Abstract
Objective: To assess how well primary care clinicians select patients needing early referral to a dentist based on an oral cavity examination.
Design: Prospective comparison of the screening oral cavity examinations performed by primary care clinicians with that performed by a dentist.
Setting: General medicine clinic and dental clinic of a Veterans Affairs Medical Center.
Patients: A sample of 86 consecutive patients attending regularly scheduled appointments in a primary care medical clinic.
Measures: Each patient was examined independently by two primary care clinicians and then one dentist. History and physical findings, clinical impression, and plan based on the oral cavity examination were recorded. The reference standard was the examination by a dentist blinded to the patient’s history.
Results: The prevalences of lesions suspicious for premalignancy, periodontal disease, calculus, and caries were 23%, 37%, 54%, and 18%, respectively. When the primary care clinicians noticed a lesion suspicious for premalignancy, the likelihood that such a lesion was present increased significantly (LR+=2.7 to 6.6). However, a normal examination by the primary care clinicians did not significantly lower the likelihood of a premalignant lesion (LR −=0.7 to 0.8). The primary care clinicians were more efficient at evaluating dental and gingival conditions (LR +=2.7 to 5.8, LR−=0.2 to 0.7).
Conclusions: Screening for oral disease by primary care clinicians is justified but should not replace routine screening by dentists.
Similar content being viewed by others
References
American Cancer Society. Cancer statistics. CA Cancer J Clin. 1993;43(1):18.
Current Estimates from the National Health Interview Survey: United States, 1987. Vital and Health Statistics. Series 10, No. 166. DHHS Publ. No. (PHS) 88-1594. Public Health Service. Washington, DC: U.S. Government Printing Office, 1987.
U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore: Williams and Wilkins, 1989;91, 351.
Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J. 1979;121:1–45.
National Cancer Institute. Working Guidelines for Early Cancer Detection: Rationale and Supporting Evidence to Decrease Mortality. Bethesda, MD: National Cancer Institute, 1987.
American Cancer Society. Guidelines for the cancer-related checkup: Recommendations and rationale. CA Cancer J Clin. 1980;30:4–50.
Feinstein AR. Clinical Epidemiology. The Architecture of Clinical Research. Philadelphia: W. B. Saunders, 1985.
Pietila T, Pietila I, Vaataja P. Early screening for orthodontic treatment. Differences in assessments made by a consultant orthodontist and three public health dentists. Community Dent Oral Epidemiol. 1992;20:208–13.
Mauriello SM, Bader JD, Disney JA, Graves RC. Examiner agreement between hygienists and dentists for caries prevalence examinations. J Public Health Dent. 1990;50:32–7.
Simel DL, Samsa GP, Matchar DB. Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol. 1991;44:763–70.
Sackett DL. A primer on the precision and accuracy of the clinical examination. JAMA. 1991;267:2638–44.
Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine (second ed). Boston: Little, Brown, 1991.
Simel DL, Feussner JR, Delong ER, Matchar DB. Intermediate, indeterminate, and uninterpretable diagnostic test results. Med Decis Making. 1987;7:107–14.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.
Fleiss JL. Statistical Methods for Rates and Proportions. Second ed. New York: John Wiley & Sons, 1981;112–35.
Begg CB. Biases in the assessment of diagnostic tests. Stat Med. 1987;6:411–23.
Bouqout JE. Common oral lesions found during a mass screening examination. J Am Dent Assoc. 1986;112:50–7.
Ernster VL, Grady DG, Greene JC, et al. Smokeless tobacco use and health effects among baseball players. JAMA. 1990;264:218–24.
Kaugars GE, Riley WT, Brandt RB, Burns JC, Svirsky JA. The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors. Cancer. 1992;70:2579–85.
Fedele DJ, Jones JA, Niessen LC. Oral cancer screening in the elderly. J Am Geriatr Soc. 1991;39:920–5.
Author information
Authors and Affiliations
Additional information
Supported in part by a grant from the A. W. Mellon Foundation.
Rights and permissions
About this article
Cite this article
Westman, E.C., Duffy, M.B. & Simel, D.L. Should physicians screen for oral disease?. J Gen Intern Med 9, 558–562 (1994). https://doi.org/10.1007/BF02599281
Issue Date:
DOI: https://doi.org/10.1007/BF02599281