Factors which determine the referral of potentially malignant disorders by primary care dentists

The detection of potentially malignant disorders (PMD) is of paramount importance, yet few studies have examined what factors or cues primary care dentists (PCDs) take into account when diagnosing and referring PMD. The objective of this study was to determine what cues PCDs use when making a decision to refer PMD to secondary care.

Ten clinical vignettes were presented to PCDs using a website in the public domain. Five vignettes represented PMD and five represented benign conditions. Participants were asked to provide a differential diagnosis, a referral decision and score 12 supplied cues based on their importance in this decision. Optimal data analysis was then used to determine which of the 12 cues were significant at predicting the participants' referral decision.

147 participants responded and the number of accurate diagnoses for the PMD group ranged from 46.3 to 79.5%, whilst the number of correct referral decisions ranged from 77.6 to 86.9%. The number of accurate diagnoses and referral decisions in the benign group ranged from 63.0 to 89.0% and 40.1 to 71.9% respectively. Risk factors were statistically significant in their ability to predict a referral decision in both groups, but overall there appeared to be a lack of discrimination in the referral decision.

The results show that PCDs use a range of cues in the decision making process and suggest that if they are at all in doubt or are faced with worrying cues, their default position is to refer. Whilst this is reassuring, greater education of PCDs and standardised criteria are essential to avoid over-referral.