Interview: Diagnosing fibro-osseous lesions
Dr. David MacDonald is known across dental sectors for his 2011 book “Oral & Maxillofacial Radiology: a Diagnostic Approach,” published by Wiley-Blackwell. He is associate professor and chairman of the Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia. He trained in the United Kingdom and held appointments at the universities of Hong Kong, Edinburgh and Bergen.
He responded to several questions from Dental Tribune about his work in diagnosing fibro-osseous lesions.
What can you tell us about fibro-osseous lesions?
There are three of them, which though they have a similar microscopy, they differ markedly in behavior. Fibrous dysplasia can cause significant deformity and occasionally blindness, but in most cases ceases growth and never becomes reactivated. Ossifying fibroma is a benign tumour that will keep growing until it is completely removed. If not, it can recur. Osseous dysplasia, although the most innocuous, is perhaps the most important because it is more common. It is particularly more likely to be encountered in BC’s Lower Mainland, because of the substantial East Asian population.
Why is precise diagnosis of such lesions so critical?
As displayed by a current publication by myself and UBC co-authors, on another important lesion, early and accurate diagnosis is most likely to result in the most appropriate treatment and the best outcome for the patient.
Have there been any recent advancements in diagnosis and/or treatment protocols?
The most important of the recent advances has been a better and detailed understanding of the clinical and conventional radiological features of the most frequent and important lesions affecting the face and jaws. The outcomes of their treatment have been determined by long-term follow-up of consecutive case series.
It has been my privilege to lead in this area — first with detailed reporting of consecutive case series of the Hong Kong Chinese — and then developing a novel method of systematic review so that dental professionals can at a glance see what features of a particular lesion are expected in the global community in which they are practicing or in the particular patient they are attending to. The results of this research have substantially contributed to my 2011 Wiley-Blackwell textbook. The evidence has been rendered down into decision-trees, which suggest to the clinician the most logical differential, if not definitive, diagnosis.
Do all dental professionals need better diagnostic skills with these lesions?
The vast majority of dental care in the community is provided by family or community-based dentists or dental hygienists. If the lesions have not been detected and identified by them, then those, particularly with the most serious outcomes, will have achieved larger dimensions by the time they present for treatment. Furthermore, if the dentist or dental hygienist does not detect them in time then really no one else will.
Any final comment?
Dental education does not stop when the title “doctor” or “registered dental hygienist” is conferred, but is life-long. Dental professionals have to keep abreast of new developments and technologies, which most often enhance the quality of the services they can offer their patients. Occasionally, these novelties are double-edged and have significant disadvantages as well as advantages. One such technology is cone-beam computed tomography (CBCT), of which there are now more than 150 in British Columbia alone.
Note: This article was published in Dental Tribune Canada Edition, Vol. 7 No. 1, February 2013.