Kondori Ida, Mottin Roberta W, Laskin Daniel M
Virginia Commonwealth University School of Dentistry, Richmond, Virginia 23298-0566, USA.
Quintessence Int. 2011 Jul-Aug;42(7):575-7.
Dentists play an important role in the early diagnosis and treatment of oral lesions. However, treatment based solely on a clinical impression of the diagnosis, without histologic confirmation, can result in serious consequences, particularly when the lesion is precancerous or cancerous. The purpose of this study was to determine the overall accuracy of clinical diagnoses made by dentists as well as to compare the diagnostic ability of general practitioners with members of various dental specialties.
The biopsy reports of 976 specimens submitted to the Department of Oral and Maxillofacial Pathology, Virginia Commonwealth University School of Dentistry, between January 2009 and January 2010 were reviewed. The presumptive clinical diagnosis made by the practitioner and the final histologic diagnosis on each specimen were recorded in addition to whether the submitting dentist was a general practitioner or a specialist.
Of the clinical diagnoses made by the submitting dentists, 43% were incorrect. General dentists misdiagnosed 45.9%, oral and maxillofacial surgeons 42.8%, endodontists 42.2%, and periodontists 41.2% of the time. The most commonly missed clinical diagnoses were hyperkeratosis (16%), focal inflammatory fibrous hyperplasia (10%), fibroma (8%), periapical granuloma (7%), and radicular cyst (6%). Cancerous lesions were misdiagnosed 5.6% of the time.
The high rates of clinical misdiagnosis by dental practitioners indicate that all excised lesions should to be submitted for histologic diagnosis.
牙医在口腔病变的早期诊断和治疗中发挥着重要作用。然而，仅基于临床诊断印象而无组织学确诊的治疗可能会导致严重后果，尤其是当病变为癌前病变或癌症时。本研究的目的是确定牙医做出的临床诊断的总体准确性，并比较全科医生与各牙科专科医生的诊断能力。
回顾了2009年1月至2010年1月间提交给弗吉尼亚联邦大学牙科学院口腔颌面病理学系的976份标本的活检报告。除了记录提交标本的牙医是全科医生还是专科医生外，还记录了从业者做出的初步临床诊断和每个标本的最终组织学诊断。
在提交标本的牙医做出的临床诊断中，43%是错误的。全科牙医误诊率为45.9%，口腔颌面外科医生为42.8%，牙髓病医生为42.2%，牙周病医生为41.2%。最常漏诊的临床诊断是角化过度（16%）、局灶性炎性纤维增生（10%）、纤维瘤（8%）、根尖肉芽肿（7%）和根端囊肿（6%）。癌症病变的误诊率为5.6%。
牙科从业者临床误诊率较高，表明所有切除的病变都应提交进行组织学诊断。
