Oral Cancer Screenings
According to the American Dental Association (ADA), oral cancer screenings should be performed routinely at every patient visit. Extraorally, lymph nodes should be palpated for abnormalities and the skin should be examined. Intraorally, the most common locations for oral cancer include the ventral and lateral surfaces of the tongue, the floor of the mouth and the tonsillar pillars. These four areas should be specifically examined. The entire process takes one to two minutes, and can often be completed before the patient realizes what you have done.
There is no excuse for not completing a conventional oral cancer screening on every patient, but should we be doing more? There are several adjunctive oral cancer screening devices on the market today. The most recent recommendations from the ADA Council on Scientific Affairs regarding screening for oral squamous cell carcinomas can be found in the May 2010 issue of JADA.
There are three types of cancer detection devices on the market assessed in this study. Each device utilizes a specific property of light with tissue.
1. Tissue Reflectance (Microlux DL™, Orascoptic DK™ and ViziLite® Plus)
2. Autofluorescence (VELscope®)
3. Tissue Reflectance and Autofluorescence (Identafi®)
We are not taught to use any of these devices at the University of Florida, College of Dentistry. The primary focus is on the conventional visual and tactile oral cancer screening. It’s up to the clinician to decide whether or not they feel it’s necessary to use adjunctive screening devices within their practice, but the option does exist.
Patients at high risk for oral cancer include tobacco and alcohol users, patients with HPV infection, males and adults greater than 44 years in age. If I were going to use a detection device for oral cancer, then these are the patients I would specifically target. Dentists often charge for the use of these detection devices on patients. I would feel guilty charging a patient for this service if they were not high risk.
If you spot something suspicious in your patient’s mouth, record its size, location and color in the chart. Take clinical photos to assist with diagnosis and follow-up. Check the lesion again in about two weeks. If it’s gone, then that’s great. If it’s not, then biopsy and document any changes. Refer for care to an oral pathologist or oral surgeon if necessary.
Once a lesion has been identified, a surgical biopsy is the best way to arrive at a definitive diagnosis. It is necessary for dentists to become comfortable performing biopsies in their office versus referring to an oral surgeon. What if the patient is afraid to go to the biopsy appointment? You have the perfect opportunity to get the sample yourself before the patient leaves and it is too late. This is reason enough to learn.
Most of the time your oral cancer screenings will be negative, but the few cases that are positive make it worth checking every patient. Oral cancer, when caught early, can be easily treated. Early diagnosis is the goal. Unfortunately, most cases are caught in later, more aggressive stages, leaving the patient with a five-year survival rate. A minute or two with each patient will allow you to save someone’s life.