Unique interdisciplinary postgraduate training at the interface of dentistry and medicine
Caroline Shiboski, DDS, MPH, PhD
Chair, Department of
Office of Admissions & Outreach
513 Parnassus Ave., S-619
San Francisco, CA 94143-0430
The Postgraduate Program in Oral Medicine is a full-time, 36-month residency, accredited by the Commission on Dental Accreditation, leading to a certificate in oral medicine and an MS degree in oral and craniofacial sciences. The program is aimed at preparing dentists to diagnose and treat complex oral problems, manage oral conditions and diseases that occur in medically complex patients, recognize and manage oral manifestations of primary and acquired immunodeficiency, and manage oral diseases, salivary gland dysfunction, facial pain and chemosensory disorders. The program's main goal is to train residents for either a full-time or part-time career in academic settings as an oral medicine specialist who can treat a diverse patient population, participate in interdisciplinary care and contribute to the knowledge base through research.
The School of Dentistry’s partnership with UCSF Health Sciences Campus, and its close relationship to world-renowned schools of medicine, nursing and pharmacy, gives residents a wide range of training experiences in patient care and research.
On the clinical front, you will work with health professionals from a variety of disciplines in your training in the prevention, diagnosis, evaluation and treatment of oral disease. UCSF’s Comprehensive Cancer Center, HIV clinics and transplant services are among the best in the country, and the program's rotations in these centers and clinics offer residents unique exposure to the care of medically complex patients. The Sol Silverman Oral Medicine Clinic, the program's major clinical training site, has provided innovative leadership since 1956 in the field of oral medicine both nationally and internationally. This offers residents a thriving educational environment and excellent training ground where they gain knowledge in a wide range of oral diseases and conditions.
On the research front, the program offers many opportunities for interdisciplinary research collaborations. UCSF has one of the richest environments anywhere for a student to do research, whether clinical or basic science. In addition to a required course in clinical research, a wide selection of courses is available within the School of Dentistry and the other schools on campus for residents to take. The broad range of research interests among the faculty throughout the Department of Orofacial Sciences and the campus affords you the opportunity to choose among a wide variety of research projects.
The program has always focused on its efforts to constantly develop innovative interdisciplinary training experiences that will produce well-rounded specialists within the field of oral medicine and beyond.
Instruction in all areas of oral medicine is provided through lectures, seminars, conferences and clinical training in outpatient and inpatient settings.
Residents spend much of their first year attending core courses required by the American Board of Oral Medicine and the UCSF Graduate Division. All residents complete a specially tailored core curriculum that includes courses in biostatistics, clinical research, oral biology, developmental biology, oral medicine, oral pathology, immunology, behavioral sciences and medical ethics. Residents also take a 20-hour course on physical diagnosis for instruction in performing physical exam and assessment, which provides a foundation for the clinical rotation in internal medicine and other clinical rotations taken during the second year.
The didactic component of the residency program also includes ongoing weekly oral medicine seminars, oral biology seminars, journal club and patient management conferences, which review teaching cases from the Sol Silverman Oral Medicine Clinic and the UCSF Oral Pathology Service, throughout the length of the program. Residents also attend Head and Neck Tumor Board, an interdisciplinary treatment planning conference where residents participate in diagnosis and management of cases. This forum gives residents the opportunity to learn clinical pathologic, radiologic, surgical and radiation and chemotherapy management aspects of patients with complex conditions that affect the oral, maxillofacial, and head and neck complex. Residents also attend medical grand round/primary care grand rounds lectures offered by the UCSF School of Medicine on the UCSF campus.
This fundamental and didactic instruction provides background for and complements clinical rotations taken in the second year.
Development of clinical skills is a key goal of the program, with residents being given increasing time and responsibilities as they advance.
