Patterns of dental attendance before referral V3.0
Research type
Research Study
Full title
A case series study on patterns of dental attendance before urgent referral.
IRAS ID
326504
Contact name
Joshua Yong Jin Cheng
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
1 years, 8 months, 2 days
Research summary
Research Summary
The incidence of oral cancer in England is on the rise. It is well reported that early detection of oral cancer improves survival rates and reduces morbidity. As dentists play a vital role in the early diagnosis of oral cancer, there is more development of early diagnosis initiatives in the dental setting. However, there is a debate about the effectiveness of such initiatives since those at higher risk of oral cancer may not be regular attendees of dental practices.
It is well documented in the literature that individuals who never or irregularly attend the dentist are more likely to be incident cases of oral cancer. However, there are limited studies investigating the relationship between dental attendance and staging of oral cancer.In light of England’s rising oral cancer incidence and the conflicting evidence regarding the feasibility of opportunistic oral cancer screening in dental practices, research is warranted to investigate the dental attendance of patients prior to their diagnosis of oral cancer in England. As such, this study intends to carry out in-depth analysis of the patients’ dental attendance in terms of the number of dental visits, frequency of dental visits, reasons for visiting and barriers to dental care prior to urgent referral for suspected oral cancer. In addition, this study will evaluate whether a frequency of dental attendance has an association with the stage of diagnosis of oral cancer as no research of such kind has been carried out in the UK. This study will be targeted at patients within the Tower Hamlets Borough, an area where oral cancer incidence has been increasing and the proportion of adults assessing dental care is low. This will also provide insight to patients’ barriers to dental care. Thus, this will help clarify the potential reach of early diagnosis initiatives in dental practices and direct the appropriate resources in this area.
Summary of Results
"The number of people diagnosed with mouth cancer is increasing in England. Mouth cancer is easier to treat when it is detected early, when it is small, but a lot of people with mouth cancer are diagnosed when the disease has grown and spread to other parts of the body. This means it is harder to treat and there is less chance people can be cured.
It has been suggested that one way to help to detect mouth cancer earlier is screening at dental practices when people are attending for other reasons such as a routine check-up or dental treatment. However, it is not known how well this will work as those at higher risk of oral cancer (due to tobacco use, alcohol consumption, older age, higher deprivation, South Asian ethnic origin) may not visit the dentist regularly.This study aimed to investigate the patterns of dental attendance of patients before they were referred for investigation of suspected mouth cancer.
102 participants were recruited from the Oral and Maxillofacial department of The Royal London Dental Hospital over a period of 10 months. Participants completed face-to-face or telephone interview using a structured questionnaire that asked about
dental attendance, demographic details and health-related behaviours.Of the 102 participants, 51 participants (50%) reported attending the dentist for regular check-ups, 13 participants (13%) for occasional check-ups, 32 participants (31%) only when they were having trouble, and 6 participants (6%) reported never been to a dentist.
The mean number of dental visits amongst the 102 participants in the past 5 years was 6 visits (range 0-30). 90 participants (88%) reported having attended the dentist within the past 5 years and 74 participants (73%) had been to the dentist in the year before the urgent suspected cancer referral. None of the visits made by the 74 participants in the year before the urgent suspected cancer referral were related to possible oral cancer symptoms. The majority were for routine check-ups (48%) or non-urgent treatment (restorative work, scale and polish, other preventative care: 47%). The remainder were for urgent treatment (extraction, root canal treatment: 5%).
There was no significant difference in the average number of dental visits in the last 5 years for people of different ages, level of socio-economic deprivation, smoking status, alcohol consumption, sex or ethnicity. However, there were differences in reasons for dental attendance. Almost half (47%) of the Asian and 44% of Black participants attended the dentist only when having trouble with their teeth or dentures as compared to 17% of White participants. Among current smokers and betel quid chewers, 28% attended the dentist for regular check-ups, compared to 57% of non-smokers and non-chewers. Only 40% of participants living in the most deprived areas of deprivation attended for regular checks-ups compared to 90% of those living in the least deprived areas.Conclusion: There were no demographic or health-related behaviour differences in the number of dental visits in the 5 years before referral for urgent suspected mouth cancer and the majority of patients had visited their dentist over this time period. However, dental attendance for regular check-ups was lower among higher-risk groups (smokers, those from ethnic minorities, and those living in more deprived areas). Relying exclusively on opportunistic screening in routine check-ups could result in excluding those most in need. A broader approach, integrating opportunistic screening at any dental visit has more scope for impact."
REC name
Wales REC 3
REC reference
24/WA/0103
Date of REC Opinion
8 Apr 2024
REC opinion
Further Information Favourable Opinion