Table 2 - uploaded by Caroline Zimmermann
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Analysis between groups (M1, M2 and M3) of lesions A and B descriptions, performed by the Dunn`s test.
Source publication
Poor description of oral lesions jeopardize the prioritization of appointments in Oral Medicine. The present study investigated whether the use of support tools changes the quality of descriptions focusing on health care prioritization. Two oral lesions (A and B) were described by 64 dental students and 48 dentists using three methods: (a) without...
Contexts in source publication
Context 1
... to the Kruskal-Wallis test results, the null hypothesis was rejected. In Table 2, the results of the between group analyses are shown. There was no difference between free descriptions and descriptions supported with the SMOH form (M1 and M2, respectively, p = 0.864). ...
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Citations
... Primary diagnosis of lesions is mainly conducted through clinical observations and periodic examination is needed to identify possible alterations, such as: spreading, augmentation, and changes in the lesion's morphology, size, texture, and color 1,2 . Additional tools for lesion evaluation are important to allow the analysis and data registration of lesions regarding their clinical aspects, including lesional measurements 3 . ...
Lesion evaluation through photographs is a common clinical practice and its performance using computational tools is encouraged. Objective: To assess the reliability of the computer program SMART Monitoring (SM) in giving adequate lesion measurements through clinical photography. Materials and methods: A cross-sectional study was conducted with 28 patients diagnosed with oral or skin flat lesions. Each lesion was measured twice: clinically and by photographic image. Photographs were taken using a 3D-printed scale as a reference for SM measurements of the total lesional area (mm²) and the two longest axes (length and width) by two different operators. The agreement was evaluated between the axis's measurements of the two operators with the clinic measurements by the Bland-Altman plot. Results: Both operators revealed excellent agreement (ICC=0.98) regarding measurements of the lesion's axes and the total lesional area with no difference between operators. Comparison of the axes' values from SM to clinical measurements were also not different (p=0.82 and p=0.43). The Bland-Altman plot revealed that most mean differences were within the 95% confidence interval. Conclusion: SMART Monitoring proved to be a reliable tool for measuring oral or skin flat lesions on clinical photographs, regarding length, width, and total area measurements. The values obtained using SMART Monitoring presented an excellent agreement with the clinical measurements.
... In particular, potentially malignant disorders are often misjudged [18,21]. A Brazilian study compared three questionnaires to describe photographs of oral mucosal lesions and showed that questionnaires with schematic illustrations could increase the quality of the information transmitted [22]. Moreover, this increase supports the progression of interdisciplinary digital exchange and can avoid possible errors that can lead to a delay in treatment, such as misinterpretation of the classification into benign or malignant findings [22]. ...
... A Brazilian study compared three questionnaires to describe photographs of oral mucosal lesions and showed that questionnaires with schematic illustrations could increase the quality of the information transmitted [22]. Moreover, this increase supports the progression of interdisciplinary digital exchange and can avoid possible errors that can lead to a delay in treatment, such as misinterpretation of the classification into benign or malignant findings [22]. Therefore, not only is a structured procedure in terms of tooth treatment useful, but it should also be essential for examining the oral mucosa and should be an integral part of the preventive dental examination. ...
... The task for all students in both groups comprised the following four steps: To collect the medical history of the patient, to perform a standardized intraoral investigation, to give a detailed description of a mucosal lesion and, finally, to come to a conclusion with a suspected diagnosis. For the description of the mucosal lesion, students either followed the standard protocol (Group 1), which included a template for a structured medical history and only a blank field in the description section, or it used a detailed questionnaire (Group 2), which was inspired by the questionnaire of Zimmermann et al. [22] and contained additional graphics and further tools, as seen in the Supplementary Materials. Each student was given 10 min of processing time. ...
Structured examination and treatment are essential in medicine. For dental students, a structured approach to the assessment of oral mucosal lesions is missing thus far. To validate an approach, a structured questionnaire was compared with the habitually used free description of oral lesions (white lesions, ulcers, hyperplasia). Thirty-three dental students were divided into two groups (Group 1 (n = 17) used the free description; Group 2 (n = 16) used a guided questionnaire) to characterize mucosal lesions in patients and make a tentative diagnosis. Although no difference was found between the groups regarding the suspected diagnosis or the histopathological findings, there was a significant advantage of the structured questionnaire in all aspects of the description compared to the free description (p = 0.000018). Thus, a structured description is an important aspect in the evaluation of oral mucosal changes, and a guided questionnaire should be implemented in the study of dentistry.
... Strategies in the system to improve the response rates could be considered, such as the response models' suggestions or required fields. 19 Regarding the clinical images of the cases, no images were provided for more than 10% of the requests. Moreover, the teleconsultant considered most of the submitted low-quality images, although they were mainly obtained through smartphones. ...
... Moreover, the teleconsultant considered most of the submitted low-quality images, although they were mainly obtained through smartphones. The quality of clinical information provided by the applicant could improve if a guide instrument was proposed for the description of the intraoral examination findings 19 and intraoral photography instructions. 10 Since no systematic effort was made in the present study to standardize or train dentists to image acquisition, it could be suggested as a strategy to overcome the barriers exposed. ...
