Cues used by dentists in the early detection of oral cancer and oral potentially malignant lesions: findings from the National Dental Practice-Based Research Network

Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Sep;130(3):264-272. doi: 10.1016/j.oooo.2020.05.007. Epub 2020 May 23.


Objective: The aim of this study was to assess the influence of clinical cues on risk assessment of cancer-associated mucosal abnormalities.

Study design: We differentiated lesions with a low risk from those with a high risk for premalignancy or malignancy by using 4 cues: (1) color, (2) location, (3) induration, and (4) pain on exploration. Combinations of color and location were presented through 8 photographs, with induration and pain status variably presented in the standardized history and physical findings. This created 16 clinical scenarios (vignettes) that were permutations of the 4 cues. Three questions assessed the extent to which each cue was used in obtaining a clinical impression as to whether a lesion was benign, premalignant, or malignant.

Results: Completed vignette questionnaires were obtained from 130 of 228 invited dentists, (two-thirds males; 79% white; mean age 52 years; average weekly hours of practice 33 hours). Only 40% of the responding dentists had statistically significant decision policies to assign a clinical diagnosis of a lesion as benign, premalignant, or malignant. Lesion location and color were the 2 dominant cues. As a cue, induration was used as a cue by more of the respondents in determining a clinical diagnosis of malignancy, and pain was infrequently used as a cue.

Conclusions: Many dentists do not to have a decision strategy for the clinical diagnosis and risk stratification of oral potentially malignant lesions.

MeSH terms

  • Cues
  • Dentists
  • Early Detection of Cancer
  • Humans
  • Male
  • Middle Aged
  • Mouth Neoplasms* / diagnosis
  • Precancerous Conditions*
  • Surveys and Questionnaires