title: Comparative accuracy of different members of the dental team in detecting malignant and non-malignant oral lesions.
abstract: OBJECTIVE
  Role substitution between primary care dentists (PCDs) and dental hygienists and therapists is increasingly being used in a number of different countries. Opponents to this development argue that it is unsafe and frequently cite the potential for missing oral malignancy as an inherent danger. The aim of the present study was to determine the comparative diagnostic test accuracy of different members of the dental team when differentiating between standardised photographs of mouth cancer, potentially malignant disorders and benign oral lesions.
  
  
  METHODS
  A total of 192 dental professionals, comprising 96 PCDs, 63 DH-Ts, nine hospital-based dental staff and 24 other dental professionals were sampled purposively. Following orientation, participants were asked to score 90 clinical photographs that depicted cases of oral squamous cell carcinoma, potentially malignant disorders and non-malignant lesions of the oral mucosa. For each photograph participants were asked to determine whether they felt the lesion was representative of carcinoma, a potentially malignant disorder (test positive), or whether the lesion was benign (test negative). They were also asked to record their confidence in their decision on a 0-10 scale. Judgement decisions were compared against the known histopathological diagnosis of each lesion. Sensitivity and specificity were calculated for each participant and clinical group.
  
  
  RESULTS
  The diagnostic test accuracy of PCDs and DH-Ts was similar. There was a median sensitivity of 81% Interquartile range (IQR) 19%) for PCDs and 77% (IQR 19%) for DH-T, with specificity of 73% (IQR 16%) and 69% (IQR 17%) respectively. DH-Ts missed fewer frank malignant lesions compared to PCDs.
  
  
  CONCLUSIONS
  The performance of PCDs and DH-Ts when differentiating between mouth cancer, potentially malignant disorders and benign lesions is comparable. DH-Ts should be regarded as being as competent as PCDs as front-line healthcare workers with regard to detection of mouth cancer. However, considerable heterogeneity in detection was found within both clinical groups, suggesting that training remains paramount.
authors.affiliation: The University of Manchester, Oxford Road, Manchester, M13 9PL.
authors.forename: P
authors.initials: P
authors.lastname: Brocklehurst
authors.affiliation: The University of Manchester, Oxford Road, Manchester, M13 9PL.
authors.forename: M N
authors.initials: MN
authors.lastname: Pemberton
authors.affiliation: The University of Manchester, Oxford Road, Manchester, M13 9PL.
authors.forename: R
authors.initials: R
authors.lastname: Macey
authors.affiliation: Biostatistics, School of Dentistry, The University of Manchester, Oxford Road, Manchester, M13 9PL.
authors.forename: C
authors.initials: C
authors.lastname: Cotton
authors.affiliation: Oral Medicine, Central Manchester University Hospitals NHS Foundation Trust, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester, M13 9PL.
authors.forename: T
authors.initials: T
authors.lastname: Walsh
authors.affiliation: School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY.
authors.forename: M
authors.initials: M
authors.lastname: Lewis
mesh_terms: D000328:Adult; D003756:Dental Hygienists; D003797:Dental Staff; D003815:Dentists; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000175:diagnosis*; D009062:Mouth Neoplasms / Q000175:diagnosis*