We read your article titled ‘Building bridges with dentistry’ with great interest.1 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 that 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 alluded to within your review, there are a range of factors that make procurement of a functioning network challenging.
First, the engagement of the adult population with dental services in the UK is extremely poor. 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 did not find any evidence to suggest that GPs are inferior to primary care dentists in the detection of oral cancer.2 We speculate that this may be due to the small number of cases diagnosed by primary care practitioners through their careers. While educational programmes within primary care are important, there should also be recognition that the disease itself is extremely variable. In our experiences, there have been patients presenting with symptoms outside the NICE checklist, who went on to receive a cancer diagnosis. These included: odynophagia, sore throat, weight loss, anorexia, and cervical dysphagia.
Second, an issue our research group expands upon in an upcoming publication (accepted BDJ, not yet available), for which we evaluate the diagnostic journeys patients with oral cancer took from primary care to secondary care, much of the ‘diagnostic delay’ took place within secondary care from interdisciplinary referrals (gastroenterology, maxillofacial surgery, ENT).
Unfortunately, the lack of current robust referral pathways between primary medical and dental services raises questions about the appropriateness for interprofessional referrals, as these would need to be auditable to assess prevention of delay in cancer diagnosis.
- © British Journal of General Practice 2020
