pathology specialties in Brazil is a
challenge in the future perspective that should be care-
fully managed and aimed to strengthen education,
training, and clinical performance.
Research funding is limited in Brazil. There are few
opportunities for investigations targeting oral medicine-
based research questions. Consequently, most oral medi-
cine clinicians are not engaged in research. Therefore,
research groups should work to increase awareness of oral
medicine and its interfaces with medicine, aiming to get
more public funding for research and international train-
ing opportunities. Collaboration with oral medicine
experts located in other countries, such as the USA and
Europe, should be carried out through jointly funded proj-
ects. Finally, Brazilian oral medicine specialists should
work to allow full reimbursements from insurance compa-
nies to cover costs of care in the field of oral medicine.
ORAL MEDICINE
64 Santos-Silva et al.
CREDIT AUTHOR STATEMENT
Dr. Santos-Silva presented part of this manuscript’s
data during the “2021 AAOM Virtual Annual Confer-
ence. Oral Medicine: The New Era”. Session entitled
A Global Perspective of Oral Medicine: History, Cur-
rent Status, and International Collaborative Efforts.
All authors contributed in the same capacity in the
conception, design and writing of the manuscript. All
have been part of the process that led to the establish-
ment of oral medicine as a specialty in Brazil.
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