Accuracy of Dentists in the Clinical Diagnosis of Oral Lesions
Kondori I, Mottlin RW, Laskin DM
Quintessence Int. 2011;42:575 -577
Clinical Diagnosis of Oral Lesions
Detection, evaluation, and management of oral lesions are critical responsibilities for oral healthcare providers. Although most oral lesions are benign, they can represent chronic mucosal disorders or malignant processes, both of which may require extensive management. Kondori and colleagues provide data on the overall accuracy of clinical diagnoses of oral lesions made by dentists and compare the diagnostic ability of general dentists with that of various dental specialists in this area.
Investigators reviewed 976 biopsy reports from specimens submitted to the Department of Oral and Maxillofacial Pathology of the Virginia Commonwealth University from January 2009 to January 2010. The presumptive clinical diagnosis made by the clinician was compared with the final histologic diagnosis made by the pathologist. Investigators also noted whether the presumptive clinical diagnosis was rendered by a general dentist or a dental specialist. The major conclusions of this study are as follows:
Overall, 43% of the clinical diagnoses made by submitting dentists were incorrect;
The rate of clinical misdiagnosis for general dentists was nearly 46%;
Rates of clinical misdiagnosis among dental specialists were 42.8%, 42.2%, and 41.2% for maxillofacial surgeons, endodontists, and periodontists, respectively; and
Malignant lesions were clinically misdiagnosed at a rate of 5.6%.
Viewpoint
Published studies surveying knowledge and opinions on oral mucosal lesions among general dentists and dental specialists, along with referral patterns, demonstrate the challenges encountered by oral healthcare providers with respect to this specific clinical issue. In a recent global survey of oral medicine practitioners, evaluation and management of oral lesions were reported as the primary component of their respective clinical practices, which substantiates the concept that patients with oral mucosal lesions are often referred by general dentists and dental specialists for further evaluation and management.
The results of Kondori and colleagues' study support previous findings about the difficulties dentists have in diagnosing oral lesions, irrespective of the type of practice. The study authors also advocate for dentists to submit all excised tissue specimens for microscopic examination in light of the overall rate of clinical misdiagnoses, especially for malignant lesions.
Education on detection, evaluation, and management of oral lesions should be further emphasized in dental school curricula, postdoctoral dental residency programs, and continuing education courses for oral healthcare professionals.
Abstract