Evaluation of Potentially Malignant Disorders in the Oral Cavity
Publication Date: October 1, 2017
Last Updated: March 14, 2022
Recommendations
The panel suggests that clinicians* should obtain an updated medical, social, and dental history and perform an intraoral and extraoral conventional visual and tactile examination† in all adult patients. (, )
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The panel suggests that for adult patients with a clinically evident oral mucosal lesion with an unknown clinical diagnosis considered to be seemingly innocuous or nonsuspicious of malignancy, or other symptoms, clinicians should follow up periodically with the patient to determine the need for further evaluation. If the lesion has not resolved and the clinical diagnosis of a PMD cannot be ruled out, then clinicians should perform a biopsy of the lesion or refer the patient to a specialist.§ (C, L)
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The panel suggests that for adult patients with a clinically evident oral mucosal lesion considered to be suspicious of a PMD or malignant disorder, or other symptoms, clinicians should perform a biopsy of the lesion or provide immediate referral to a specialist. (CL)
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The panel does not recommend cytologic adjuncts for the evaluation of PMDs among adult patients with clinically evident, seemingly innocuous, or suspicious lesions. Should a patient decline the clinician's recommendation for performing a biopsy of the lesion or referral to a specialist, the clinician can use a cytologic adjunct to provide additional lesion assessment. (CL)
A positive or atypical cytologic test result reinforces the need for a biopsy or referral. A negative cytologic test result indicates the need for periodic follow-up of the patient. If the clinician detects persistence or progression of the lesion, immediately performing a biopsy of the lesion or referral to a specialist is indicated.
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The panel does not recommend autofluorescence, tissue reflectance, or vital staining adjuncts for the evaluation of PMDs among adult patients with clinically evident, seemingly innocuous, or suspicious lesions. (C, )
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The panel suggests that for adult patients with no clinically evident lesions or symptoms, no further action is necessary at that time. (CL)
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The panel does not recommend commercially available salivary adjuncts for the evaluation of PMDs among adult patients with or without clinically evident, seemingly innocuous, or suspicious lesions, and their use should be considered only in the context of research. (CL)
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A positive or atypical cytologic test result reinforces the need for a biopsy or referral. A negative cytologic test result indicates the need for periodic follow-up of the patient. If the clinician detects persistence or progression of the lesion, immediately performing a biopsy of the lesion or referral to a specialist is indicated. (, )
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Title
Evaluation of Potentially Malignant Disorders in the Oral Cavity
Publication Month/Year
October 1, 2017
Last Updated Month/Year
August 3, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations to inform primary care clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions, including potentially malignant disorders (PMDs), in the oral cavity.
Target Patient Population
Patients with oral lesions
Inclusion Criteria
Male, Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Laboratory services, Outpatient
Intended Users
Dentist, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening
Diseases/Conditions (MeSH)
D002294 - Carcinoma, Squamous Cell, D018307 - Neoplasms, Squamous Cell, D003945 - Diagnosis, Oral, D009909 - Oral Health, D019242 - Oral Medicine
Keywords
squamous cell carcinoma, oral cavity, cancer screening, oncology, oral cancer, potentially malignant disorders