Dental Protection has put together a list of top tips for dental teams planning to participate in November’s mouth cancer awareness campaign.
New statistics, published by the British Dental Health Foundation, reveal there were 6,767 new cases of oral cancer in 2011, a rise of 33% since 2000.
Additionally, deaths from mouth cancer surpassed 2,000 in 2011 for the first time.
Coinciding with the news of these rocketing figures, the British Dental Health Foundation’s Mouth Cancer Action Month takes place in November and presents the perfect opportunity for dentists to raise the profile of this disease with patients.
Most dental professionals will not come across many cases of oral cancer in their career but, in view of these latest statistics, it is important to know which patients are most likely to be at risk, how to spot signs and how to respond appropriately.
The most significant contributory factors are smoking and heavy drinking, while the use of smokeless tobacco, chewing betel nut, and a poor diet can also increase the risk.
The Human papilloma Virus (HPV) is a pre-cursor for oral cancer and, currently, there is a vociferous campaign for the UK’s HPV vaccination programme (currently offered to girls only) to extend to all adolescent boys, too, in order to stem its rise in future generations.
The particularly aggressive nature of oral cancer means that missing one opportunity to make an early diagnosis or prompt referral can have serious consequences for the patient’s prognosis, Dental Protection maintains.
To coincide with the month-long campaign, the British Dental Health Foundation is encouraging practices throughout the UK to signpost the fact that every oral health check includes an examination for signs and symptoms of mouth cancer. By highlighting this element of a standard dental examination, BDHF believes that it will be ‘effective in helping to educate patients about mouth cancer as well as encouraging better oral health’.
Nigel Carter, chief executive of the British Dental Health Foundation, says: ‘Holding sessions to ‘opportunistically examine’ for mouth cancer remains an important activity if we are to increase awareness of the disease, improve early detection, and ultimately improve survival rates – it is important however, that they are not billed as ‘screening’ sessions.
‘We also hope that by billing them as oral health checks (that involve mouth cancer examinations), it will make members of the dental team feel more comfortable about holding them, and increase the overall uptake in the activity.’
This year, the British Dental Health Foundation’s target is for 250 dental practices to hold these free oral health check sessions, either in their dental practice, by going out into their local communities, or by visiting workplaces in the area as part of their occupational health programmes.
Any such screening should be informed by a lifestyle enquiry (use of tobacco, alcohol, betel nut etc) and a regular review of the patient’s medical history.
Smokers should be encouraged to seek professional help with smoking cessation.
Dento-legal adviser at Dental Protection, Julia Densem, explains: ‘If there is any doubt about an individual case, ask a colleague in your practice to have a look at the patient with you and/or make a referral to the local maxillofacial surgeon or oral medicine clinic. This referral should be made with the patient’s consent and an explanation of why a second opinion is being sought. A clinical photograph is often helpful to demonstrate the area of concern.’
She adds: ‘If the records can show an ulcer was found, described clearly, and the patient was advised to return for review 10 days later, there is hope. If they also mention the patient failed to attend the review and ignored documented attempts to seek a review appointment, any allegation of negligence can be rejected.’
The clinician also needs to explain the significance of their examination to patients, in terms they can understand, in the hope that, by removing or minimising risks, the patient’s future oral and dental health can be protected or improved.
Comprehensive records are another essential part of examining the patient. In addition to the clinical findings it is important to record any discussion of them with the patient, Julia Densem says: ‘If you fail to give the patient sufficient information, at an appropriate time, about relevant risk factors, it could be thought that you denied them an opportunity to take remedial action to avoid the occurrence, or deterioration of a condition.’
‘Whether or not the patient would have acted upon such advice is a separate issue – and an important one – but, if the information, explanation and advice is not given at all, and a problem results or a clinical situation deteriorates, the clinician will be left arguing from a position of relative weakness.’
Dental Protection suggests the most effective oral screening is one that follows a reproducible format, for every adult patient:
- A visual inspection of all areas of the mouth, with a good light, including the floor of mouth, gingivae, sulci, palate, tongue and oropharynx
- Any unusual lesions should be palpated and examined by touch
- A note should be made of the site, size, colour and consistency of any lesion
- An extra-oral examination should be performed, routinely checking the salivary glands, lymph nodes and bones of the lower face
- A careful survey of the rest of the face can reveal a variety of skin lesions, melanoma, basal cell and squamous cell carcinoma
- It is entirely appropriate for a dentist to make a referral to an appropriate specialist for further investigation. Palpable masses in the salivary glands and nodes can be readily detected, and an early referral made
- It is important to assess nerve function, particularly with regard to patients with facial pain; areas of sensory loss associated with pain should be investigated by a maxillofacial surgeon or a neurologist
- Facial nerve weakness in a case with a parotid mass suggests rapid growth associated with malignant change.
Additionally, dental professionals are reminded to keep up to date with their continuing professional development (CPD) education. The GDC has included Oral Cancer: Improving Early Detection as a ‘recommended’ topic in its CPD scheme since 2012.