Referral patterns, lesion prevalence, and patient care parameters in a clinical oral pathology practice

The purpose of this study was to determine the following parameters in a referral-based private practice oral and maxillofacial pathology clinic: (1) sources of clinical referrals; (2) types of problems referred; and (3) clinical effectiveness of treatment.

Clinical charts were reviewed for a cohort of 362 patients seen over a 2 1/2-year period (1993-1995). From these charts, we determined the source of referral and the final diagnosis for each patient. In addition, 50 patients were randomly selected and surveyed by telephone; each was asked a series of questions to determine the following: (1) the number of health care practitioners previously seen with regard to the patient's condition; (2) the length of time that the condition had been present before the patient came to the oral and maxillofacial pathology clinic; (3) the costs associated with medications and office visits that had been incurred before the patient came to the oral and maxillofacial pathology clinic; (4) the costs associated with medications and office visits that were incurred at the oral and maxillofacial pathology clinic; and (5) the patient's level of satisfaction with the oral and maxillofacial pathology clinic.

Fifty-five percent of the referrals came from dentists, and 45% came from physicians. The 3 problems most commonly seen were candidiasis (12%), burning mouth syndrome (10%), and lichen planus (8%). For the 50 patients who were interviewed, the mean number of health care practitioners seen previously was 2.2 (range, 1-9). The mean time from initial symptoms to evaluation by an oral pathologist was 15 months. The mean approximate cost of medications and office visits before evaluation by an oral pathologist was $350 (range, $30-$4,000; median, $100); this compared with a cost of $94 (range, $50-$300; median, $70) for the patient visit and medications associated with the oral pathology appointment. The difference was statistically significant (P < or = .001).

This preliminary study suggests that the clinical evaluation of oral lesions by an oral pathologist appears to be cost-effective and should be an integral part of a comprehensive health management system. These results should be corroborated by similar multicenter studies.