OBJECTIVE: To describe the diagnostic details of a sample of histologically diagnosed malignant and potentially malignant oral lesions from Ireland; to examine how these lesions were first detected, and by whom; and to determine whether factors influenced how these lesions were detected, who detected them, and the type of lesion diagnosed. METHODS: A retrospective review was carried out of the clinical notes relating to oral lesions histologically diagnosed as squamous cell carcinoma (SCC), carcinoma in-situ, or epithelial dysplasia from biopsies performed in hospital-based specialist units and submitted to a diagnostic pathology service based in Dublin, Ireland, between June and December 2015. In addition to sex, age, and smoking status, details were collected relating to the diagnosis, how the lesion was detected, and by whom. RESULTS: There were 100 cases reviewed: SCC (29), carcinoma in-situ (5), and epithelial dysplasia (66). There were 49 opportunistic findings: dentists detected 47 (94 percent), and 51 presenting complaints: primary care physicians (PCPs) detected 30 (60 percent). There was a lower likelihood of opportunistic findings among males (odds ratio 0.41; 95 percent CI 0.18, 0.91). CONCLUSIONS: Dentists in Ireland detected significant proportions of malignant and potentially malignant oral lesions as opportunistic findings, although opportunistic findings were less likely to occur among male patients.

The aim of this study was to assess older adults' experience of care in an academic dental practice to identify opportunities to improve the patient experience for older adults. A cross-sectional descriptive survey design with a sample of adults aged 65 and older was conducted using the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) 12-month survey 2.0, with supplemental survey item sets addressing cultural competence and health literacy. A total of 850 older adults were invited to participate in the survey in fall 2016, and a 43% response rate was achieved. Overall, participants reported a positive experience of care and high ratings for their dental providers. Significant differences were found based on age, education level, race, and health status. A significantly more favorable experience of care was reported by patients aged 75 and older, as well as adults without any college education. Non-white patients were less likely to highly rate their dental providers and gave lower ratings for experiencing trust with their dental providers than white patients. Patients reporting good/fair/poor health were also less likely than those reporting very good/excellent health to highly rate their dental providers, and they gave lower ratings for patient-provider communication. This study demonstrated the feasibility of using the CG-CAHPS survey to assess the patient experience for older adults in an academic dental practice. Results identified opportunities for improving the dental practice and underscored the importance of enhancing dental curricula in areas of cultural competence, health literacy, and diversity.

The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21 Century."