A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 2. Mechanics of the referral and patient communication EDITOR'S SUMMARY

Background and aims The diagnosis of early and pre-malignant lesions of oral squamous cell carcinoma is of paramount importance given the mortality rate of late stage disease. Although studies have been undertaken examining how dentists manage and refer potentially malignant lesions, the majority of the research has used questionnaires, with the inherent bias this introduces. The aim of this study was to use qualitative methods to understand in more detail how practitioners manage potentially malignant lesions once they have been discovered. Methods Semi-structured interviews were undertaken with eighteen dentists in Sheffield, transcribed and analysed using thematic analysis. Results Five codes were identified relating to the mechanics of the referral, the management of the lesion and the patient's risk factors. Health promotional activities were not being undertaken by all the participants and for some, explaining positive results and giving advice about alcohol was perceived as particularly difficult. Conclusion Overall, the present research suggests that further training is required to help dentists broach difficult issues with their patients.