Evaluating, documenting and following up oral pathological conditions. A suggested protocol.
BACKGROUND
Many textbooks and articles are available to assist dentists in examining patients, establishing diagnoses for oral lesions and understanding the techniques of biopsy. There is little guidance in the literature, however, on when and how to follow up lesions that have a low index of clinical suspicion, or for which the pathological diagnosis does not demonstrate any overt signs of malignancy or premalignancy.


METHODS
The authors reviewed the literature, talked to numerous clinicians and sought legal opinions regarding how a reasonable and prudent dentist should manage patients with clinically evident oral lesions that do not suggest any adverse long-term effects on the health and safety of the patient.


RESULTS
The few guidelines available in the literature, coupled with the observations of the authors and others, allow logical and reasonable interim recommendations to be proposed regarding the frequency of examinations, the timing of invasive procedures and medicolegally prudent documentation guidelines. Future studies are needed to refine these recommendations.


CONCLUSIONS
Some dentists have been sued for alleged failure to monitor patients, document cases or refer patients with oral lesions. The recommendations provided here can help dentists manage these patients, but they should not be construed as being rigid guidelines or legal standards that apply to all clinical situations. In some cases, the judgment and experience of clinicians may indicate the need to deviate from these recommendations. Refinements of these guidelines may emerge on the basis of future studies.
Department of Oral and Maxillofacial Surgery & Pharmacology, Baylor Collage of Dentistry, Texas A&M University System Health Science Center, P.O. Box 660677, Dallas, Texas 75266-0677, USA. ralexander@tambcd.edu
R E
RE
Alexander
J M
JM
Wright
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S
Thiebaud
D001706:Biopsy; D002985:Clinical Protocols; D003142:Communication; D003729:Dental Care / Q000331:legislation & jurisprudence; D003792:Dental Records / Q000331:legislation & jurisprudence; D003812:Dentist-Patient Relations; D005500:Follow-Up Studies; D006801:Humans; D007972:Leukoplakia, Oral / Q000175:diagnosis / Q000628:therapy; D009059:Mouth Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D012017:Referral and Consultation / Q000331:legislation & jurisprudence; D013997:Time Factors