Sol Silverman Oral Medicine Clinic: Residents spend a significant amount of time in the Sol Silverman Oral Medicine Clinic learning to evaluate and manage patients with a variety of systemic diseases and head and neck complaints. The clinic is a major referral center for the Bay Area and Northern California. Its oral medicine specialists manage a large number of patients, totaling over 3,000 visits per year, which provides a unique opportunity for training for our postgraduate residents. Stem cell and solid organ transplant recipients are commonly treated in the Sol Silverman Oral Medicine Clinic, as they often develop oral complications (e.g., graft-versus-host disease for stem transplant recipients and opportunistic oral infections for solid organ transplant recipients). Residents also gain expertise in the management of patients with inflammatory oral mucosal disease (such as lichen planus, pemphigoid, pemphigus and erythema multiforme), infectious diseases affecting the oral mucosa, salivary gland disorders, oral cancer (diagnosis of oral cancer, pre-radiation work-up and follow-up during and following radiation for patients with head and neck cancer) and chronic orofacial pain syndromes. Following patients over time will provide a better understanding of the natural history of the disease as well as the outcome of therapy.
Rotations: The second year of oral medicine residency includes a number of hospital-based training rotations in UCSF Medical Center. Residents complete a full-time four-week rotation in the internal medicine inpatient service in the UCSF Division of Hospital Medicine, where they perform physical examinations and work-up on patients and attend rotation-related lectures and seminars. Additional rotations in several medical subspecialties throughout the year in inpatient and outpatient settings are structured to provide an in-depth, varied experience that provides a deeper understanding of etiology, pathophysiology and differential diagnosis and medical management of medically complex patients and oral medicine conditions. Rotations include oral pathology/radiology, diabetes, radiation oncology, medical oncology, infectious disease/HIV, transplant nephrology and hepatology, viral hepatology, Sjögren's syndrome/rheumatology and dermatology.
Internal Medicine Rotation
Site: Inpatient Hospital Service, UCSF Medical Center
Faculty: Bradley Sharpe, MD
Residents learn to perform complete admission histories and physical examinations; select and interpret appropriate diagnostic tests; develop assessments, including differential diagnosis, based on information gathered from the history, physical exam and laboratory tests; and present patients to the attending. This rotation provides an excellent opportunity to learn to manage, diagnose and treat (or refer for treatment) general medicine cases. The rotation includes a daily one-hour conference where residents and fellows from the School of Medicine (who also rotate through this service) discuss cases seen that day with attending physicians.
Site: Diabetes Outpatient Clinic, UCSF Medical Center
Faculty: Umesh Masharani, MBBS
Residents shadow the attending physician during consultations. Residents are expected to collect patient histories and to present them to the attending. This rotation provides the opportunity to observe a physician manage diabetes, and to diagnose and treat (or refer for treatment) various diabetes-associated diseases (e.g., disorders of the kidney, heart, thyroid, pancreas and neuropathy). They also learn to monitor laboratory values relevant to the management of diabetes. Residents perform oral soft tissue examination on patients visiting the diabetes clinic and treat patients who are found to have oral candidiasis.
Sites: Liver Disease and Viral Hepatitis Outpatient Clinic and Liver Transplant Outpatient Clinic, UCSF Medical Center
Faculty: Norah Terrault, MD (liver disease and viral hepatitis); Philip Rosenthal, MD (liver transplant)
The rotations take place in three outpatient clinics at UCSF:
- Liver Disease: This clinic offers diagnosis and treatment of all forms of liver disease and evaluation of patients with severe liver diseases for whom liver transplantation is being considered, as well as consultation on patients with complex hepatic problems. Residents shadow Dr. Terrault during her Tuesday morning clinic. Specialized procedures include TIPS shunt placement for management of ascites or variceal bleeding, and genetic liver disease (hemochromatosis, porphyria, Wilson disease and others).
- Viral Liver Disease: This clinic specializes in the diagnosis and management of patients with chronic viral hepatitis. Residents shadow Dr. Terrault, whose Monday clinic focuses mainly on hepatitis C patients. Residents learn how to interpret laboratory values of patients with chronic hepatitis C. They also learn about the criteria used to determine eligibility for hepatitis C therapy (mainly with pegylated interferon), and about the responses to, and side effects of, therapy.
- The Liver Transplantation Program at UCSF, one of the most active in the country in terms of both volume and clinical research, is headed by Dr. Rosenthal, pediatric medical director. Programs exist for both adult and pediatric liver transplantation, and survival statistics are among the very best in the United States. The program also has performed pioneering research in a number of different areas, including post-transplant viral hepatitis, the use of new immunosuppressive agents, transplantation for fulminant hepatic failure and the use of live donors for liver transplantation. Residents rotate through the pediatric liver transplant outpatient unit, where they shadow Dr. Rosenthal and learn about the main causes of liver failure in children, medical management of pediatric liver transplant recipients and the potential effects of immunosuppressive therapy on the oral cavity.
