3 hygienists. 3 screenings. 3 lives saved. Oral cancer screenings and why the standard of care matters

Coauthors:

Jonathan Jones, AAS, RDH

Lani McBeth, BS, RDH

Stephanie Shada, BS, RDH

In the June 2024 issue of RDH magazine, I wrote a recap of the oral cancer screening course I presented at RDH Under One Roof 2023 on “The Cotten Method” of screening.^1-3 Following are stories by three dental hygienists who have put this screening into practice and changed the lives of their patients. Their stories matter.

Stephanie’s story: “Just a slight asymmetry”

I was away from dental hygiene for a time when I chose to stay home with my four kids. Due to circumstances beyond my control, my hygiene license became inactive. To return to dental hygiene after a divorce, I attended a reeducation course through Central Regional Dental Testing Service (CRDTS) and took clinical boards again through this program. Returning to hygiene practice in 2024, I decided to take Susan Cotten’s hands-on oral cancer screening workshop at RDH Under One Roof and immediately started to implement what I'd learned.

Not long after taking Susan’s workshop, I identified a slight asymmetry in the thyroid of a 28-year-old male patient. I had the patient feel what I felt and showed it to him in the mirror. It was subtle, but he could see it. I told him to have his doctor check his thyroid at his next physical appointment. Today, I would say things differently. I would recommend making an appointment right away to have it evaluated and biopsied. I thoroughly documented my findings and the conversation with the patient.

A month or so later, his mom came in for a dental appointment and asked to speak with me. With tears in her eyes, she gave me a big hug and said, “You saved my son’s life!” Her son had been diagnosed with thyroid cancer. She said the doctors were amazed that it was even caught because it was so small and told my patient that they probably would have missed it on an exam. At his next hygiene appointment, he brought me flowers and a gift card to show his gratitude.

It takes a few minutes to perform The Cotten Method of screening. Those few minutes were worth it to help that one patient and bring peace and relief to his family.

Lani’s story: “It’s been there for 12 years”

The Cotten Method fundamentally reshaped how I practice dental hygiene. One of the most impactful experiences involved a 55-year-old female new patient. As always, I began with a comprehensive review of her medical and dental histories, followed by a thorough extraoral and intraoral examination, including a head and neck cancer screening.

I discovered a large lesion on her palate. When I asked about it, she said, “It’s been there for 12 years. My other office has been watching it—it hasn’t changed.” She initially declined further imaging, such as a CBCT or panoramic radiograph. Continuing with her hygiene visit, I shared a quote from Susan Cotten that has stayed with me: “If it’s not right, it’s wrong.” I took a few moments to educate the patient on the importance of further evaluating the lesion, even if it appeared unchanged.

She called the office the next week to say she had changed her mind and wanted to do the CBCT imaging. The conversation I had with this patient at her hygiene appointment made the difference. The scan revealed the lesion had extended into the sinus, not the palate as it initially appeared. She was diagnosed with advanced-stage adenoid carcinoma.

This case reinforced two essential truths: we must never skip a comprehensive extraoral and intraoral exam, and we must always take the time to educate our patients, as education can significantly impact outcomes. My role is to screen, not diagnose. When I serve as a guest hygienist, I commonly hear, “No one’s ever done that before.” That tells me we have work to do in clinical consistency and team alignment.

Every dental office needs a clear protocol for referral and follow-up when suspicious findings arise. Our patients deserve more than guesswork—they deserve thoroughness, advocacy, and a coordinated approach. We don’t have “biopsy eyes,” but we do have the tools, training, and responsibility to ensure every patient receives the most comprehensive care possible.

Jonathan’s story: “No one’s ever done that before”

My patients were accustomed to an intraoral cancer screening before I joined the practice. However, a comprehensive visual and tactile extraoral head and neck exam was not done before my arrival. The easiest way for me to perform this comprehensive exam is at the conclusion of my hygiene treatment. The first time I perform the exam, I always explain to the patient exactly where I will be palpating and examining and what I am looking for and feeling. I continue to explain what I am feeling, seeing, and where my hands are traveling. In the event I see something, I will always take a photo and share my findings with the patient. If it is a palpable node or mass, I always have the patient palpate themselves to identify what, where, and how large the suspected area is. This allows the patient to monitor any changes and be able to direct their PCP or specialist to the exact location.

When the dentist I work with comes in for his examination, he always performs a comprehensive visual and tactile extraoral and intraoral evaluation as well. I share my findings with the doctor in front of the patient. This allows the patient to hear my findings again, as well as confirming my findings are being reviewed by the doctor.

Because of our diligence, we were able to give a newly retired patient a second chance at life. A small, palpable nodule along her thyroid was later confirmed through ultrasound and biopsy to be one of the rarest types of thyroid cancer, medullary thyroid carcinoma. Routine bloodwork had not picked up on this cancer. Medullary thyroid cancer affects approximately 1,000 people a year in the United States.⁴

We play a vital role in the early detection of oral and head and neck cancers. Prioritize diligence and a comprehensive oral cancer screening and head and neck exam. Your assessment can save lives and elevate the standard of care we provide.

Performing a comprehensive screening is nonnegotiable. Advocate for the time to assess, screen, communicate, and connect with your patients.

A call to protect our patients and our profession

Sharing Stephanie, Lani, and Jonathan's stories and their life-saving work as dental hygienists is so important. Each one has received approximately 3,000 hours of rigorous education, graduated from a Commission on Dental Accreditation (CODA) accredited dental hygiene program, passed written and clinical board exams, and is licensed to provide optimal preventive care to the public.

But there is a movement to lower the standard of care received at dental hygiene appointments by eliminating these requirements to practice dental hygiene. At the same time, the number of Americans diagnosed with oral and oropharyngeal cancer is continually on the rise. If this movement is successful, will lives be saved or lost in the push to increase the number of undereducated dental hygienists in the workforce?

Be encouraged by the diligence, courage, and application of knowledge demonstrated by these three hygienists. We must not allow the standard of care to be lowered, endangering the lives of our patients. 

Related reading: I screen, you screen, we all screen: No one has ever done that before!

Editor's note: This article appeared in the August/September 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Cotten S. I screen, you screen, we all screen: no one has ever done that before! RDH. June 20, 2024. https://www.rdhmag.com/patient-care/article/55020084/i-screen-you-screen-we-all-screen-no-one-has-ever-done-that-before
2. Cotten S. The Cotten Method of screening. RDH. April 12, 2022. https://www.rdhmag.com/resources/document/14271019/the-cotten-method-of-screening
3. Save more lives. National Network of Healthcare Hygienists. https://www.healthcarehygienists.org/the-cotten-method-oral-cancer-screening
4. Medullary thyroid cancer. Cleveland Clinic. Reviewed January 16, 2025. Accessed July 19, 2025. https://my.clevelandclinic.org/health/diseases/22873-medullary-thyroid-cancer-mtc