Accuracy of screening for potentially malignant disorders of the oral mucosa by dentists in primary care.
OBJECTIVE
To examine the accuracy of a screening programme for potentially malignant disorders of the oral mucosa by visual inspection in primary health care.


METHODS
The study was based on secondary data from the Primary Care Information System maintained by seven units of family health in São Paulo City managed by a non-governmental agency. The reference population was composed of 15,072 residents 50 years old or more of both genders. The study population comprised 2,980 individuals. During screening in community settings, the oral mucosa was examined by trained dentists and distributed into two categories: (a) screen negative (b) screen positive. All participants underwent comprehensive clinical exams by a general dental practitioner supervised by a specialist. Individual records were grouped in a working dataset. Point and 95% confidence interval estimates were calculated regarding measures of sensitivity (Se), specificity (Sp) and positive and negative predictive values (PPV and NPV, respectively).


RESULTS
18.0% of the population was considered screen positive. A total of 133 lesions (4.5%) were identified and 8 cases of oral cancer were confirmed, which corresponded to a prevalence rate of 27 cases in 10,000 people, a much higher rate than expected. The measures found were Se: 91.7% (85.3-95.6), Sp: 85.4% (84.1-86.7), PPV: 22.7% (19.3-26.5), NPV: 99.5% (99.2-99.8). The visual screen presented high accuracy.


CONCLUSIONS
The test presented high sensibility and specificity values. From a public health point of view, the high accuracy levels showed the importance of oral health teams on family health strategy for more comprehensive primary care. Targeting risk groups and delegating the screening to community health agents may improve PPV and coverage.
Brazilian Ministry of Health, São Paulo, Brazil.
Luis Cláudio
LC
Sartori
Paulo
P
Frazão
D001938:Brazil / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology; D003815:Dentists / Q000592:standards*; D004919:Erythroplasia / Q000453:epidemiology; D005260:Female; D005792:General Practice, Dental; D006801:Humans; D007972:Leukoplakia, Oral / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D009059:Mouth Diseases / Q000453:epidemiology*; D019226:Oral Ulcer / Q000453:epidemiology; D010808:Physical Examination; D010859:Pigmentation Disorders / Q000453:epidemiology; D011230:Precancerous Conditions / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards*; D012680:Sensitivity and Specificity; D013039:Specialties, Dental