Evaluating, documenting and following up oral pathological conditions - A suggested protocol

Background. Many textbooks and articles are available to assist dentists in examining patients, establishing diagnoses for oral lesions and understand ing the techniques of biopsy. There is little guidance in the literature, h owever, on when and how to follow up lesions that have a low index of clini cal suspicion, or for which the pathological diagnosis does not demonstrate and overt signs of malignancy or premalignancy. Types of Studies Reviewed. The authors reviewed the literature, talked to n umerous clinicians and sought legal opinions regarding how a reasonable and prudent dentist should manage patients with clinically evident oral lesion s that do not suggest any adverse long-term effects on the health and safet y of the patient. Results. The few guidelines available in the literature, coupled with the o bservations of the authors and others, allow logical and reasonable interim recommendations to be proposed regarding the frequency of examinations, th e timing of invasive procedures and medicolegally prudent documentation gui delines. Future studies are needed to refine these recommendations. Clinical Implications. Some dentists have been sued for alleged failure to monitor patients, document cases or refer patients with oral lesions. The r ecommendations provided here can help dentists manage these patients, but t hey should not be construed as being rigid guidelines or legal standards th at apply to all clinical situations. In some cases, the judgement and exper ience of clinician may indicate the need to deviate from these recommendati ons. Refinements of these guidelines may emerge on the basis of future stud ies.