Cues used by dentists in the early detection of oral cancer and oral potentially malignant lesions: findings from the National Dental Practice-Based Research Network

Head and neck exam practices of dental professionals

OBJECTIVE

Periodic examination of the head and neck includes screening for oral cancer, which is largely performed in dental offices by vigilant oral healthcare providers. The aim of this study was to assess practice patterns among Virginia dentists in performing head and neck exams and the referral rates of biopsies after completion of head and neck exams. We hypothesized that not all dentists perform head and neck exams and there is a difference between dentists who refer patients for a biopsy and those that perform biopsies.

METHODS

General dentists and dental specialists who are members of the Virginia Dental Association were invited to participate in a cross-sectional survey study through REDCap to self-report their head and neck exam protocols.

RESULTS

A total of 224 providers completed the survey. The majority of respondents were general dentists with more than 20 years in practice, who practice in a private setting, and see more than 10 patients in a day. All respondents stated they perform intraoral examinations, but 10 respondents stated they do not perform extraoral examinations. Nearly a third of respondents reported doing their own biopsies.

CONCLUSIONS

Although only 8.5% of oral healthcare providers in Virginia responded to our survey, respondents are following the 2017 ADA good practice statement by providing their patients with head and neck exams to screen for oral cancer. Additional education pertaining to extraoral anatomy, malignant transformation of oral potentially malignant disorders, and pathology procedures may be helpful to clinicians.

Factors important in the correct evaluation of oral high-risk lesions during the telehealth era

BACKGROUND

Considering that early detection of squamous cell carcinoma (SCC) improves prognosis and clinical examination is the primary detection method, we identified factors related to the clinical evaluation of oral mucosal lesions. Due to the growing role of telehealth, our study was based on clinical image evaluation.

SUBJECTS AND METHODS

Oral medicine specialists and dental students evaluated six images of benign, potentially malignant, or SCC lesions (18 images in total). We analyzed the role of personal factors of the examiners and the visual pathological features of the lesion upon which the participants based their evaluation.

RESULTS

One hundred thirty-three subjects participated. Half of the benign images were correctly evaluated. On average 1.2 (±SD1.3) cancer pictures were recognized correctly and 3.66 (±SD1.42) images were considered potentially malignant. Potentially malignant lesions were correctly evaluated at an average of 4.08 (±SD1.48) images. For cancer and potentially malignant lesion images, there were significantly better results among clinicians with the worst results from the fourth-year students. Student results correlated significantly with years of study, number of weeks spent in the oral medicine clinic, and interest in oral pathology. Consideration of lesion irregularity yielded a correct diagnosis, whereas wrong answers were based on color changes. Lesion size and margins were considered equally important.

CONCLUSIONS

Using clinical images as part of the diagnostic process provides good results, though increased clinical experience for graduates and undergraduates may be necessary to improve accuracy. Therefore, emphasizing the important visual parameters of malignancy may be valuable in the current telehealth era.

Oral potentially malignant disorders - An assessment of knowledge and attitude to future education in undergraduate dental students

INTRODUCTION

The aim of this study was to assess the knowledge and clinical experience of oral potentially malignant disorders (OPMDs) in undergraduate dental students in six European countries (Croatia, France, Italy, Portugal, Spain and United Kingdom) and assess student's attitude and preference to future education on the topic. A secondary aim was to identify gaps in student's knowledge and clinical practice. The study was a part of the Erasmus+ project "Oral Potentially Malignant Disorders: Healthcare Professionals Training" (Grant No: 2020-1-UK01-KA202-078917).

MATERIALS AND METHODS

An online questionnaire was distributed to all final-year students in six partner universities. This consisted of four parts assessing: (1) knowledge on OPMDs, (2) clinical experience with this group of patients, (3) self-rated competence in the management of OPMDs and (4) preferences with regard to future education.

RESULTS

Two hundred and sixty final-year dental students from six partner universities responded to the questionnaire. Response rates varied from 12% to 92% between partner universities. Significant differences in clinical experience and knowledge were found between students. Students with more clinical exposure to OPMDs rated their knowledge and competence in the management of OPMDs higher than students with less clinical experience. The majority of students were interested in future education on OPMDs, preferably via short educational videos.

CONCLUSION

The majority of students have received theoretical knowledge of OPMDs during their undergraduate studies, however, not all had clinical exposure to this group of patients. Students were open to further education on OPMDs. Important deficiencies in knowledge were identified that need to be addressed and it is anticipated that the e-learning platform and e-book that are in development by partner institutions will help to improve overall knowledge of OPMDs.

Early detection of oral cancer: a key role for dentists?

Purpose

The majority of suspected malignant changes in the oral mucosa are detected by dentists in private practice. Statements regarding the effectiveness of visual examination of the oral cavity for early detection are not necessarily transferable between different health care systems. Our clinical-epidemiological and methodological aim was thus to conduct a prospective regional study in dental practices under everyday conditions, assess the frequency and type of oral mucosal changes, and evaluate the dental examination methodology.

Methods

A prospective observational study was conducted, combining a feasibility study of early detection of oral cancer and its documentation with phase I ‘modelling’ to conceptualize complex interventions in health services research. Dentists in private practice continuously recruited patients over 6 months and used two different sheets for the documentation of suspicious lesions. Statistical analysis involved descriptive statistics and tests for differences (Welch test) or association (Chi-squared test).

Results

Twenty-five dentists (mean age: 50 years, 24% females) participated in this study. Eleven dentists achieved the overall aim of recruiting 200 patients. Around 4200 patients (mean age: 52 years, 57.5% females) participated. The prevalence of suspicious lesions was 8.5%.

Conclusion

It became apparent that a study in cooperation with dentists in private practice to generate clinical-epidemiological data on the early detection of oral mucosal lesions under everyday conditions can be carried out successfully. Further studies with a corresponding level of evidence should be carried out to be able to draw conclusions about the effectiveness of the early detection measure under everyday practice conditions.

Healthcare Professional in the Loop (HPIL): Classification of Standard and Oral Cancer-Causing Anomalous Regions of Oral Cavity Using Textural Analysis Technique in Autofluorescence Imaging

Oral mucosal lesions (OML) and oral potentially malignant disorders (OPMDs) have been identified as having the potential to transform into oral squamous cell carcinoma (OSCC). This research focuses on the human-in-the-loop-system named Healthcare Professionals in the Loop (HPIL) to support diagnosis through an advanced machine learning procedure. HPIL is a novel system approach based on the textural pattern of OML and OPMDs (anomalous regions) to differentiate them from standard regions of the oral cavity by using autofluorescence imaging. An innovative method based on pre-processing, e.g., the Deriche-Canny edge detector and circular Hough transform (CHT); a post-processing textural analysis approach using the gray-level co-occurrence matrix (GLCM); and a feature selection algorithm (linear discriminant analysis (LDA)), followed by k-nearest neighbor (KNN) to classify OPMDs and the standard region, is proposed in this paper. The accuracy, sensitivity, and specificity in differentiating between standard and anomalous regions of the oral cavity are 83%, 85%, and 84%, respectively. The performance evaluation was plotted through the receiver operating characteristics of periodontist diagnosis with the HPIL system and without the system. This method of classifying OML and OPMD areas may help the dental specialist to identify anomalous regions for performing their biopsies more efficiently to predict the histological diagnosis of epithelial dysplasia.