Training Plan for the prevention, early diagnosis, and follow-up of oral potentially malignant disorders
Abstract
Introduction: This research addresses the training deficit in Potentially Malignant Oral Disorders (PMOD) among dentists in the Milagro canton of Ecuador, where 58% of professionals acknowledge insufficient preparation and only 22% practice systematic visual screening, highlighting a critical gap in the early detection of lesions with the potential for malignant transformation. Materials and methods: A mixed-methods approach with a sequential explanatory design was used, organized in three phases: needs assessment using the CDOPMD-16 instrument applied to 16 dentists and documentary analysis of 67 clinical records and institutional reports from CENCAI.SA (2023-2025); design of the FORMA-PMOD plan with three modules (40 hours); and validation by seven experts using the modified Lawshe Content Validity Coefficient. Results: The needs assessment revealed that 64% were unaware of updated biopsy criteria, 81% had not requested an oral biopsy in the last year, and 88% lacked follow-up protocols; Document analysis confirmed the absence of standardized records of mucosal lesions in 54% of medical records. Expert validation yielded agreement rates exceeding 85% across all evaluated criteria, with average scores between 4.14 and 4.71 out of 5. Discussion: These findings align with documented regional patterns in Latin America, where the shortage of trained professionals constitutes a structural barrier to early diagnosis. The plan addresses these deficits through a modular architecture based on andragogical principles and competencies defined by the Pan American Health Organization (PAHO) for primary care. Conclusions: The FORMA-OPMD plan is a contextualized and validated training tool, with the capacity for replication in other cantons of the Guayas province and the potential to be integrated into the Ecuadorian Ministry of Public Health's dental care network as a strategy to reduce the late detection of oral mucosal lesions (OPMD).
References
Iocca, O., Sollecito, T. P., Alawi, F., Weinstein, G. S., Newman, J. G., De Virgilio, A., Nicolai, P., Freedman, N. D., & van der Waal, I. (2020). Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head & Neck, 42(3), 539-555. https://doi.org/10.1002/hed.26006
Knowles, M. S., Holton, E. F., & Swanson, R. A. (2015). The adult learner: The definitive classic in adult education and human resource development (8th ed.). Routledge.
Martínez-Ramírez, J., Pérez-Sayáns, M., Warnakulasuriya, S., Pérez-López, D., Blanco-Carrión, A., Diniz-Freitas, M., Marichalar-Mendia, X., Aguirre-Urizar, J. M., Bagan, J. V., Kerr, A. R., & Lodi, G. (2024). Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean. Oral Diseases, 30(7), 4174-4184. https://doi.org/10.1111/odi.14903
Mello, F. W., Miguel, A. F. P., Dutra, K. L., Porporatti, A. L., Warnakulasuriya, S., Guerra, E. N. S., & Rivero, E. R. C. (2018). Prevalence of oral potentially malignant disorders: A systematic review and meta-analysis. Journal of Oral Pathology & Medicine, 47(7), 633-640. https://doi.org/10.1111/jop.12726
Ministerio de Salud Pública del Ecuador. (2022). Detección oportuna del cáncer oral en Ecuador: énfasis en tamizaje precoz y vigilancia en salud pública. https://www.salud.gob.ec/estadisticas-de-salud/
Organización Panamericana de la Salud. (2025a). Cáncer oral en las Américas: tendencias de incidencia, mortalidad y diagnóstico tardío. Boletín Epidemiológico OPS. https://www.paho.org/es/temas/cancer/cancer-oral
Organización Panamericana de la Salud. (2025b). Promoción y prevención en salud bucal: modelos de riesgo, mínima intervención y seguimiento en las Américas. https://www.paho.org/es/temas/salud-bucal
Paiva, J. P., Jorge, J., Santos, E. S., Migowski, A., Cohen-Goldemberg, D., Kowalski, L. P., Brandão, T. B., Ribeiro, A. C., Lopes, M. A., Vargas, P. A., Silva, E. A., Warnakulasuriya, S., & Santos-Silva, A. R. (2024). Estimating the burden of care for oral potentially malignant disorders and oral cancer in Brazilian dental practice. Medicina Oral Patología Oral y Cirugía Bucal, 29(5), e719-e726. https://doi.org/10.4317/medoral.26701
Ramírez-Amador, V., Anaya-Saavedra, G., Petti, S., Lara-Flores, N., Aranda-Romo, S., Cruz-Monroy, E., Muela-Campos, D., Nava-Villalba, M., Ocampo-Acosta, F., Pulido-Díaz, K., & Rumayor-Piña, A. (2024). Oral cancer and precancer in Oral Pathology and Medicine curricula of Mexican dental schools. Oral Diseases, 30(4), 2150-2157. https://doi.org/10.1111/odi.14639
Santos-Leite, É. G., Sobral, L., Gilligan, G., Flores-Ramos, J., González-Arriagada, W., & Vega, C. (2024). Oral pathology and oral medicine in Latin American countries: current stage. Medicina Oral Patología Oral y Cirugía Bucal, 29(4), e527-e532. https://doi.org/10.4317/medoral.26500
Suárez-López, C. A., Mejía-García, M., Serna-Muñoz, C., & Álvarez-Martínez, E. (2025). Efficacy of an educational health intervention for oral cancer aimed at dentists and dental students. Journal of Cancer Education. Advance online publication. https://doi.org/10.1007/s13187-025-02644-9
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660
Tristán-López, A. (2008). Modificación al modelo de Lawshe para el dictamen cuantitativo de la validez de contenido de un instrumento objetivo. Avances en Medición, 6(1), 37-48.
Warnakulasuriya, S. (2020). Oral potentially malignant disorders: A comprehensive review on clinical aspects and management. Oral Oncology, 102, 104550. https://doi.org/10.1016/j.oraloncology.2019.104550
Warnakulasuriya, S., Kujan, O., Aguirre-Urizar, J. M., Bagan, J. V., González-Moles, M. Á., Kerr, A. R., Lodi, G., Mello, F. W., Monteiro, L., Ogden, G. R., Sloan, P., & Johnson, N. W. (2021). Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer. Oral Diseases, 27(8), 1862-1880. https://doi.org/10.1111/odi.13704
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191-2194. https://doi.org/10.1001/jama.2013.281053
Published
Issue
Section
License
Copyright (c) 2026 Geisy Terrero Morales, Roberto Milanés Gómez, Raúl Alejandro Montes de Oca Celeiro
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This journal provides immediate open access to its content, based on the principle that offering the public free access to research helps a greater global exchange of knowledge. Each author is responsible for the content of each of their articles.
Universidad de Oriente 