Improving oral cancer screenings
by Keverly Sugden, RDH, BASDH
Dental hygienists are the health drivers of the dental profession. The screenings and examinations that we perform on our patients are crucial to their survival. A thorough oral cancer screening can mean the difference between life and death for a patient. Hygienists are the front line in early detection because many of our patients see us on a routine basis. We all know cancer screenings are important, but do we all do them correctly and thoroughly? Statistics show that only 20% of dentists in America do effective oral cancer screenings. Dental hygienists need to do their part in early detection of this deadly disease.
The facts are in! The Oral Cancer Foundation states the following statistics. The past three years have seen an annual increase in the incidence of oral cancer. There will be 35,000 newly diagnosed Americans this year and only half of them will be alive in five years. Oral cancer will cause over 8,000 deaths, one person per hour.
The death rate in oral cancer is much higher than for many other cancers because it is often diagnosed in the very late stages. Many times oral cancer is not discovered until it has spread to the lymph nodes. Oral cancer is very dangerous, and the patient often has no symptoms in the early stages and has a high risk of producing secondary tumors. Many of us have family members and friends who have suffered from cancer. We owe it to our patients to perform a thorough oral cancer risk assessment and screening.
The first step in implementing a thorough oral cancer screening protocol is to understand patient risk factors. Risk assessment involves reviewing the patient’s medical history, age, and habits such as tobacco and alcohol use. The American Cancer Society states that men above age 45 and elderly patients have the highest risk of developing oral cancer. The demographics for oral cancer are changing, and now there are many young people with oral cancer due to smokeless tobacco use and human papillomavirus (HPV). Oral cancer affects men twice as often as women, and affects the black population twice as often as the white population. Patients who smoke and drink regularly have a 15 times greater risk of developing oral cancer. How many of your daily patients fall into these categories?
How to improve your oral cancer screenings
The next crucial step toward improving your oral cancer screening protocol is proper screening and examination techniques. Magnification loupes are necessary in conventional oral cancer screenings. A thorough screening starts with a visual exam of the lips, buccal mucosa, hard and soft palate, and tongue. It is important to check the oropharynx, nasopharynx, and larynx.
A complete palpation of the lips, floor of the mouth, and neck should follow the visual exam. A great resource for reviewing oral cancer screening techniques is available at www.oralcancerfoundation.org. Conventional visual exams are not always complete and effective and can yield many false positives. Many times early detection is not accomplished and with conventional screening techniques oral cancers are found in the late stages.
There are several helpful adjuncts to conventional oral cancer screenings. ViziLite® Plus with T-Blue (www.Zila.com) is a system that uses chemiluminescent light to improve visualization of lesions. The patient rinses with acetic acid, and a fluorescent wand is used along with special filtered eyewear. ViziLite Plus allows abnormal lesions to appear white. T-Blue oral lesion marking system assists the dentist in marking the extent of the lesion to refer for a biopsy. ViziLite Plus is inexpensive and easy to use.
There are several types of portable scopes available for early cancer detections. The VELscope® (LEDdental) is a handheld scope that emits a blue light and causes normal tissue to appear a fluorescent green. Abnormal epithelial tissue loses fluorescence. The clinician will immediately be able to differentiate between the two tissues. The VELscope is very efficient and effective. More information is available at www.velscope.com. The Orascoptic DK™ is a three-in-one diagnostic kit that features a handheld device with a mirror and powerful LED light that will transilluminate teeth to show fractures and early carious lesions. The device also can be used with an acetic acid wash and fluorescent light to improve visualization of oral lesions. More information on this product is available at www.orascoptic.com.
One of the most recent and cutting-edge technologies is the Identafi™ 3000 ultra. The Identafi 3000 ultra is a lightweight, cordless, and ergonomically-designed oral cancer screening and early detection device. The instrument’s unique design allows the dental professional to perform three exams in one oral cancer screening. The Identafi 3000 ultra is the size of an electric toothbrush and employs three wavelengths of light to enhance early and accurate detection of oral cancers.
The hygienist uses the LED white light first to illuminate the oral tissues and enhance visualization. Next, the dental professional turns the handle and the device emits a violet light that excites normal tissue to appear fluorescent. The filtered eyewear enhances the visual effect, and the hygienist can differentiate between abnormal (nonfluorescent) and normal (fluorescent) tissue. In the final stage of the exam, the hygienist switches the device to emit green amber light. This green amber light allows the dental professional to differentiate between normal and abnormal tissue vasculature, which allows the dentist to be more confident in referring for biopsies. More information about this exciting new technology is available at www.trimara.net.
Please take the time to review these technologies with your employer and find one that will work for your practice. Review your oral cancer screening protocol and implement an effective and efficient standard. According to the National Cancer Institute, the death rate for oral cancer in the United States is higher than that of many other cancers. Oral cancer screenings and assessments are the most important part of our routine patient examinations. Make this a priority in your practice and do the right thing for your patients!
About the Author
Keverly Sugden, RDH, BASDH, is an author, speaker and practicing dental hygienist. She is an adjunct faculty member. She has published articles on group practice management and MI dentistry. Keverly is a member of the American Dental Hygienists’ Association and works with local legislators on access to care for children. She has written a training program for large group xadental practices and has organized corporately sponsored continuing education courses for dental hygienists. Keverly can be contacted at [email protected].