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- Page navigation anchor for Referral to dentistReferral to dentistI have serious reservations about NICE's recommendation of "urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist." There is no mechanism for such referral. Instead, GPs can merely advise patients to seek an urgent dental appointment - and meticulously document having done so. The context is an explicit concern about "possible oral cancer." A medicolegal opinion is merited regarding a GPs liability if a patient failed to act on this advice, or found themselves unable to obtain a timely appointment, and subsequently had a delayed diagnosis of cancer or other adverse outcome.For lumps on the lip or in the oral cavity NICE's wording implies that dentists may be better able to determine if they are "consistent with oral cancer." This may be true also of red or red and white patches, but it remains puzzling that NICE believe exactly the same clinical description should lead a dentist to refer as a suspected cancer under the 2 week rule but a GP merely to recommend a dentist.Competing Interests: None declared.
- Page navigation anchor for Interdental and GP relationships in oral cancerInterdental and GP relationships in oral cancerWe read your article titled ‘building bridges with dentistry’ with great interest. It is vitally important for the academic community to continue to study oral health, so we thank you for your valuable contribution.Oral cancer, a disease entity which is growing in prevalence in the UK, for which outcome is related to the timeliness of diagnosis, has been the focus of a growing body of research. Certainly, the development of a primary care-dentistry network, in principle, may improve the diagnostic process. However, as eluded to within your review, there are a range of factors which make procurement of a functioning network challenging.Firstly, the engagement of the adult population with dental services in the UK is extremely poor, sitting around 50% in the last 2 years. Unfortunately, the patient groups at greater risk of oral cancer (increasing age, low socioeconomic background, male gender), tend to be the groups less likely to attend dental services. Our systematic review, which you referenced within your review, did not find any evidence to suggest GPs are inferior to primary care dentists in the detection of oral cancer. We speculate this may be due to the small number of cases diagnosed by primary care practitioners through their careers. Whilst educational programmes within primary care are ubiquitously important, there should also be recognition that the disease itself is extremely variab...Show MoreCompeting Interests: None declared.