Oral mucosal disease: dilemmas and challenges in general dental practice

Oral medicine (OM) is a recognised component of all UK undergraduate dental programmes and practising dentists are expected to safely investigate and manage patients presenting with oral mucosal disease. Delivering OM care for patients in a general dental practice setting does however come with a number of challenges and dilemmas for practitioners.General dental practitioners may be limited in their ability to arrange diagnostic tests such as biopsies or blood tests, important in reaching a definitive OM diagnosis. Lack of operator skill or lack of access to appropriate laboratory facilities to process diagnostic samples will likely contribute to this. In addition, general dental practitioners may feel underconfident to reliably interpret test results. Management of OM patients can also be time-consuming and may not generate a significant remunerative reward under current NHS payment systems.OM is a subject that overlaps with several medical specialities, and up until 2010, required dual qualification in both undergraduate dentistry and medicine. Practitioners who have not undertaken OM training beyond undergraduate dentistry may lack confidence with the subject, and fear of misjudging a lesion of concern will certainly prompt referrals from primary care into hospital-based OM clinics. Identifies expected knowledge, skills and standards of oral medicine care within primary care, as outlined by the General Dental Council and UK Committee of Postgraduate Dental Deans and Directors, and highlights the range of oral medicine conditions general dental practitioners may be faced with in practice.Outlines National Institute for Health and Care Excellence guidance regarding the urgent referral pathway for suspected head and neck cancer.Highlights factors limiting the practice of oral medicine in primary care and provides an opinion regarding potential changes that may improve access to oral medicine care and advice.