A study of mass screening for oral mucosal diseases of adults

Abstract

The purpose of the present study was to evaluate the procedures recommended by WHO (World Health Organization) for examination and recording via a mass screening of oral mucosal diseases in adults. WHO procedures have defined a criteria for these diseases (A method). As a comparison to the WHO method, alternatively mass screening of oral mucosa was also conducted in a way that is characterised by the description of the detected symptoms of oral mucosa (B method). This evaluation was achieved through the analysis of the precision level of a general dental practicioner (GP) of the coincident rate, sensitivity, specificity, false positive rate and false negative rate of the diagnosis. The precision level was calculated by comparison of the results of the detection by a GP to that of an oral surgeon (SP) fully experienced in the diagnosis of oral mucosal disease. One hundredeighty five people (21 women, 164 men, mean age 33.4 ranged from 18 to 63 years) who work in manufacturing establishments were examined for oral mucosa. Out of 185 persons 113 were examined and reported on using the WHO method (A method). The remaining 72 were examined and reported on using the B method. Prior to the screening the examiners were a SP and a GP who had one day training and were calibrated according to the WHO guide (1980). The following results were obtained. 1) The coincident rate between the diagnosis by the GP and the SP was 82.3% using the WHO method (A method). and 29.2% using the B method. Sensitivity was 47.6% in A method and 27.7% in B method. was 88.3% using the A method. and 15.4% using the B method. The false positive rate was 52.4% with the A method. and 77.2% with the B method. The false negative rate was 11.7% with the A method, and 81.0% with the B method. 2) Out of 185 people 27 cases (14.6%) were detected as having oral mucosal diseases: leukoplakia (3.8%), lichen planus (0.5%), leukoedema (2.7%), leukokeratosis nicotina palatini (3.2%), and others (4.3%).
These results showed that the WHO procedures clearly surpassed the B method and were useful for mass screening of oral mucosal diseases in adults. In the A method a low value of sensitivity compared to specificity suggested that the training and calibration of a GP should be taken into account and improved.