Wednesday, July 27, 2011

Dentists Have a High Oral Lesion Misdiagnosis Rate?

Oral squamaous cell carcinoma

Apparently so, according to a new study.
General dentists correctly diagnosed only 54.1% of all oral lesions from which they submitted biopsy specimens to Virginia Commonwealth University School of Dentistry’s oral pathology department from January 2009 to January 2010. Oral and maxillofacial surgeons, endodontists, and periodontists also had a very high misdiagnosis rate according to a new study published in the July-August issue of Quintessence International.

The lead investigator argues that the results are congruent with those of previous studies and hence are generalizable to the rest of the country. Daniel M. Laskin, DDS, also believes that there are no barriers to submitting samples for pathology analysis and that it is important that all dentists do so.

"Most dental schools have oral pathology departments that render such service. It is also possible to send specimens to a nearby hospital, which all have pathology departments," observed Dr. Laskin, professor and chairman eeritus, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry, Richmond.

Gary L. Henkel, DDS, a dentist who heads Horsham Dental Elements in Horsham, Pennsylvania, agrees.

"Those percentages are really scary but they do not surprise me at all. Many lesions appear very similar clinically — they are red or white, raised or flat, ulcerated or not, but those criteria fit thousands of oral disease entities," Dr. Henkel told Medscape Medical News. "Microscopic diagnosis is often the only way to differentiate lesions of varying origin. That's why in the operating room, all removed tissue is sent for microscopic evaluation."
And, the rate of misdiagnosis did not particularly matter if you were a general dentist or an oral surgeon.
In the study, Dr. Laskin and his colleagues reviewed the biopsy reports of all 976 tissue specimens submitted to the Department of Oral and Maxillofacial Pathology at Virginia Commonwealth University from January 2009 to January 2010. They found that 43% of the diagnoses made by the submitting clinician were incorrect.

General dentists misdiagnosed 45.9% of the oral lesions they submitted, oral and maxillofacial surgeons misdiagnosed 42.8%, endodontists misdiagnosed 42.2%, and periodontists misdiagnosed 41.2% (P = .8).

Hyperkeratosis was the most commonly missed benign clinical diagnosis, at 16% of such missed diagnoses. The other commonly misdiagnosed benign conditions were focal inflammatory fibrous hyperplasia (10%), fibroma (8%), periapical granuloma (7%), and radicular cyst (6%). Malignant lesions were misdiagnosed 5.6% of the time.
So, what does this mean?

Dentists who are often seen more frequently than primary care physicians must take greater care in their oral examination and not rely on just clinical, observational findings.

If in doubt, biopsy and receive microscopic laboratory findings.

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