Sites: Inpatient Kidney Transplant Unit and Outpatient Kidney Transplant Unit, UCSF Medical Center
Faculty: Stephen Tomlanovich, MD
The nephrology rotation has two components: a rotation in the hospital Kidney Transplant Unit (KTU) and a rotation in the outpatient KTU. During the hospital rotation, residents go on morning and afternoon rounds with the transplant team and follow patients from intake (pre-transplant) to discharge five days post-transplant. They learn about various kidney function tests and the complex immunosuppressive, antiviral, antifungal and antibiotic regimens that are administered after transplant. They also learn about the various causes of renal failure. Then they spend six weeks shadowing Dr. Tomlanovich in the outpatient KTU every Thursday morning. Here they learn about the long-term follow-up of renal transplant recipients and how various drug regimens are tapered to leave only a maintenance immunosuppressive regimen. They also learn about the various stages of renal failure and can observe patients on dialysis who also arefollowed in the outpatient KTU.
Infectious Disease Rotation
Sites: Outpatient HIV Clinic and Urgent Care Infectious Disease Clinic, UCSF Medical Center
Faculty: Marc Jacobsen, MD
- Continuity Clinic: In this clinic for HIV-infected patients, residents observe a broad spectrum of medication issues and chronic condition issues other than HIV (e.g., hyperlipidemia, diabetes, hypertension, chronic hepatitis B or C) and behavioral issues.
- Urgent Care Infectious Disease Clinic: Residents participate in the work-up of a wide spectrum of disease pathology and differential diagnosis in urgent care.
Sites: Oncology Outpatient Clinic and Pediatric Bone Marrow Transplant Clinic, UCSF Medical Center
Faculty: Alan Kramer, MD (medical oncology); Biljana Horn, MD, and Morten Cowan, MD (hematology/oncology)
- Medical Oncology: This rotation takes place on Mondays in an outpatient clinic at UCSF where Dr. Kramer manages patients undergoing chemotherapy as treatment of various types of head and neck cancer, lymphoma, breast cancer, prostate cancer and leukemia. The chemotherapy is often administered in parallel to radiation therapy (RT), providing residents the opportunity to understand the mechanism of action of various chemotherapeutic agents, their risks, benefits and side effects when administered alone or in conjunction with RT. Residents also perform oral examinations on patients and manage salivary hypofunction, candidiasis and ulcerations when these conditions occur.
- Hematology/Oncology: This rotation takes place on Wednesday morning in the Pediatric Bone Marrow Transplant Clinic at UCSF. Patients from birth to age 18 who have received a hematopoietic stem cell graft (from various sources such as peripheral blood, bone marrow or umbilical cord) as treatment of recurrent leukemia or other blood dyscrasia are managed until complete immune reconstitution. Residents shadow the attending physician and learn about the various forms of both acute and chronic graft-versus-host disease (GvHD) that may occur in this patient population. They specifically learn how to recognize the clinical signs of oral GvHD and various management approaches ranging from topical steroid applications, if GvHD is mild and limited to the oral cavity, to systemic therapy if GvHD is more severe and affects other organs, such as the lungs, skin, eyes, liver and GI tract.
Head and Neck Radiation Oncology Rotation
Site: UCSF Medical Center at Mount Zion
Faculty: Jeanne Quivey, MD, and Sue Yom, MD, PhD
Intensity Modulated Radiation Therapy (IMRT) has been used to treat head and neck cancers at UCSF since 1987. Residents shadow Dr. Quivey during pre-radiation consultations, treatment planning sessions and consultations that occur at regular intervals as patients are undergoing radiation therapy. Residents also observe the simulation phase that precedes IMRT.
