United Kingdom and Ireland oral medicine and oral and maxillofacial surgery multidisciplinary clinics for the management of oral epithelial dysplasia.

Abstract

Oral epithelial dysplastic (OED) lesions have an increased risk of malignant change compared to normal mucosa. Multidisciplinary teams (MDTs) are widely used in medicine including for the management of patients with OED. There is little consensus in treatment, but a management algorithm from a joint oral medicine-oral and maxillofacial surgery (OM-OMFS) dysplasia management clinic was proposed in 2015 (the Liverpool Algorithm). We wished to determine the use of OM-OMFS MDTs for managing patients with OED in dental hospitals in the UK and Ireland using an online survey with results anonymised for analysis. We surveyed oral medicine units in the UK and Ireland reporting their use of joint clinics and management algorithms. All nineteen units responded with eight having OM-OMFS MDTs. Three used a published algorithm (Liverpool algorithm) and five used the algorithm with adaptations. 50% of units always excised lesions with moderate or severe dysplasia, with varying review intervals for different degrees of dysplasia. Seven of eight units kept patients with mild dysplasia under review for five years before discharge; for severe dysplasia some units never discharged. A total of 42% of oral medicine units in the UK and Ireland have MDTs for patients with OED. Most MDTs use the Liverpool Algorithm, or a slight variation of it, to help manage their patients. Wider adoption of MDTs and use of published algorithms may improve patient care by promoting consistent monitoring and management criteria.