Referral Patterns in Oral Medicine: A Retrospective Analysis of an Oral Medicine University Center in Southern Italy

Abstract

Referral of a patient from one healthcare provider to another is an important part of the medical practice. The aim of this study was to analyze the referral process to the Oral Medicine Unit in a university-based tertiary center in Southern Italy. A chart review of new referrals to the Oral Medicine Unit during a 24-month period was conducted. The following data were recorded: demographic characteristics, medical history, number of physicians seen prior to Oral Medicine assessment, referral source, diagnostic procedures ordered by referrals, reason for referral, site of lesion/condition, final diagnosis. Then, the rates of correct identification for health-care professionals and the appropriateness of the reference diagnosis based on the disease were calculated with descriptive statistic indicators. There were 583 new first consultations. A total of 62.9% of patients were referred by general dental practitioners, 27.4% by physicians, and 9.7% did not have a referral. The most common diseases for referral were immune-mediated diseases (39.6%) and oro-facial pain disorders (25.2%). Only 28.5% of patients had a correct provisional diagnosis. The results of this study show the need to implement curricula in the field of oral medicine among dentistry and medical students, and to support the continuing education among healthcare providers to reduce diagnostic delay for oral diseases.

Patients journey to diagnosis and treatment of oral mucosal lesions: A report on three cases

“…This resulted in increased patient anxiety and distress due to a lack of diagnosis and treatment. This is in line with previous studies, which reported that patients with oral mucosal lesions underwent unnecessary tests and were not diagnosed or misdiagnosed despite being seen by multiple clinicians 5,6 . This resulted in diagnostic delays, which could worsen the prognosis for many conditions or at least affect the patients' oral health‐related quality of life 5 …”

“…diagnostic delays, which could worsen the prognosis for many conditions or at least affect the patients' oral healthrelated quality of life. 5 The patient in the first case had only a mild burning sensation but was distressed by the recurrent nature of the lesions and the lack of diagnosis even after a biopsy. Most BMG lesions are asymptomatic, and despite being a benign lesion, BMG triggers concerns for patients and causes diagnostic difficulties for professionals, as the diagnosis is entirely based on the history and clinical presentation, and a tissue biopsy is unnecessary.…”

“…Some studies indicated that white‐red lesions were the most common reason for referral and that the tongue was the most common site of concern 15 . Others indicated that OLP and BMS were the most frequent conditions to be referred, followed by orofacial pain disorders, which is in line with the increase in the prevalence of chronic pain worldwide 5 . However, specific guidelines and policies on referrals to OM are lacking among most healthcare systems 21 …”

“…15 Others indicated that OLP and BMS were the most frequent conditions to be referred, followed by orofacial pain disorders, which is in line with the increase in the prevalence of chronic pain worldwide. 5 However, specific guidelines and policies on referrals to OM are lacking among most healthcare systems. 21 HCPs can improve access to oral healthcare for their patients, but this is dependent on HCPs receiving adequate training in oral diseases and oral manifestations of systemic diseases.…”

“…Moreover, 50% of referring HCPs were unable to make a clinical diagnosis of an oral mucosal lesion, and only 40% of the provisional diagnosis provided in the referring letter concurred with the diagnosis made by the OM 4 . In another study, only 28.5% of referred patients to a university‐based OM clinic had an accurate provisional diagnosis 5 . These remarkable findings indicate HCPs lack of competency skill in diagnosing oral mucosal lesions, causing delay in patient care.…”