Scope and purpose This guideline concerns patients with no lesions, innocuous or nonsuspicious lesions, lesions suspected to be potentially malignant as well as malignant lesions of the oral cavity. The audience for this guideline is health care workers who examine the mouth as well as community dental health co-ordinators and policy makers.

Methodology The Appraisal of Guidelines Research & Evaluation reporting checklist II and the GIN-McMaster Guideline Development Checklist were followed and the guideline is partly informed by systematic reviews and diagnostic test accuracy meta-analyses. Studies assessing patients' values and preferences were also considered. The process of moving from the evidence to decisions and the formulation was guided by GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Review and Updating Updates for this guideline will be conducted every five years or when new emerging evidence indicates a potential change in the recommendation statements from the expert panel. Any updated versions of this guideline will be available at the ADA Center for Evidence-Based Dentistry's website: www.ebd.ada

Recommendations The expert panel developed six conditional recommendations, all based on evidence rated as low to very low quality using GRADE.

1. For patients with a clinically evident oral mucosal lesion with an unknown clinical diagnosis considered to be seemingly innocuous or nonsuspicious of malignancy, or other symptoms, clinicians should follow up periodically to determine the need for further evaluation. If the lesion has not resolved and the clinical diagnosis of a potentially malignant disorder cannot be ruled out, then clinicians should perform a biopsy of the lesion or refer the patient to a specialist.

2. For patients with a clinically evident oral mucosal lesion considered to be suspicious of a potentially malignant or malignant disorder, or other symptoms, clinicians should perform a biopsy of the lesion or provide immediate referral to a specialist.

3. Cytologic adjuncts for the evaluation of potentially malignant disorders among adult patients with clinically evident, seemingly innocuous or suspicious lesions are not recommended. Should a patient decline the clinician's recommendation for performing a biopsy of the lesion or referral to a specialist, the clinician can use a cytologic adjunct to provide additional lesion assessment. A positive or atypical cytologic test result reinforces the need for a biopsy or referral.A negative cytologic test result indicates the need for periodic follow-up of the patient. If the clinician detects persistence or progression of the lesion, immediately performing a biopsy of the lesion or referral to a specialist is indicated.

4. The panel does not recommend autofluorescence, tissue reflectance or vital staining adjuncts for the evaluation of potentially malignant disorders among adult patients with clinically evident, seemingly innocuous or suspicious lesions.

5. The panel suggests that for patients with no clinically evident lesions or symptoms, no further action is necessary at that time.

6. The panel does not recommend commercially available salivary adjuncts for the evaluation of potentially malignant disorders among adult patients with or without clinically evident, seemingly innocuous or suspicious lesions and their use should be considered only in the context of research.

Research recommendations There is a need for better estimation of the prevalence of potentially malignant disorders (PMDs) and oral squamous cell carcinoma (OSCC) in populations with different baseline risks. More information on patients' values and preferences is required as well as studies on the diagnostic test accuracy of cytologic and salivary adjuncts.

范围和目的本指南涉及没有病变，无害或非可疑病变，疑似可能为恶性的病变以及口腔的恶性病变的患者。本指南的受众是检查口腔的卫生保健工作者以及社区牙齿健康协调员和政策制定者。

方法学遵循《指南研究与评估报告评估清单II》和《 GIN-McMaster指南制定清单》，该指南部分通过系统综述和诊断测试准确性荟萃分析提供信息。还考虑了评估患者价值和偏好的研究。从证据过渡到决策和制定的过程以GRADE（建议评估，制定和评估的等级）为指导。

每五年或当新出现的证据表明专家组的建议声明可能发生变化时，将对本指南进行审查和更新。该指南的任何更新版本都可以在ADA循证牙科中心的网站上找到：www.ebd.ada

建议专家小组提出了六项有条件的建议，所有这些建议均基于使用GRADE评定为低至极低质量的证据。

1.对于临床上明显口腔粘膜病变且临床诊断未知的患者，看似无害或对肿瘤或其他症状无怀疑，临床医生应定期进行随访，以确定是否需要进一步评估。如果病变尚未解决，并且不能排除对潜在恶性疾病的临床诊断，则临床医生应该对病变进行活检或将患者转诊给专科医生。

2.对于临床上明显的口腔粘膜病变被认为可能存在恶性或恶性疾病或其他症状的患者，临床医生应对该病变进行活检或立即转诊给专科医生。

3.不建议在临床上明显，看似无害或可疑病变的成年患者中使用细胞学辅助手段评估潜在的恶性疾病。如果患者拒绝临床医生对病变进行活检或转诊给专家的建议，则临床医生可以使用细胞学辅助手段进行额外的病变评估。阳性或非典型的细胞学检查结果会增加对活检或转诊的需求。阴性的细胞学检查结果表明需要对患者进行定期随访。如果临床医生检测到病灶持续存在或进展，则应立即对病灶进行活检或转诊给专科医生。

4.专家组不建议使用自体荧光，组织反射率或活体染色辅助剂来评估具有临床明显，看似无害或可疑病变的成年患者中潜在的恶性疾病。

5.专家组建议，对于没有临床明显病变或症状的患者，当时无需采取进一步措施。

6.专家组不建议使用市售唾液辅助剂评估有或没有临床明显，看似无害或可疑病变的成年患者中潜在的恶性疾病，仅在研究中考虑使用它们。

研究建议需要更好地估计具有不同基线风险的人群中潜在恶性疾病（PMD）和口腔鳞状细胞癌（OSCC）的患病率。需要更多有关患者的价值观和偏爱的信息，以及有关细胞学和唾液辅助物的诊断测试准确性的研究。