dentistry emblem colorAfter an informed public that is knowledgeable about the risk factors for oral cancer, the dental community is the first line of defense in early detection of the disease. Including both generalists and specialists, there are over 100,000 dentists in the US, each one seeing between 8 and 15 patients per day. If you include those patients who come to a practice and see someone other than the dentist, such as the hygienist, the number of patient visits is significantly higher. The American Dental Association states that 60% of the US population sees a dentist every year. Just doing “opportunistic” cancer screenings of the existing patient population which visits a dental office every day, would yield tens of thousands of opportunities to catch oral cancer in its early stages. One of our goals is to initiate an effort within the dental community to aggressively screen all of the patients who visit their practices. At the same time we are launching a public awareness campaign. This campaign is intended to drive public awareness of oral cancer, and to instill in the public’s mind the need for an annual screening for this disease. One only has to look at the impact of the annual PAP smear, mammogram, and prostate exam, to see how effectively an aware and involved public can contribute to early detection, when coupled with a motivated medical community.

The dental community needs to assume this same leadership role if oral cancer is to be

brought down from its undeserved high ranking as a killer.

Published studies (Horowitz et. al. in two studies ten years apart) show that currently less than 15-25% of those who visit a dentist regularly report having had an oral cancer screening. Most frequently when it is done it is accomplished by the RDH in the office and not the doctor. RDH’s are qualified to do these screenings and bring suspect areas to the attention of the doctor in the office for further examination and potentially additional diagnostic procedures such as biopsy. This low percentage of patients screened is unfortunate, when you consider that historically, the greatest strides in combating most cancers have come from increased awareness and aggressive campaigns directed at early detection. It is now commonplace to annually get a PAP smear for cervical cancer, a mammogram to check for breast cancer, or PSA and digital rectal exams for prostate cancer. These screening efforts have been possible as a result of the increased public awareness of the value of catching cancers in their earliest forms, combined with education or new technologies for conducting the examinations. Oral cancer is no different. Actually, it is potentially easier to obtain public compliance for oral cancer screenings, since unlike many other cancer screening procedures, there is no invasive technique necessary to look for it, no discomfort or pain involved, and it is very inexpensive to have your mouth examined for the early signs of disease. Education of the public regarding the risk factors which lead to oral cancer, recognition of the early signs and symptoms, and the development of patient awareness, are primary responsibilities of the dental community. This is dentistry’s cancer and area of responsibility.

It is important that both private individuals, and members of the dental community, realize that a visit to the dentist is no longer only about a filling, a crown, or a postponable cleaning, but can be a matter of life and death. Dental examinations, when properly done and which include a screening for oral cancer, will save lives. If you are a dental professional, we encourage you to become a member of the foundation, and partner with us in this effort to increase the number of annual screenings which are being done. We can provide you with materials such as waiting room brochures which explain to your patients the risk factors and early signs and symptoms of the disease, as well as help them realize the importance of opportunistic annual screenings. We have a public self exam, self discovery of abnormal tissues, and self referral to a dental professional education site. We encourage you to send patients to it so that between visits to your office they can self screen at home. The address of that website with the short training video for them is www.checkyourmouth.org

Discovery and diagnosis

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Historically, it has been difficult to determine which abnormal tissues in the mouth are worthy of concern. The fact is, the average person routinely has conditions existing in their mouths that mimic the appearance of pre-cancerous changes, and very early cancers of the soft tissues. One study determined that the average dentist sees 3-5 patients a day who exhibit soft tissue abnormalities, the vast majority of which are benign in nature. Even the simplest things, such as a canker sore (herpes simplex), the wound left by accidentally biting the inside of your cheek, or sore spots from a poorly fitting prosthetic appliance or denture, all at first examination, share similarities with dangerous lesions. Some of these conditions cause physical discomfort, others are painless. The question is which ones deserve action, and which ones bear watching and waiting?

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