A.O. Akinyamoju, B.F. Adeyemi, A.D. Odofin, A.O. Balogun, and C.A. Akinyamoju
Dept. of Oral Pathology, College of Medicine, University of Ibadan/University College Hospital, Ibadan
Background: Oral histopathology services are oral diagnostic procedures. General Dental Practitioners (GDPs) are routinely exposed to oral lesions that require biopsies. Hence, the study’s objective of assessing the perception and the utilization of oral histopathology services by GDPs.
Methods: This was a cross-sectional study conducted at dental clinics distributed across Southwest Nigeria. A self-administered questionnaire consisting of sections addressing the socio-demographic/professional aspects; the beliefs of GDPs and their utilization of oral histopathology services was used to collect data. A modified 5-point Likert rating scale was used to indicate the extent of agreement or disagreement with statement constructs. Analysis was done using SPSS for windows version 20.0. Significance was assessed at 5%.
Results: There were 56.1% males and 43.9% females. The peak age range was 30-39 years (35.4%), while 58.5% had < 10 years of practice and 79.3% work in government dental centres. Many of the respondents (61.0%) thought suspicious lesions should be biopsied, 47.6% thought that specialists’ skills were not required for biopsy. Furthermore, 53.7% had poor perception scores while 81.1% of those who had seen oral lesions that required biopsies, had poor utilization scores.
Conclusion: The GDPs had a poor perception and utilization of oral histopathology services. Continuous medical education is needed to increase awareness amongst dentists.
Keywords: Missed opportunity, Malaria in pregnancy, Nigeria.
Oral biopsy and histopathology services are a part of oral diagnostic procedures carried out in dental clinics and histopathology laboratories of tertiary institutions or privately owned laboratories respectively.1,2 It involves the removal, in part or in entirety an intraoral or orofacial lesion and it’s transference to a designated laboratory for tissue processing and slide preparation onward for reporting by an oral pathologist in order to arrive at a diagnosis, which then guides treatment.1-3 Dentistry is primarily a surgical specialty in which the sub-specialties perform minor surgical procedures.4 Likewise, general dental practitioners (GDPs) are also routinely exposed to oral lesions that may require biopsy taking or referral to a specialist.5
However, there are reports indicating that dental practitioners may sometimes discard pathologic tissue taken from patients,6 including diseased periapical tissue7 contrary to the policy on excised tissue that states that “All tissue removed from the oral and maxillofacial region of human patients should be submitted to a pathology laboratory for examination.” 8 In some instances, the otherwise “benign looking or inconsequential lesion” ends up being malignant after histopathology.9 Similarly, periapical tissue attached to teeth, seen after tooth extraction may actually be occult malignancy.9
The detection of suspicious lesions and the management of histopathology reports should be within the confines of general dental practice10,11 as GDPs make up 80% of the dental workforce4 as well as playing the role of primary oral care providers, thus serving as “gatekeepers” in referring complex cases to specialist.12 Therefore, GDPs should be capable of doing incisional and excisional biopsies instead of referring such patients to tertiary centres. 10 However, low utilization of these services by GDPs have been reported and reasons suggested include fear of medicolegal complications, use of wrong biopsy technique and regarding biopsy taking as a specialistprocedure.13 An example is the study by Murgod et al where 14.9% of GDPs carried out biopsies themselves, while 34.3% and 31.3 % called a specialist or referred to a higher centre respectively.13
Similarly, other studies have reported that these services are predominantly utilized by dental specialists and a small proportion of GDPs. Wan and Savage in their study reported GDPs submitted 10.9% of biopsies at a private oral pathology service in Brisbane, Australia, with a majority (76.2%) of GDPs surveyed, referring all biopsies to a specialist.14 Also, other reports corroborate this.6,15 This was attributed to low number of cases seen by GDPs requiring biopsies.11
At present, there is paucity of information on how GDPs view and utilize oral histopathology services in this clime, thus the need to evaluate this. Therefore, this study set out to assess the perception and the utilization of oral histopathology services by GDP’s domiciled in Southwest Nigeria.
MATERIALS AND METHODS
This was a cross-sectional study. A total sample of all dentists practising in government and privately owned dental hospitals/clinics in Oyo, Ogun, Ondo, Ekiti and Osun states was used. The inclusion criterion was dental practitioners with an undergraduate qualification of Bachelor of dental surgery while exclusion criteria were non consenting respondents and those that had undergone specialist training. Ethical approval was obtained from the Oyo State Ministry of Health (Ref. No. AD 13/479/987).
A list of all known government and privately owned dental clinics within the study area was obtained from the hospital management boards of the respective states and the dentists were approached to administer the questionnaires. In all, 84 questionnaires were distributed to general practice dentists in five states in southwest Nigeria. The purpose of the study was explained to the dentist and verbal consent was obtained before administering the questionnaire. A pre-tested, semi-structured and self-administered questionnaire was utilized for data collection. Two of the authors (AOA and CAA) had previously evaluated the questionnaire to ensure the questions were suitable and easily understood by the respondents. The questionnaire consisted of three sections: Section A addressed the socio-demographic and professional aspects, while Section B consisted of a fifteen item constructs that defined and described the beliefs, preferences, judgements, opinions or actions of the respondents on oral histopathology services. Similarly, Section C consisted of a six item constructs that examined the utilization of oral histopathology services by general practice dentists.