High Oral Lesion Misdiagnosis Rate Among Dentists

Rosemary Frei

July 27, 2011

July 27, 2011 — General dentists correctly diagnosed only 54.1% of all oral lesions from which they submitted biopsy specimens to Virginia Commonwealth University School of Dentistry’s oral pathology department from January 2009 to January 2010. Oral and maxillofacial surgeons, endodontists, and periodontists also had a very high misdiagnosis rate according to a new study published in the July-August issue of Quintessence International.

The lead investigator argues that the results are congruent with those of previous studies and hence are generalizable to the rest of the country. Daniel M. Laskin, DDS, also believes that there are no barriers to submitting samples for pathology analysis and that it is important that all dentists do so.

"Most dental schools have oral pathology departments that render such service. It is also possible to send specimens to a nearby hospital, which all have pathology departments," observed Dr. Laskin, professor and chairman eeritus, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry, Richmond.

Gary L. Henkel, DDS, a dentist who heads Horsham Dental Elements in Horsham, Pennsylvania, agrees.

"Those percentages are really scary but they do not surprise me at all. Many lesions appear very similar clinically — they are red or white, raised or flat, ulcerated or not, but those criteria fit thousands of oral disease entities," Dr. Henkel told Medscape Medical News. "Microscopic diagnosis is often the only way to differentiate lesions of varying origin. That's why in the operating room, all removed tissue is sent for microscopic evaluation."

In the study, Dr. Laskin and his colleagues reviewed the biopsy reports of all 976 tissue specimens submitted to the Department of Oral and Maxillofacial Pathology at Virginia Commonwealth University from January 2009 to January 2010. They found that 43% of the diagnoses made by the submitting clinician were incorrect.

General dentists misdiagnosed 45.9% of the oral lesions they submitted, oral and maxillofacial surgeons misdiagnosed 42.8%, endodontists misdiagnosed 42.2%, and periodontists misdiagnosed 41.2% (P = .8).

Hyperkeratosis was the most commonly missed benign clinical diagnosis, at 16% of such missed diagnoses. The other commonly misdiagnosed benign conditions were focal inflammatory fibrous hyperplasia (10%), fibroma (8%), periapical granuloma (7%), and radicular cyst (6%). Malignant lesions were misdiagnosed 5.6% of the time.

The team speculates that there may well be an even greater rate of misdiagnosis in clinical practice because a significant percentage of excised tissue may not be submitted for microscopic evaluation.

"This not only further emphasizes the need for having all excised tissues examined, but also it confirms the necessity of not relying solely on clinical impressions in deciding whether to observe or remove an oral lesion," they conclude.

The study authors have disclosed no relevant financial relationships.

Quintessence Int. 2011;42:575-577. Abstract

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