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New guidance for care of patients with oral potentially malignant disorders

A recent paper guides general dentists on how to manage cases of oral potentially malignant disorders once their patients return from specialist treatment. (Image: Karan Bunjean/Shutterstock)

LONDON, UK: General dental practitioners (GDPs) now have clearer recommendations to which they can refer for successfully monitoring and managing oral potentially malignant disorders (OPMDs) in patients who have been discharged from specialised oral or maxillofacial units. Based on advice from a group of eight universities, research institutes and health programmes across Europe, an educational article outlines the essential symptomology, associated risks and best practices for follow-up for GDPs who have previously lacked official guidance for after-care in such cases.

OPMDs have been defined by the World Health Organization Collaborating Centre for Oral Cancer as “any oral mucosal abnormality that is associated with a statistically increased risk of developing oral cancer”. Prevalence is estimated to vary widely in different parts of the world; however, the overall incidence of OPMDs is about 4.47% globally.

As the COVID-19 pandemic drastically altered the capabilities of GDPs, the Royal College of Surgeons of England introduced guidance specific to triaging and patient management for the altered circumstances, which assisted GDPs who were under added pressure to identify OPMDs while working with fewer resources. However, once their patients have been successfully diagnosed, treated and released from a specialist unit, there is generally a lack of guidance available for those same GDPs for ongoing case management.

In this paper, the contributing organisations cover the management of the following conditions: leucoplakia, proliferative verrucous leucoplakia, erythroplakia, oral lichen planus, lichenoid lesions, oral lupus erythematosus, actinic cheilitis, palatal lesions in reverse smokers, dyskeratosis congenita and oral graft-versus-host disease. In addition to a brief outline of each condition, the contributors suggest key symptomology, offer guidance on when to refer a patient back to a specialist or to a hospital and encourage GDPs to keep an accurate description of problematic lesions, including clinical photographs, if at all possible.

Following the suggested procedures will help provide the best possible outcome should patients need referral. The document also details aspects of patient behaviour about which their GDPs can counsel them in their specific situation. This could include, for example, offering assistance with smoking cessation or alcohol use. GDPs are encouraged to teach patients how to self-monitor their lesions so that they can advocate for themselves, if need be.

The paper, titled “Oral potentially malignant disorders: Advice on management in primary care”, was published online on 23 September 2022 in the Journal of Oral Medicine and Oral Surgery.

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