Preface

“Sex does matter. It matters in ways we did not expect. And it matters in ways we have not yet begun to imagine.” [1]

The oral cavity has been described as the window of systemic disease. Over the past two decades, evidence-based studies have focused on the interrelationships among sex, gender, systemic disease, and oral health. There has been an evolution from regarding the male patient as the normal model of health to examining gender differences that goes beyond reproductive function only. These differences are driven by a combination of biologic, social, and environmental factors.

The establishment of the National Institutes of Health Office of Research in Women's Health in 1990 set a precedent by including women as subjects for scientific research. The Surgeon General's Healthy People 2010 report also has stressed the importance of examining how sex and gender may influence the diagnosis and treatment of disease. Finally, more than 15 Centers of Excellence in Women's Health across the United States have followed mandates by Congress to require the inclusion of women in federally funded clinical trials.

Our participation as leaders in the field of oral health and disease places us in a pivotal position to recognize gender-specific oral diseases and their influence on the health of the individual. Recognition of the sexual dimorphism of various disease states and conditions allows for more rapid diagnosis and initiation of treatment.

Dr. Meredith August and I are privileged to provide an innovative Oral and Maxillofacial Surgery Clinics issue that addresses how oral and maxillofacial diseases exhibit sex-based differences. Specifically, the treatment of the female patient poses unique challenges and is an area as yet incompletely explored. Only recently have oral health care researchers incorporated female gender as a predictor variable for developing oral diseases that manifest themselves systemically. There is also a paucity of dental and medical training to provide evidence-based distinctions between men and women that can be integrated into the health care educational curricula. Such gaps affect the quality of training.

Topics chosen for inclusion in this issue hopefully focus on salient differences between male and female patients and how treatment considerations may differ. The article discussing anesthesia and pain management reviews the physiologic differences that impact on care and focuses on pain management strategies that are tailored to women. Other topics include osteoporosis and the complications associated with therapy (specifically the use of bisphosphonates). Cosmetic surgery, far more common in female patients, is discussed from the standpoint of patient expectations and addresses the specific problems seen in the aging female face. Idiopathic condylar resorption, more common in female patients, is also reviewed. The effect of female sex hormones on oral tissues and systemically is addressed in articles reviewing autoimmune diseases, eating disorders, temporomandibular disorders, and the care of the pregnant patient. Articles that discuss the awakening of oral and maxillofacial surgeons to cancer in the young female patient and the importance of diagnosing a victim of violence and abuse are important contributions to our body of literature. This information may provide strategies for appropriate and rapid diagnoses that will be life saving.

As a co–guest editor for this issue, I would first like to thank my co–guest editor, Meredith August, who has been a mentor, friend, and colleague. I am fortunate for her expertise and support to undertake this endeavor with me. I wish to extend my thanks to John Vassallo, editor of Oral and Maxillofacial Surgical Clinics, and Dr. Richard Haug for his support and encouragement of this project. Special thanks are given to Dr. Thomas Dodson, who has been the perfect mentor over many years, and to my academic chairman, Dr. Leonard Kaban, who leads us all with his tireless hard work and commitment to excellence. A warm thanks goes to Dr. Julie Glowacki, who has been a role model and stalwart friend to me. I also thank my former program directors, Drs. Orrett Ogle, Jeffrey Carter, Donald Chase, and Harry Dym, for their respect and support. Thanks as well to Drs. Thomas Flynn and Bruce Donoff for supporting my educational endeavors at the Harvard School of Dental Medicine. Appreciation goes to Neal Blustein, who has helped to make the editing of this issue easy.

I have been fortunate to have experienced the educational riches by many of those who have agreed to contribute to this issue. I am privileged to share this issue with Drs. Karen Crowley, Thomas Dodson, Maria Papageorge, Ghali Ghali, Julie Glowacki, Sal Ruggiero, Vasiliki Karlis, Marci Levine, Andrea Schreiber, Gayle Miranda, Thomas Flynn, MariaTroulis, Maria Papadaki, Leonard Kaban, Deborah Zeitler and Franci Stavropoulos. In addition, I thank the co-authors; fellows and residents who have made this issue a first of its kind!

I dedicate this issue to the memory of my father, Samuel, and my sister, Nadine Andrea. Most important is my appreciation to those closest to me. My mother has been the driving force of support throughout my career. She will always be my energy! My sons, Seth Paul and Noah Adam, have endured my educational odyssey with few complaints. I am most fortunate to have them at my side. I thank my closest friend and confidant, Peg Herod, who has read many of the drafts, regardless of page numbers. I must thank my students and residents, both past and present, which I have had the privilege of teaching. From them I have learned more than from any book. Our relationship embodies the definition of academic oral and maxillofacial surgery. I will strive to continue to meet their expectations as an educator.