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Call for Dentist to Screen for Oral Cancer

Value Of Screening

Your primary role as a dentist is to educate the public to the value of a dental examination. This compels the dentist to do the exam. Creating a win all the way around. Prevention of deaths from oral cancer. Dentists can offer better chances of cure, normal and full life to patients.

This elevates the stature of the profession. It makes a visit to the dentist nonnegotiable. Educate the patients the value of dental examination. Because there are conditions— such as squamous cell carcinoma—which are equally deadly if the patient has them. Yet no one ever talks about going to the dentist for cancer screening. It’s always for cleaning. And there is nothing wrong with that.

But, its time that periodic screening of the oral cavity was explained -- as it reduces mortality from oral cancer. Over a 9-year period, a 32% reduction in mortality was observed among those who under vent at least one visual oral screening examination.

Diagnostic Phase

The dentist at the initial interview should assess high risk elements like current and prior illness, health habits, behavior and lifestyle. General health of the patient can be found by asking about medications, dietary patterns, smoking and alcohol consumption. This is pivotal in the decisions to screen for potential oral diseases. The new advances in screening technologies, support a call by OCF to dentists to commit to oral cancer screening as part of routine daily practice. The disease is often identified at an advanced stage, significantly reducing the probability of successful treatment. Half of oral cancer patients die within 5 years of diagnosis. Early detection of the disease (stages I and II) is associated with a vast improvement in survival rate; 80% of patients survive for 5 years compared with 20% of those with advanced disease (stages III and IV).

The typically late diagnosis of oral cancer is ironic because the oral cavity is readily accessible for screening, and visible changes in the mucosa (in most cases) are associated with development of the disease. Oral cancer is frequently preceded by an identifiable premalignant lesion and the progression from dysplasia to cancer occurs over years.3 This should allow dentists an opportunity to detect early changes. Nevertheless, most oral cancers are still detected at a late stage, when treatment is complex, costly, often disfiguring and marked by poor outcome.

It is well known that oral cancer is strongly associated with tobacco and alcohol consumption, together responsible for about 75% of oral cancers. When these 2 factors are combined, the risk is multiplied.

Moreover, 90% of oral cancers occur in people over 45 years of age. Noteworthy, however, is a universally observed trend toward an increase in the number of younger adults without apparent risk, who develop the disease. This trend supports the extension of oral cancer screening to include all adults.

Dentists in India could play a major role in early detection of this fatal disease. Given the potential for dentists to serve as frontline advocates, why has there been so little change in the stage of identification of this disease? A major challenge has been differentiating between benign and precancerous or early cancerous mucosal changes when there are often no distinctive clinical features that separate the conditions.

This often results in diagnostic delay. Fortunately, help may be on the way! Toluidine blue has a long history of use as a vital stain to identify oral cancers and has been used sporadically in dental practice for years. Historically, this stain has been less reliable in the identification of premalignant disease. New data has shown that premalignant oral lesions that stain positively are 6 times more likely to become oral cancers than those that do not stain. This finding supports a new role for this vital stain in identification of high-risk oral lesions.

Another recent focus has been on the use of tissue fluorescence to identify alterations in biochemistry and morphology that may be associated with the development of oral cancer.

A simple hand-held device, the VELscope has recently been developed for use by dentists to visualize tissue fluorescence in the oral cavity directly. A blue light is directed at the surface of the oral mucosa. Normal tissue will fluoresce and appear pale geen. Abnormal tissue loses this fluorescence and appears dark brown to black. The device achieved a sensitivity of 98% and a specificity of 100% when discriminating normal mucosa from tissue with biopsy-proven severe dysplasia, carcinoma in situ or invasive carcinoma.

It is vitally important to recognize that the use of any visual aid is an adjunct to the conventional head and neck examination. There is no replacement for this important examination!

Oral cancer is the sixth most common cancer in the world and is a devastating disease with terrible consequences to the individual and to society. The integration of an oral cancer screening examination into daily practice requires little additional time or expense in an already busy practice. The challenge to the dental profession is to ensure that all adult patients have a brief but regular oral cancer screening examination

Working together with a strong commitment to change, dentists have the opportunity to make a dramatic difference. The World Health Organization has made a commitment to take action against the neglected burden of oral cancer, mainly by emphasizing prevention. Oral Cancer Foundation (OCF) is an apt initiative for early detection and prevention. This initiative requires a personal response from every dentists in India to get involved and we at OCF and via our SPOT Centers reinforce the value of incorporating an oral cancer screening examination into the daily practice along with the provision of education to the patients.