Sousa Fabrício Bitu, Freitas e Silva Malena Regina de, Fernandes Clarissa Pessoa, Silva Paulo Goberlânio de Barros, Alves Ana Paula Negreiros Nunes
Departamento de Clínica Odontológica, Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil.
Universidade Federal do Ceará, Sobral, Ceará, Brasil.
Braz Oral Res. 2014;28 Spec No. doi: 10.1590/1807-3107BOR-2014.vol28.0018. Epub 2014 Jun 20.
The aim of this study is to share the experience of implementing a network for the diagnosis of oral cancer by integrating primary, secondary, and tertiary oral health care centers and identifying the possible weaknesses of the process. The study also investigated the risks of exposure to the main risk factors for oral and lip cancer and their most common potentially malignant lesions (PML). A quantitative cross-sectional study was conducted in two different regions, with patients seen at a primary health care facility from August 2010 to July 2011. Patients with oral lesions were referred to dental specialty centers for biopsy. Patients with PML were treated in dental specialty centers, and patients with squamous cell carcinoma (SCC) were referred to tertiary health care facilities. The dentists' knowledge of PML and SCC was assessed by an objective questionnaire. A total of 3,965 individuals were examined, 296 lesions were found, and 73 biopsies were performed, of which 13.7% were diagnosed as PML and 9.6% as SCC. Tobacco use and sunlight exposure were associated with SCC (85.7%) and PML (80%), respectively. In total, 55 dentists were assessed. The lesions most commonly recognized as PML were leukoplakia (74%), erythroplakia (57%), and actinic cheilosis (56%). Most dentists (74%) felt incapable of performing biopsies, most likely because of an anxiety towards oral cancer, and 57% had never performed one. The integration of primary and secondary health care enables the diagnosis of PML and SCC and establishes a diagnosis network. However, the inability of most primary care dentists to identify PML and perform biopsies is a weakness of the diagnostic process.
本研究的目的是分享通过整合初级、二级和三级口腔保健中心来实施口腔癌诊断网络的经验，并找出该过程中可能存在的薄弱环节。该研究还调查了口腔和唇癌主要风险因素及其最常见的潜在恶性病变（PML）的暴露风险。在两个不同地区进行了一项定量横断面研究，研究对象为2010年8月至2011年7月在初级保健机构就诊的患者。有口腔病变的患者被转诊至牙科专科中心进行活检。患有PML的患者在牙科专科中心接受治疗，而患有鳞状细胞癌（SCC）的患者被转诊至三级保健机构。通过客观问卷评估牙医对PML和SCC的了解情况。总共检查了3965人，发现296处病变，进行了73次活检，其中13.7%被诊断为PML，9.6%被诊断为SCC。吸烟和阳光照射分别与SCC（85.7%）和PML（80%）相关。总共评估了55名牙医。最常被认为是PML的病变是白斑（74%）、红斑（57%）和光化性唇炎（56%）。大多数牙医（74%）认为自己没有能力进行活检，很可能是因为对口腔癌感到焦虑，57%的牙医从未进行过活检。初级和二级保健的整合能够诊断PML和SCC，并建立一个诊断网络。然而，大多数初级保健牙医无法识别PML并进行活检是诊断过程中的一个薄弱环节。
