Accuracy of Dental Clinicians in Diagnosing Pathologies: A Retrospective Study

Objectives: UNMC exempt IRB approval was obtained to study the accuracy of diagnosis of six common diseases by dentists in the USA.
Methods: All submitted biopsy requests to the UNMC Oral Pathology Biopsy service at the University of Nebraska Medical Center College Of Dentistry from the years 1983, 1995, 2005, and 2015 were reviewed and statistically analyzed using Chi-square test, ANOVA, Tukey’s method, and Kappa agreement to determine the relative diagnostic accuracy of common oral pathologies for general dentists, oral surgeons, endodontists and periodontists and whether overall clinician accuracy increased over the years. The six oral pathologies reviewed were: fibroma, squamous cell carcinoma, papilloma, periapical cyst, dentigerous cyst, and mucocele.
Results: A total of 6113 biopsy cases were submitted to the Oral Pathology Biopsy service during these years, with 3415 (55.86%) of these cases pertaining to the six reviewed diseases. General dentists had the lowest accuracy in diagnosing each disease. Periodontists were most accurate at diagnosing fibromas (79.84%) and squamous cell carcinoma (75%). Oral surgeons were most accurate at diagnosing papillomas (79.84%), dentigerous cysts (77.72%), and mucoceles (88.94%). Endodontists were most accurate at diagnosing periapical cysts (94.48%). Overall clinician accuracy improved significantly from 1983 (46.18%) to 2015 (74.07%), though from 1995 (70.65%) to 2015 there was minimal change.
Conclusions: The results of this study suggest that clinicians who undergo additional years of educational training are more accurate in diagnosing common oral diseases. Additionally, since 1983 dental clinicians as a group have improved their accuracy when diagnosing oral pathologies. This suggests a change in curriculum with increased clinical experiences may improve general dentist’s ability to recognize common oral pathologies prevalent in the patient population.