Dental Oncology Rotation
Site: Sol Silverman Oral Medicine Clinic
Faculty: Oral Medicine and General Practice Residency (GPR) faculty
This rotation takes place at the Sol Silverman Oral Medicine Clinic where residents rotate alongside GPR faculty and residents and oral medicine specialists on pre-radiation and post-radiation consults. Residents shadow the specialists as they evaluate oncology patients before and after they undergo head and neck radiation therapy. Residents treat and manage the dental and oral side effects and sequele of cancer therapy such as mouth sores, thrush and dry mouth. Residents gain knowledge in diagnosis and management of these conditions and the developmental side effects of cancer therapy. Residents also learn to manage and coordinate treatment between the different disciplines involved in treatment of cancer patients.
Autoimmune Dermatology Rotation
Site: Autoimmune Dermatology Clinic, UCSF Medical Center
Faculty: Kari Connolly, MD
The clinical rotation takes place in the Autoimmune Dermatology Clinic, an outpatient clinic that focuses on the management of patients with mucocutaneous disorders thought to be of autoimmune etiology (e.g., lichen planus, pemphigus, pemphigoid, lupus). Residents collect patient histories and work up cases with Dr. Connolly. They perform oral examinations when relevant and learn how to collect a skin biopsy. This rotation is very complementary to the oral medicine clinical rotation as residents work up diseases they have encountered in the Oral Medicine Clinic among patients with extensive skin involvement.
Orofacial Pain/TMD Rotation
Sites: The Center for Orofacial Pain, Department of Oral and Maxillofacial Surgery, UCSF
Faculty: Charles McNeill, DDS (Center for Orofacial Pain); David Lee, MD (UCSF Pain Management Center)
The Center for Orofacial Pain: Residents learn how to perform a comprehensive work-up of patients with temporomandibular disorders and other orofacial pain-related disorders. They learn about the most up-to-date pharmacologic agents used in pain management, occlusal appliances and the use of physical therapy in the management of myofacial dysfunction.
- UCSF Pain Management Center (PMC): The PMC has been in existence since 1987, treating patients from all over the world with complicated and chronic medical, surgical and neurological pain problems. The staff, based in the Department of Anesthesia, comprises a variety of doctors and therapists with specialties in anesthesia, neurology, psychology, nursing and physical therapy. Patients consult the PMC because of various types of back pain, neuropathic (nerve) pain, cancer pain, musculoskeletal/rheumatologic pain, post-injury or surgical pain and many others. A wide variety of treatment modalities is available, and each patient's case is personally reviewed by the multidisciplinary staff so that the best combination of therapies is offered to each person. Oral Medicine residents shadow faculty at the PMC, observing the process of making a differential diagnosis on a chronic pain patient and developing an appropriate treatment plan.
Sjögren's Syndrome/Rheumatology Rotation
Site: UCSF Sjögren's Syndrome Clinic
Faculty: Ava Wu, DDS
Residents shadow Dr. Wu as she performs the oral and salivary evaluation of patients with suspected Sjögren's syndrome. Residents learn to perform the parotid saliva collection and the labial salivary gland biopsy. They also shadow the ophthalmologist who performs the Schirmer test, tear break-up time and ocular staining to evaluate patients for kera-conjunctivitis sicca. In addition, residents shadow the rheumatologist who performs a comprehensive review of systems among all patients with suspected Sjögren's syndrome.
Research is an integral component of the mission and goals of the program. Early on in their training, oral medicine residents will identify one or more areas of clinical research to pursue, with faculty supervision, over the course of the program. Research training includes courses in clinical research protocol development, biostatistics and bioethics. Faculty members represent a broad array of scientific fields using clinical, epidemiological and basic science approaches in their investigations. This diversity of scope establishes a broad base for research programs and training available to residents. Students are required to complete a master's level research project under the supervision of a thesis adviser and committee, in accordance with the guidelines of the University of California Graduate Division. It is expected that the outcome of this work will be presented at a national meeting and published in the scientific literature.
Our faculty are nationally and internationally recognized for their contributions to the fields of oral medicine and oral pathology.
Oral Medicine Faculty
Caroline Shiboski, DDS, MH, PhD, Director
Daniel Ramos, DDS, PhD, Co-director
Annie Chou, DDS, PhD
Deborah Greenspan, BDS, DSc
John Robinson, DDS
Piri Veluppillai, DDS, MS
Ava Wu, DDS
Oral Pathology Faculty
Richard Jordan, DDS, PhD
Kyle Jones, DDS, PhD