Challenges of oral medicine specialists at the time of COVID-19 pandemic

Factors important in the correct evaluation of oral high-risk lesions during the telehealth era

BACKGROUND

Considering that early detection of squamous cell carcinoma (SCC) improves prognosis and clinical examination is the primary detection method, we identified factors related to the clinical evaluation of oral mucosal lesions. Due to the growing role of telehealth, our study was based on clinical image evaluation.

SUBJECTS AND METHODS

Oral medicine specialists and dental students evaluated six images of benign, potentially malignant, or SCC lesions (18 images in total). We analyzed the role of personal factors of the examiners and the visual pathological features of the lesion upon which the participants based their evaluation.

RESULTS

One hundred thirty-three subjects participated. Half of the benign images were correctly evaluated. On average 1.2 (±SD1.3) cancer pictures were recognized correctly and 3.66 (±SD1.42) images were considered potentially malignant. Potentially malignant lesions were correctly evaluated at an average of 4.08 (±SD1.48) images. For cancer and potentially malignant lesion images, there were significantly better results among clinicians with the worst results from the fourth-year students. Student results correlated significantly with years of study, number of weeks spent in the oral medicine clinic, and interest in oral pathology. Consideration of lesion irregularity yielded a correct diagnosis, whereas wrong answers were based on color changes. Lesion size and margins were considered equally important.

CONCLUSIONS

Using clinical images as part of the diagnostic process provides good results, though increased clinical experience for graduates and undergraduates may be necessary to improve accuracy. Therefore, emphasizing the important visual parameters of malignancy may be valuable in the current telehealth era.

Oral potentially malignant disorders: advice on management in primary care

Introduction: The diagnosis of and risks associated with oral potentially malignant disorders (OPMD) have been widely reported, but little has been published on the management of OPMDs in a primary dental care setting. Hospital services face ongoing pressures due to long-term follow-up, with a need for surveillance to be jointly undertaken with primary dental care clinicians. In a primary care setting, identification and surveillance of OPMDs can be challenging as no universal guidance exists on recommended recall intervals. Corpus: In this article, an update on OPMDs is provided and, based on the practices of six Oral Medicine units in Europe (London (United Kingdom), Milan (Italy), Bordeaux (France), Porto (Portugal), Zagreb (Croatia) and Santiago de Compostela (Spain)), aiming to provide guidance on monitoring in a primary care setting in Europe. Conclusion: Oral medicine clinicians can provide guidance to general dental practitioners (GDPs) on recommended recall intervals. It is important that they feel confident in monitoring these conditions and, when concerned, to arrange referral to a hospital or appropriate specialist. GDPs should document descriptions of lesions and, if possible, take clinical photographs. Patients should be counselled on modifiable lifestyle factors and directed to oral medicine society websites to access patient information leaflets.

Satisfaction Level of the Oral Medicine Patients Using Teledentistry During the COVID-19 Pandemic: A Factor Analysis

OBJECTIVES

The aim of this article is to describe oral medicine patients' satisfaction level with teledentistry services during COVID-19 pandemic by a factor analysis.

MATERIALS AND METHODS

An observational cross-sectional study was conducted in the Oral Medicine Clinic in 31 patients who used teledentistry services at the beginning of the COVID-19 pandemic under informed consent. Questionnaire modification was validated with the Rasch model analysis and components that contribute to satisfaction were analyzed by the factor analysis. A total of satisfaction scores were then categorized into five levels (very dissatisfied; not satisfied; moderate; satisfied and very satisfied).

RESULTS

The questionnaire shows Cronbach's alpha of 0.83 and a reliability item of 0.95 with a separation of 4.49. The factor analysis shows two components that contribute to satisfaction, namely, components convenience and communication. One hundred percent of the subjects were in the satisfied and very satisfied categories.

DISCUSSION

The Rasch model can determine the validity and reliability of the questionnaire used more accurately. The components of convenience and communication are the main things that are considered when patients choose teledentistry services.

CONCLUSION

Oral medicine patients' satisfaction level with teledentistry services during the COVID-19 pandemic was 100% in the satisfied and very satisfied categories, with contributing factors being convenience and communication.

COVID-19 pandemic reduces the negative perception of oral health-related quality of life in adolescents

Purpose

As people around the world are facing the Covid-19 outbreak, their perception of oral health problems could be changed. This study aimed to evaluate the immediate effects of the Covid-19 pandemic on oral health-related quality of life (OHRQoL) of adolescents.

Methods

A cohort study with schoolchildren from southern Brazil was conducted. Data on adolescents’ OHRQoL were collected from December 2019 to February 2020 (T1), before the Brazilian Covid-19 outbreak. Posteriorly, the data were collected again in June and July of 2020 (T2), under the Brazilian Covid-19 outbreak. The OHRQoL was assessed using the Brazilian short version of the CPQ11-14. Demographic and socioeconomic characteristics and the degree of social distancing were also assessed. Changes in OHRQoL between T1 and T2 were evaluated by adjusted Multilevel Poisson regression models for repeated measures.

Results

From 290 individuals evaluated at T1, 207 were reevaluated at T2 (response rate of 71.3%). The overall CPQ11-14 mean score was significantly lower during the pandemic, reducing from 10.8 at T1 to 7.7 at T2. This significant reduction was also observed for all CPQ domains, indicating a lower negative impact of oral conditions on adolescents' quality of life during the pandemic. Adolescents from families that had a middle or low degree of social distancing during the pandemic and whose parents were harmed in employment had higher CPQ11-14 scores.

Conclusion

Overall and specific-domains CPQ-14 scores were significantly lower during the Brazilian Covid-19 outbreak, indicating a decrease in the perception of oral health problems by adolescents over that period.

[Key dental challenges during COVID-19 pandemic: oral health monitoring in patients with chronic oral mucosal diseases]

OBJECTIVE

To develop an effective system of an interactive dynamic telemonitoring of oral health in patients with oral lichen planus (LP) during the COVID-19 pandemic.

MATERIAL AND METHODS

The observational longitudinal prospective cohort study (follow-up for 12 months) involved 53 patients (19 men and 34 women aged 49-65 years) with various forms of LP in persistent remission. During the entire observation period dentists carried out telemonitoring (through a Telegram group) of oral health of patients with LP registering the preservation/coming out from remission, as well as the causes of exacerbation of LP.

RESULTS

The developed interactive monitoring system based on the use of available video feedback communication technologies (via Telegram, WhatsApp, Viber messengers) provided stable remission in 28.3% of patients with LP (mainly typical and hyperkeratotic forms) and effective relief of exacerbations (mainly erosive-ulcerative forms) associated with the new coronavirus infection COVID-19 in 35.8% of cases, exacerbation of concomitant systemic pathology (excluding COVID-19) in 16.9%, local traumatic risk factors in 15.1%, development of post-vaccination reactions in 3.9%. COVID-19-associated exacerbation of LP is a polymorphic symptom complex manifested by a change in classical clinical picture and heavier course of skin-mucosal dermatosis due to the addition of new, atypical for LP, manifested COVID-19-associated intraoral symptoms and generalization of skin lesions. Periods of exacerbation of LP in COVID-19 patients are significantly longer, with shorter remissions than in the prepandemic period.

CONCLUSION

Interactive telemonitoring of oral health in patients with chronic oral mucosal diseases is a safe and effective tool for dispensary observation, management and maintenance of social communications during periods of social isolation.