Oral mucosal screening as an integral part of routine dental care

Abstract

The principal aim of this study was to assess the feasibility of conducting a systematic examination of the oral mucosa, as an integral part of the routine dental check-up and in conditions comparable with those in NHS dental practice. A total of 1949 individuals, who were already registered as patients with an industrial dental clinic, were invited to attend for an oral screen as part of their dental examination. Of these, 1947 patients agreed to participate and were also asked to complete a 'habits' questionnaire relating to their tobacco and alcohol use. A systematic examination of the oral mucosa was undertaken as part of the routine dental inspection and mucosal lesions were recorded as either a positive or negative screening result. Lesions included as a positive result were those which may be associated with early cancer or precancer. Four patients (0.2%) were considered to have a positive screening result and these were referred for specialist evaluation. Of these, two had tobacco-related leukoplakia, one had oral lichen planus and the other had an early squamous cell carcinoma. This study has confirmed that a systematic and thorough examination of the oral mucosa can realistically be carried out as part of the routine dental inspection in NHS dental practice.

Attitudes to biopsy procedures in general dental practice

“…27 Cowan et al 17 found that 94% of dentists regularly examine the oral soft tissues for potentially malignant lesions. In our study 157 (69%) dentists reported carrying out examination of the oral soft tissues every 6 months whilst 25 (11%) carried it out annually.…”

Opportunistic screening for oral cancer and precancer in general dental practice: results of a demonstration study

“…14,15 Most studies are of specific age groups, but those which show a high prevalence have usually been conducted in high risk groups and have been carried out with some element of targeting, either in countries where the prevalence of oral cancer and precancer is high, 28,30,31,33,40 in high-risk populations such as heavy smokers and drinkers or betel quid users, 24,36,42,47 as part of multiphasic screening such as those attending lung cancer clinics 46 or in convenience populations like the institutionalised elderly, forces personnel and attenders of hospital outpatients clinics or medical practices. 14,15,32,39 An informative UK study was that carried out by Pearson et al 47 among the Bangladeshi population of East London. This showed a prevalence of leukoplakia of 25%, with a positive association with betel quid or paan chewing.…”

Oral cancer in the UK: to screen or not to screen

“…In the UK, examination of the oral cavity has been reported to have a sensitivity ranging from 71 to 81% and a speci®city of 99% or more when screening was carried out by general dental practitioners, with dental specialists' diagnosis as the gold standard [113,114,118]. In two studies [113,114], detection of a white or red patch or ulcer of more than 2 weeks duration constituted a positive test.…”

“…However, in a study of the feasibility of conducting oral screening as part of a routine dental check-up in a comparable setting to a NHS practice, almost all (1947/1949) subjects of any age registered with an industrial dental clinic who were invited to attend for an oral screen as part of their dental examination agreed to participate [114]. An invitational screening programme [115] targeting 4348 subjects (aged 40 and over) registered with an inner city medical practice in North London reported that 25.7% of those invited accepted; a further 8.5% responded after a second mailing.…”