This study aimed to describe the telediagnosis of oral lesions through a telehealth program offered in the State of Paraná, southern Brazil. This report included all oral medicine-related teleconsultations between January 2015 and December 2019. Primary care dentists from the public health services of the state were trained to use the Telessaúde Brasil Redes platform, a national telehealth program that provides telediagnostic support through teleconsultations with specialists. Clinical information and images of oral lesions were solicited to each teleconsultation request. An oral medicine specialist evaluated the cases and provided diagnostic hypotheses, management, and referral suggestions. Finally, dentists were invited to evaluate the services. A total of 162 cases were submitted by 44 dentists. The patient's main complaint was described in 98.8% of cases, while the duration/evolution and the type of lesions were 64.81% and 40.12%, respectively. No images were attached to 19 (11.70%) patients. The information sent was sufficient for diagnostic reasoning in 125 (77.16%) requests. The specialist considered 78 cases (48.1%) to be resolved in primary care. Among respondents (45.7%), dentists considered that the teleconsultation "totally attended" their needs in 92% of requests. The description of the telehealth platform usage in oral medicine in Paraná showed the need to improve the participation of primary care dentists and the quality of clinical information provided as barriers to be overcome, aiming for the best usage of the platform.
... These data highlight the need for training professionals responsible for consulting requests, particularly when it is intended to establish a large-scale service. 36,37 A study in the field of teledermatology agrees with this statement, because it showed that, with training, it is possible to improve the quality of the photographs obtained. 39 Interestingly, in 42% of cases in the present study, complementary tests were unnecessary for diagnostic purposes. ...
Objectives
: This study aimed to evaluate the accuracy of EstomatoNet/TelessaúdeRS, a telediagnosis service for oral diseases available to primary healthcare professionals in southern Brazil.
Study Design
: The sample of this multicenter cross-sectional study comprised 100 patients seen at the oral medicine outpatient clinic of three Brazilian Dental Schools (University of Campinas, Federal University of Pernambuco, and Federal University of Santa Catarina) from March 2019 to October 2019. In addition to the face-to-face assistance provided by graduate students and with the final diagnosis validated by the professors of these institutions, a remote evaluation was requested for these patients through the EstomatoNet/TelessaúdeRS platform.
Results
: The values of sensitivity and specificity of telediagnosis were compared with the face-to-face approach and were 100% and 96%, respectively. The agreement between examiners was almost perfect (95%). In addition, case management was relatively simple in approximately 60% of cases.
Conclusion
: Based on the results, telediagnosis for oral diseases can be considered a reliable method, representing a promising alternative for the clinical support of health professionals, particularly when they are in remote locations.
... With respect to the information system, Corwin and Bolter 14 suggest that the feedback provided by the specialists to the applicants could contribute toward improving the quality of referral forms, which is more effective than the implementation of electronic forms. Another strategy that has been discussed is the implementation of a template for describing lesions 34 . Although valid, it seems critical to adopt this strategy in view of the wide range of lesions affecting the maxillomandibular complex, as well as the difficulties perceived by professionals on lesions' description 14 . ...
Introduction: Oral lesions are present in approximately 30% of the population worldwide. Although the mouth is an anatomical region that can be easily accessed for direct visual examination, most dentists of dental surgeons have reported difficulties in the diagnosis and management of oral diseases.
Objective: The primary aim of this study was to assess the completeness of referral forms of the patients referred from the primary care to an Oral Medicine service. The secondary aim was to analyze if the complexity of the cases justify the referral to a specialist.
Methods: Data from 131 referral forms of patients referred from June 2014 to April 2016 were retrieved from the records. The referral’s completeness analysis comprised two stages. Stage 1 mainly comprised patient and applicant’s information. In the Stage 2, the documents were scored according to amount of information, including the description of the lesion characteristics and the procedures required for the patients’ diagnosis and management. The referral was considered justifiable if some procedures not available at primary care were required for diagnosis or treatment.
Results: Five (9.8%) referral forms were considered well filled. Diagnosis agreement was 71.4%. In regards to the need of referral, 40,6% of the cases (n=50) could be settle at the primary care.
Conclusion: In conclusion, few referral forms had high-quality information and the many cases could be managed at primary care health services.
... Health information and communication technologies (ICT), such as Teledentistry, can help expand access to dental health public services making it more effective [11,12]. Dental specialists can help general dentists' (GD) practice workflow through teleconsulting guidance [13]. ...
