As a board-certified oral medicine specialist with the University of Pittsburgh School of Dental Medicine, Revathi Shekar, BDS, MDS, brings high-level, specialty care to medically complex patients, bridging oral health and medical care. Oral medicine specialists are experts in the diagnosis and management of patients with oral mucosal and salivary gland diseases, oral complications resulting from systemic disease, oral complications from cancer treatment, and orofacial pain.
There are only 9 CODA-accredited oral medicine training programs in the United States. The American Board of Oral Medicine (ABOM) oversees the quality, uniformity, and continuity of U.S. training programs and certifies diplomate status of oral medicine specialists who have achieved and maintain board certification in the specialty. Diplomates in oral medicine make up less than one percent of healthcare workers globally, and, in the U.S., there are only 107 oral medicine diplomates practicing in just 32 states.
Dr. Shekar serves as an assistant professor in the Department of Diagnostic Sciences and sees patients through Oral and Maxillofacial Surgery and Prosthodontics at Montefiore, part of the University Dental Health Services practice. She works with primary care physicians, otolaryngologists, the bone marrow transplant team, and radiation oncologists from various specialty clinics across the region.
Oncologists who care for patients with head, neck, oral, and related cancers can encounter complications in the oral cavity, either from the disease itself or from medications or radiation treatment. Dr. Shekar’s oral medicine specialty care can assist the medical provider while providing relief for patients suffering through such conditions.
“I believe that integrating the specialty of oral medicine as part of an interdisciplinary care team will improve patient care delivery and health outcomes for patients,” she said.
Anitha Potluri, BDS, DMD, MDsc, is the chair of the Department of Diagnostic Sciences at Pitt Dental Medicine. “Pain in the oral cavity, especially TMJ, is among the worst pains, radiating through the head and neck,” said Dr. Potluri. “It impairs your ability to think, to function. It’s not just the disease, it’s your whole life.
“This is why we were very interested in the experience and knowledge that Dr. Shekar adds to our services,” added Dr. Potluri. “She has a unique ability to help patients with complex diseases and work with other medical specialists.”
Seeing Patients as People
Dr. Shekar’s cancer patients might face oral complications such as mucositis, graft versus- host disease, and jaw osteonecrosis. She also helps people affected by facial pain, oral mucosal growths, ulcers, infection, immune-mediated and salivary gland disorders, and neurologic and chemosensory impairment.
Patients experiencing these types of health problems may initially see their primary care physician, dentist, or other medical specialists. These doctors then refer them to Dr. Shekar, who helps them arrive at a diagnosis and care plan. “The physicians and I work with each other and with the patients to individualize their treatment plan,” she said.
“I know that a doctor’s appointment is a stressful environment for patients,” she said. “There’s a lot to remember. So, at the end of the day, I send my patients an email summarizing everything we discussed—the recommendations, do’s and don’ts, and medication-use instructions. I copy the referring physician, so everyone is looped in.”
She also gives patients her email, so they can get in touch and ask questions when they have a flare-up or other issues.
“It’s hard to navigate the health care system, so once they find a provider, I do as much as I possibly can to make it easy for them,” she said.
Dr. Shekar is aware that physical health problems can cause stress and directly impact mental health. “For most patients, it’s not just the lesions or the pain in their mouth. It’s the fact that they see multiple doctors and oftentimes don’t receive a diagnosis. That’s unsettling. I understand and can empathize with them.”
Collaborative Treatment Teams
Having Dr. Shekar in the Pittsburgh area gives dentists and physicians access to one of the few oral medicine specialists in the country. According to the American Academy of Oral Medicine, there are only nine dental schools with oral medicine residency programs in North America.
It is primarily a non-surgical specialty with procedures limited to diagnostic biopsies, small excisions, therapeutic injections, and other minor surgical interventions. In many cases, conditions are managed medically with the use of topical and systemic medications.
“Preventive care and early intervention can be very helpful in a long-term prognosis, when you have the right member of the team looking at it,” said Dr. Potluri. “Dr. Shekar has a very natural way of taking care of patients—a person-centric approach. And she applies her knowledge in an empathetic way. Her ability to care for patients is an incredible benefit to our medical community.”
“I’ve gotten incredible support from Dr. Potluri and the Department of Diagnostic Sciences,” said Dr. Shekar. “She encourages us to collaborate.”
“Dr. Shekar’s education as an oral pathologist from India, plus her advanced education from Harvard, makes her a valuable resource for her patients, for her referring physicians, and for our students,” added Dr. Potluri.
Wide-Ranging Experiences
Ever since Dr. Shekar was a young child in Bangalore, India, she wanted to help people. During her first experience at a hospital, when her mother delivered her younger brother, she was fascinated by the doctors and nurses. She went on to earn her Master of Dental Surgery degree in oral pathology and microbiology from the Tamil Nadu Dr. M.G.R. Medical University in Chennai, India.
She presented her research, “Early Phenotypic Changes of Extracted Pulp Cells in Culture,” at the International Association for Dental Research (IADR) conference in Barcelona, Spain. “This opened up the possibility of leaving home and my comfort zone,” she said.
She received additional training in oral medicine and oncology at Brigham and Women’s Hospital, Harvard School of Dental Medicine, and the Dana Farber Cancer Institute in Boston, Massachusetts.
“At Harvard, I learned from the best—be it the faculty or my patients. They taught me oral medicine, empathy, and some invaluable life lessons.”
Exploring New Perspectives
Her formative experiences in India broadened her education and inspired her approach to patient care. There, Dr. Shekar treated people with HIV-AIDS, alcohol and drug addictions, and oral pathologies.
She also volunteered with the nonprofit group Make a Difference, teaching math and science to children living in shelters. “The children I met there were the best—curious, diligent, and inspiring,” she said.
Throughout her career, Dr. Shekar continues her passion for lifelong learning and research. She has served as an editor for the textbook, Craniofacial Disorders: Temporomandibular Disorders and Beyond. She is also the author of a chapter in the textbook, An Overview of Chronic Neuropathic Orofacial Pain, and contributed a chapter on pigmented lesions for Practical Guide to Oral Soft Tissue Diseases—A Symptom-based Approach, which will publish this year.
Teaching What She’s Learned
“At school, I had the best teachers and looked up to them. I wanted to be like them. To be able to teach and treat patients was my dream,” Dr. Shekar said.
Today, she does both, as an assistant professor teaching oral medicine, orofacial pain, and oral pathology to Pitt Dental Medicine students and residents.
“Teaching brings me so much joy,” she said. “Just a few years ago I was like them, trying to store an impossible amount of information in my head. I understand that and try to do my best to make the content easy to assimilate. I want to be available to my students and be easily approachable.”
Dr. Shekar encourages her students to look at health care through the lens of the patient. “I encourage them to be empathetic, build rapport with their patients, and have good chairside manner. I prepare them to be in health care, to take care of humans.”
She sees her job as giving students an understanding that they can’t get from a textbook. “While we need to understand the signs of disease, we need to shine a light on knowing it in a way that you can apply it with real patients in real life,” she said.
By Alison Conte