A study to determine the acceptability in patients and dentists of toluidine blue in screening for oral cancer.

Opportunistic screening for oral cancer has been advocated as a possible beneficial procedure, especially with high-risk individuals. To assist in the identification of malignant lesions a dye has been developed which can be used routinely. Issues of acceptability for both patient and practitioner are raised. The adoption of this procedure for employees in a large retail chain in the UK has enabled an investigation into the use of the dye. The objective of the study was to determine the acceptability of toluidine blue in aiding the screening for oral cancer in regular attending dental patients who are at high-risk. A two-stage study design was conducted. The first stage consisted of a patient survey in which 10 patients from each of 14 stores of the retail chain were invited to complete a questionnaire. The level of embarrassment, taste and anxiety about the procedure was assessed. The second stage included a clinician questionnaire and telephone interview on the difficulties, if any, of conducting the screening procedure with the aid of the dye. The oral health screen (OHS) with OraScreen procedure was conducted in the retail store medical room. The participants consisted of 140 employees attending the routine dental examination at the store of their workplace. All employees in the survey reported that they smoked tobacco, drank alcohol and were over the age of 40 years. Fourteen dentists visited the stores to complete examinations, screening, questionnaires and telephone interview. The main outcome measures consisted of dentist and patient rating scales of acceptability developed for the study. Of the respondents 89% (n = 124) gave usable questionnaire data. The patients found the dye acceptable (for example 83% rated the oral health screen 'a comfortable experience') and 93% expected the examiner to give an opinion of the state of their mouths. A wish was expressed by 95% to take part in future oral health screens. The dentist-respondents were in favour of the use of the dye. In conclusion, the acceptability of toluidine blue dye to assist in the screening for oral cancer is good according to both patient and clinician. The use of this dye should now be encouraged more extensively by trained clinicians in the identification of oral cancerous and precancerous lesions.