Introduction
Health information and communication technologies, such as Teledentistry, can help expand access to dental health public services making it more effective. Objective: To analyze the factors that affect the implementation of a Teledentistry system in dental health public services. Methods: The study follows the Implementation Research methodological framework. A mixed-method approach was applied using a triangulation design–sequential model to collect, analyze, and interpret qualitative and quantitative data about the implementation of a Teledentistry system. A compulsory teleconsultation from the general dentist was planned to access periodontics specialized care. The study was developed in a South Brazilian capital city and the platform of the Santa Catarina Telehealth Center was used. Qualitative and quantitative data were collected sequentially to achieve a better understanding of implementation research issues. Results: In seven months, 68 teleconsulting was performed by 22% of the general dentists, prior to the referrals on periodontics. Only one reported not needing to refer the patient to the periodontist as a result of the teleconsulting guidance. Teledentistry system implementation and usage were influenced by the managers’ political and administrative awareness to deploy and maintain the intervention. Lack of sufficient resource investment, lack of system integration, and internet failures were relevant limiting factors. The teleconsultant guidelines contributed to general dentistry’s better decision-making regarding treatment, urgency of case management, and prioritization of referrals to the periodontists. Conclusion: Identifying the factors that influence the implementation and finding solutions to overcome them, can prevent future failures and improve usage of the system.
... Further, it should be legible and contain all the necessary information to avoid delaying the patient's diagnosis and treatment. 9,10 Currently, most referral letters are incomplete, not allowing the professional to receive the correct information about the patients, which may make it difficult to exactly understand the needs or concerns of those who referred them. Therefore, this study aimed to analyze all referral letters received by a single oral medicine service in Brazil. ...
Optimizing the quality of referral letters could be the first step to a correct clinical approach for patients. Referral letters should be legible and contain the necessary information to avoid delaying the patient's diagnosis and treatment. However, to date, few studies have been conducted on how referrals are performed in Brazil. Knowledge regarding the quality of referral letters can provide information to better guide health care professionals. This study was aimed at analyzing all referrals received by a single oral medicine service in Brazil. Referral letters were classified into poor, regular, good, and excellent based on key items concerning the primary morphology of the lesion, location, diagnostic hypothesis, symptomatology, time of evolution, consistency, size, and limits. A total of 500 referral letters were evaluated, including 271 (54.2%) from a private service and 229 (45.8%) from a public service. Dentists and physicians had written 475 (95%) and 25 (5%) referral letters, respectively. Among the 500 referrals analyzed in this study, the number of regular, poor, good, and excellent referrals was 236 (47.2%), 203 (40.6%), 58 (11.6%), and one (0.6%), respectively, showing a lack of important clinical information in referrals.
... Such guidelines may differ considerably in various parts of the world, depending on, among other things, the structure of the healthcare system, including the financial aspects. Recently, a preliminary study demonstrates that such initiative is valuable as an attempt to improve the referral process (9). Finally, we want to encourage to discuss the above items in Dental Associations, Associations of Oral Medicine, Associations of Oral and Maxillofacial Surgery and, of course, also in graduate and undergraduate programs in the dental field, including oral medicine and oral and maxillofacial surgery. ...
Based on a few case reports of oral mucosal diseases a number of questions is raised about the role of dentists-general practitioners in the diagnostic procedure and management of patients with such diseases. For instance, are dentists prepared to prescribe topical corticosteroids and should dentists be taught how and when to take a biopsy? And how about palpation of the neck? A strong recommendation is made to take clinical pictures for proper documentation and, if needed, for telediagnostic procedures. Another issue relates to the communication between dentists and dental specialists when dealing with patients with oral diseases. In case of a patient suffering from burning mouth syndrome or any other type of chronic orofacial pain, the question is raised whether dentists-general practitioners are prepared to manage such patients. Furthermore, there is a call for structuring the collaboration between dentists-general practitioners and dental specialists, including oral and maxillofacial surgeons.
Key words:Oral diseases, management of oral diseases, intradisciplinary collaboration in dentistry.
... 7,10 According to another definition, it should be smaller than 5 mm in diameter. 3,11 However, Bricker described that, macules occur in the same plane of the skin/ mucosa and may be of any size. 9 This term can be used for amalgam tattoos, ephelis, freckles, focal argyrosis, etc. 9,12 Patch: It is defined as a flat circumscribed area that is larger than a macule (>5 mm or > 10 mm according to different definitions) (Figure 2). ...
... 7,9,11 In two papers, nodules were defined to be greater than 5 mm and less than 20 mm in diameter. 2,3 Clinically, nodules may be above, level with, or below the skin/mucosa and can be detected by palpation. 7,12 Benign mesenchymal tumors such as lipoma and neuroma can be present as a nodule in the oral mucosa. ...
... 7,10 According to another definition, it should be smaller than 5 mm in diameter. 3,11 However, Bricker described that, macules occur in the same plane of the skin/ mucosa and may be of any size. 9 This term can be used for amalgam tattoos, ephelis, freckles, focal argyrosis, etc. 9,12 Patch: It is defined as a flat circumscribed area that is larger than a macule (>5 mm or > 10 mm according to different definitions) (Figure 2). ...
... 7,9,11 In two papers, nodules were defined to be greater than 5 mm and less than 20 mm in diameter. 2,3 Clinically, nodules may be above, level with, or below the skin/mucosa and can be detected by palpation. 7,12 Benign mesenchymal tumors such as lipoma and neuroma can be present as a nodule in the oral mucosa. ...
