Primary care clinicians and the detection and referral of potentially malignant disorders in the mouth: a summary of the current evidence.

The importance of detecting oral malignant disease is paramount. Recent government strategies have placed an emphasis on the early detection of cancer. This paper presents a brief account of the current debate around the role of oral cancer screening and provides a summary of the results of three practice-based studies that were supported by the British Society for General Dental Surgery and the Faculty of General Dental Practice (UK). Overall, there appears to be a lack of rigour among some general dental practitioners when screening for potentially malignant disorders and their incidence in dental practice is perceived to be low. Barriers remain to the implementation of smoking-cessation schemes and many general dental practitioners feel out of their depth in tackling the abuse of alcohol, despite recognising its importance as a risk factor. Patients continue to present to their general medical practitioner (GMP) when they are concerned about something in their mouth that is not related to their teeth. GMPs' ability to manage early oral cancer is discussed. A prospective randomised controlled trial (RCT), or a demonstration study, is recommended to investigate the numbers of cases of oral cancer diagnosed in primary dental care and primary medical care and to develop standardised referral criteria for early cases of this disease to reduce under- and over-referral. The RCT could also examine the potential of using auxiliary healthcare workers and examine the impact of such a programme upon secondary care services.