A survey of Indiana general dentists, published online in the Journal of the American Dental Association (JADA) on September 26, 2026, found that 83.5% agreed intraoral biopsy is within their scope, yet 67.3% had never performed one and 76.3% routinely refer biopsy cases to specialists. 82.2% named a lack of training or confidence as a barrier, and most selected hands-on training or workshops (85.4%) and clear biopsy-indication guidelines as potential facilitators.
General dentists are often the first clinicians to see an oral lesion, and the biopsy is the step that turns a suspicious lesion into a diagnosis. A new study suggests that step is still rarely taken in the general practice chair. As of October 2026, it is one of two closely timed publications: the study appeared two days before the American Dental Association (ADA) published the final recommendations of its first living guideline on early oral cancer detection, which names biopsy as the definitive diagnostic method.
For dentists in Toronto and across Ontario, the study is American, and its numbers describe Indiana, not Canada. But the questions it raises about training, confidence and referral pathways apply to any general practice that screens for oral cancer.
What the JADA Study Measured
The study, "Barriers to and facilitators of general dentists performing intraoral biopsies," was written by A. Ritchie of the Indiana University School of Dentistry's Department of Oral Pathology, Medicine and Radiology, with D. Ajayi and H.L. Taylor of Indiana University's Fairbanks School of Public Health. It was first published online on September 26, 2026, according to its Europe PMC record.
The researchers distributed a cross-sectional online survey to licensed members of the Indiana Dental Association. According to the abstract, the survey assessed demographic characteristics, training, practice characteristics, attitudes, and self-reported barriers and facilitators related to oral biopsies. The analysis focused on respondents who identified as general dentists.
- Respondents: 477 people answered, a 17.8% response rate.
- General dentists: 377 of those respondents self-identified as general dentists, and they form the analysed group.
- Design: descriptive analysis of self-reported answers. The study did not audit charts or count biopsies performed.
The Key Findings: A Gap Between Scope and Practice
The central result is a gap between what general dentists believe they may do and what they actually do.
- 83.5% agreed that performing biopsies falls within their professional scope.
- 67.3% reported never having performed a biopsy.
- 76.3% routinely referred biopsy cases to specialists.
- 18.2% felt well prepared by dental school to perform biopsies.
- 22.4% felt well prepared by continuing education.
- 82.2% named a lack of training or confidence as a barrier.
The authors' conclusion is direct: despite broad acknowledgment that oral biopsy is within their scope, most general dentists do not perform biopsies, citing inadequate training and logistical barriers. In their stated practical implications, they warn that the dental workforce's capacity to detect oral malignancies early "may be inhibited" by how infrequently general dentists biopsy, if at all.
What Would Help, According to Respondents
The survey also asked what would make general dentists more likely to biopsy. Most respondents chose hands-on training or workshops (85.4%), and the abstract also lists clear biopsy indication guidelines among the potential facilitators.
The authors propose three directions: enhanced predoctoral and continuing education, standardized biopsy guidelines, and supportive practice infrastructure.
How This Connects to the ADA's New Oral Cancer Guideline
The study's timing matters. On September 28, 2026, ADA News reported on the ADA's first living evidence-informed guideline on the early detection of oral squamous cell carcinoma and potentially malignant disorders. EBIKO Dental covered that guideline in detail in ADA Oral Cancer Guideline: Exam Every Adult, Biopsy Is Standard. As reported by ADA News, the guideline:
- Recommends that clinicians "perform a comprehensive extraoral and intraoral clinical exam on all adults."
- States that punch or scalpel biopsy followed by histopathological assessment is the preferred and definitive method for diagnosing oral and lip squamous cell carcinoma.
- Says that if a lesion does not resolve 10 to 14 days after an initial evaluation, with no definitive diagnosis or treatment plan, clinicians should recommend a prompt biopsy or referral to a specialist.
- Advises that adjunctive tests "should not replace an indicated biopsy or referral."
Read together, the two publications describe a system in which the guideline names biopsy as the standard, while the survey suggests many general dentists will meet that standard through referral rather than by biopsying themselves. The guideline itself allows either path: prompt biopsy or referral. A referral is a legitimate route, but only if it happens promptly and the patient actually completes it.
Why It Matters for Canadian Practices
The Indiana data cannot tell us how often Ontario general dentists biopsy, and EBIKO Dental is not aware of an equivalent recent Canadian survey. What is clear is the scale of the disease category in Canada. According to the Canadian Cancer Society, an estimated 8,200 people in Canada will be diagnosed with head and neck cancer in 2026, and 2,300 will die from it. The society notes that statistics for oral cavity cancer are not reported separately but are included in the head and neck category.
For a practice in Mississauga, Markham or Scarborough, the useful question is less "should my dentists biopsy?" than "what happens, step by step, after we find a lesion?" A practice that refers most lesions can still deliver timely diagnosis if its follow-up pathway is tight.
Pro Tip: Write down your practice's lesion pathway on one page: who re-evaluates at the 10 to 14 day mark, which oral surgeon or oral medicine clinic receives referrals, and who confirms within a set number of days that the patient booked. Review it at your next team meeting.
Questions Worth Asking Your Team
- Is a re-evaluation appointment booked before the patient leaves, whenever a lesion is noted?
- Do referral letters include photos, location, size, duration and a clear question for the specialist?
- Does someone track open referrals until the pathology result is back in the chart?
- If your dentists want to build biopsy skills, has your practice budgeted for hands-on continuing education, the format most respondents in this study preferred?
Pro Tip: Add an "open lesion referrals" list to your weekly huddle. A two-minute review of every outstanding referral catches the patient who never booked, which is the step most likely to break silently.
Limitations to Keep in Mind
This is a single-state, self-reported survey with a 17.8% response rate, so it may not represent all Indiana general dentists, let alone dentists in Canada. Dentists who chose to respond may differ from those who did not. The study describes attitudes and reported behaviour; it does not measure diagnostic outcomes or delays for patients. Its value lies in naming specific, fixable barriers rather than in producing a precise prevalence figure.
EBIKO Dental will continue monitoring research and guidance on oral cancer detection and what it means for general practices in the GTA and across Canada. For clinical supplies and practice resources, visit EBIKO Dental.
Sources
- Ritchie A, Ajayi D, Taylor HL. Barriers to and facilitators of general dentists performing intraoral biopsies. J Am Dent Assoc. Published online September 26, 2026 (Europe PMC record)
- ADA News: First ADA living guideline reaffirms dental exams crucial to detecting oral cancer early (September 28, 2026)
- Canadian Cancer Society: Head and neck cancer statistics
Frequently Asked Questions
Q: How many general dentists perform oral biopsies?
In a 2026 JADA survey of 377 Indiana general dentists, 67.3% said they had never performed a biopsy and 76.3% routinely referred biopsy cases to specialists, even though 83.5% agreed biopsy falls within their scope. The study is self-reported and limited to Indiana, so it does not describe Canadian practice.
Q: Why don't more general dentists do biopsies?
82.2% of general dentist respondents cited a lack of training or confidence as a barrier. Only 18.2% felt well prepared by dental school and 22.4% by continuing education. Most respondents (85.4%) selected hands-on training or workshops as something that would help.
Q: What should a dentist do if an oral lesion doesn't heal?
According to ADA News' report on the ADA's 2026 living guideline, if a lesion does not resolve 10 to 14 days after initial evaluation and there is no definitive diagnosis or treatment plan, clinicians should recommend a prompt biopsy or referral to a specialist. The guideline says adjunctive tests should not replace an indicated biopsy or referral.