A family member may have oral lichen planus. I say “may have” because while some specialists have told her the lesions in her mouth are lichen planus, others have said they’re not sure of the etiology. This family member has had multiple biopsies taken from her palate and she sees an oral surgeon yearly to monitor any changes.
The last visit to her dentist was very upsetting. When she asked what would happen if the lesions turned out to be cancerous, the frustrated dentist replied, “You’ll lose half your face.” As hard as this was to hear as her relative and a dental professional, it opened my eyes to the importance of teaching dental hygiene students how to effectively communicate and counsel patients when they find a suspicious lesion.
Head and neck cancers, including oropharyngeal cancers (OPC), are the sixth most common type of cancer in the world. The human papillomavirus (HPV) has been linked to a staggering 70% of all oropharyngeal malignancies during the past 10 years.1 Dental hygienists are in the perfect position to not only detect possible oral cancer lesions, but to counsel patients regarding HPV and its oral implications.
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What's lacking in hygiene education?
Dental hygiene students are taught how to communicate with patients. They need to use lay terms and steer clear of words that will cause fear or anxiety. Cancer is one of those words. The way students develop effective ways to communicate is often through role playing with their peers. When they practice what to say during a cancer exam, it’s often, “I found a suspicious lesion. To be safe, I’m going to refer you to a specialist so they can take a closer look at it.” Is this enough to motivate a patient to seek care from a specialist?
One major reason students lack confidence in this discussion is lack of time. A study looked at how many hours dental hygiene students were taught about OPC related to HPV. The study also looked at the training of the faculty responsible for teaching the material, and how many hours were spent teaching in the classroom and clinic.
The study found that two-year programs lack full-time faculty members with varied expertise, especially when it comes to head and neck cancers.1 The study also revealed that most students receive a maximum of two hours learning about HPV and OPC, and that those enrolled in a four-year dental hygiene program in a dental school receive the most classroom instruction on HPV.1
How to have the conversation
How can we help students to be more comfortable in this conversation? Research has shown that oral health-care providers lack the skills to discuss HPV during patient care.2 Time should be spent learning about OPC related to HPV in the classroom. If a program lacks faculty with the necessary head and neck cancer knowledge, a guest lecturer could be a great resource.
Once the foundation is set, students can use that knowledge to role play with peers. Motivational interviewing (MI) is a good tool to help students guide their patients in making the best decisions for their oral health. Since first-year students lack the necessary patient management and clinical skills, HPV MI should occur during a student’s senior year.3
Objective structured clinical examinations are also an excellent way for students to practice communication skills in a mock scenario. Interactive CE courses that focus on OPC related to HPV should be encouraged so clinicians can build their knowledge and confidence on the subject.
Due to the increase in OPC related to HPV, the need for dental hygiene programs to spend more time on the subject has never been more critical. Increasing education, along with practicing effective communication skills with students, could be a game changer in the early detection and prevention of this disease.
- Trauger KA, Stull CL, Arnett MC, Blue CM, Flynn PM. Human papillomavirus content inclusion in dental hygiene program curricula in the United States. J Dent Hyg. 2021;95(2):42-49. jdh.adha.org/content/jdenthyg/95/2/42.full.pdf
- Arnett MC, Evans MD, Stull C. Dental hygiene students’ perceptions regarding the importance of and confidence with using motivational interviewing during HPV counseling. J Dent Hyg. 2022;96(2):50-58. jdh.adha.org/
- Stull CL, Matthews E, Evans M, Arnett MC. Examining the role of HPV communication training in the knowledge, attitudes, comfort, and confidence of dental hygiene students. J Dent Hyg. 2021;95(5):47-55. jdh.adha.org/content/95/5/47