Oral Pathology Risk Management for the General Dentist: The Detected but Undiagnosed Oral Cavity Lesion

(New User) — Mon, 26 Oct 2009 09:55:00 CST

by Michael A. Kahn, DDS
Professor and Chairman, Dept. Oral and Maxillofacial Pathology,
Tufts University School of Dental Medicine
Diplomate, American Board of Oral and Maxillofacial Pathology

Note: The following protocol recommendations are based on current standard of care guidelines and should not be construed as rigid guidelines or legal standards that apply to all clinical situations. The judgment and experience of the clinician may indicate to the need to deviate from these recommendations.

The normal exfoliation of stratified squamous epithelial cells (i.e., keratinocytes) takes approximately 25 to 45 days, the time for the cell to move from the basal cell layer to the surface of the keratin layer, with thinner oral mucosa (such as cancerous high risk sites of floor of mouth/ventral and lateral tongue) being at the earlier end of this range. Thus, the rule of thumb for the initial length of observation of an undiagnosed oral lesion is 7 to 14 days, the length of time necessary for the lesion to either completely resolve or at least, following treatment, to exhibit indications of resolvement. If the lesion grows, alters its characteristics, or does not respond to treatment, then a biopsy is clearly indicated. If the undiagnosed and unchanged lesion is not treated, then the clinician must decide to biopsy or re-evaluate periodically.

For undiagnosed and unchanged lesions that are not biopsied, the clinician should record in the dental chart a provisional diagnosis and obtain informed consent from the patient. In addition, the specific anatomic site, color, morphology, size, texture, and consistency of the lesion should be documented. The lesion should be re-examined within one month, then at three, six, and 12 months after the initial examination. After one year, and assuming the undiagnosed lesion remains unchanged, the lesion should be observed at six months intervals; after two years, at six months or one year intervals, indefinitely. In addition to these guidelines, the patient should be advised to contact the dentist’s office if any changes in the lesion are noted before the next scheduled visit.

Comments (13)

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(Dental Insurance - [URL] on 30-Jan-10) Thanks for the information.
"Thus, the rule of thumb for the initial length of observation of an undiagnosed oral lesion is 7 to 14 days, the length of time necessary for the lesion to either completely resolve or at least, following treatment, to exhibit indications of resolvement."
This is the standard of care? Seems like quite awhile. How often are these lesions found to be benign?

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(Dentist on 04-Jun-10) I have a dental professional liability insurance with EDIC starting from 7/16/2009 to 7/16/2010. EDIC wanted me to pay next year MDS membership fee from 4/1/10 to 4/1/11 and threatened to cancell my insurance policy otherwise. I applied membership waiver of MDS fee and was denied the waiver in May. I did not know the decision until yesterday 6/3/10 when I got a letter from EDIC. In this letter, EDIC cancelled my policy effective 3/31/10. I called both MDS and EDIC. I plead them to allow me enough time (about 3 months, at least 1 month)to shop for another insurance. To cancell my insurane retroactively effective 3/31/10 on 5/28/2010 is not a fair practice. As a dentist, I need liability continously all the time. Although I did nothing wrong, EDIC did not follow the industrial standard to cancell my policy when it expires on 7/16/2010. When EDIC did early cancellation, it did not follow the industrial standard to allow 3 month for consumer to shop another policy.

(file recovery software - [URL] on 26-Jul-10) The oral cavity consists of the lips, teeth, gums, oral mucous membranes, palate, tongue and oral lymphoid system. The oral cavity plays essential roles in many key bodily functions, including nutrition, respiration and communication. Various specialists may be called upon to diagnose and treat diseases of the oral cavity, including general practitioners, nurse practitioners, dentists, oral surgeons, otolaryngologists, rheumatologists, dermatologist and others.

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Oral Pathology Risk Management for the General Dentist: The Detected but Undiagnosed Oral Cavity Lesion