Source: Quintessence Publishing
Objective: Dentists play an important role in the early diagnosis and treatment of oral lesions. However, treatment based solely on a clinical impression of the diagnosis, without histologic confirmation, can result in serious consequences, particularly when the lesion is precancerous or cancerous. The purpose of this study was to determine the overall accuracy of clinical diagnoses made by dentists as well as to compare the diagnostic ability of general practitioners with members of various dental specialties. Method and Materials: The biopsy reports of 976 specimens submitted to the Department of Oral and Maxillofacial Pathology, Virginia Commonwealth University School of Dentistry, between January 2009 and January 2010 were reviewed. The presumptive clinical diagnosis made by the practitioner and the final histologic diagnosis on each specimen were recorded in addition to whether the submitting dentist was a general practitioner or a specialist. Results: Of the clinical diagnoses made by the submitting dentists, 43% were incorrect. General dentists misdiagnosed 45.9%, oral and maxillofacial surgeons 42.8%, endodontists 42.2%, and periodontists 41.2% of the time. The most commonly missed clinical diagnoses were hyperkeratosis (16%), focal inflammatory fibrous hyperplasia (10%), fibroma (8%), periapical granuloma (7%), and radicular cyst (6%). Cancerous lesions were misdiagnosed 5.6% of the time. Conclusions: The high rates of clinical misdiagnosis by dental practitioners indicate that all excised lesions should to be submitted for histologic diagnosis. (Quintessence Int 2011;42:575–577)
This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
This article only reinforces what OCF has been saying all along. No one, GP or oral surgeon, can look at a lesion and determine what it is with certainty. When you are dealing with something as deadly as oral cancer which is on the rise in the US, this can not be stated strongly enough. We hear far too often that a doctor (medical or dental) has visually examined some abnormality in a patient’s mouth and told them not to worry, not really knowing through any kind of biopsy what it actually is.
OCF’s position has always been that it is less important that a doctor can readily identify what an abnormality is, than that they take the time to OPPORTUNISTICALLY look for things, and when they find something that has persisted over two weeks – they do, or refer the patient to someone competent to take a small biopsy and have a histopathology determine exactly what the suspect tissue is. Patients are only hurt by less, and professionals put them at risk in a litigious society when something that they thought was innocuous (and decide to watch for a protracted period of time), turns out to be a malignancy – now in a later and more advanced stage.
Only the pathologist that examines that small piece of tissue can tell for sure what it is. No patient has ever been upset by hearing that something is benign, and they deserve even then, to know what it is so that it can be dealt with appropriately. This study clearly shows that no matter the specialty, nor the number of years of experience matter. Every patient that is referred for biopsy is a potential lawsuit deferred, and a patient that has a gold standard, black and white answer to what is going on in their mouth. Please use the welll established referral chain to see that patients get timely and accurate answers.