Seriously, how meticulously do you check for oral cancer?
You’ve seen the statistics. You’ve heard about the high-profile cases. You know about the subtle causative factor that affects nonsmokers: HPV. You may even own a VELscope Light. But how meticulously are you checking for oral cancer? Are we doing enough not just to diagnose and treat what we can bill out routinely? Dr. Iman Sadri says it’s time to be as meticulous about oral cancer as we are about the margins of our crowns and the collections of our claims.
You’ve seen the statistics: 42,000 new cases diagnosed annually. You’ve heard the name-dropping with high-profile cases: Michael Douglas, and Adam Yauch of the Beastie Boys. You’ve heard of the subtle causative factor that affects nonsmokers: HPV. You may even own a VELscope Light. But even still, how meticulously are you checking for oral cancer? Too often as dental practitioners, the priority becomes about the phases of treatment planning. We look at the patient’s chart and ask: How is the perio? What about caries control?Do any restorations need to be replaced? Are there edentulous areas that could benefit from implant placement? But do we tell ourselves often enough that each patient may have the early signs of oral cancer even if he or she does not smoke or drink regularly? Are we meticulously checking for oral cancer as often as we are for incipient caries and abfractions? Are we looking for early, potentially precancerous lesions as diligently as we chart existing treatment?
ADDITIONAL READING |The details of oral cancer screening
If the answer is a resounding “No,” then we need to take a step back and reevaluate our daily clinical priorities. Sure, we do not want to overwhelm our patients by giving them a laundry list of items that we check for and are concerned about. Too often, a four-page treatment plan is a result of telling patients what they need all at once. We avoid this because we want to focus on the priorities or the chief complaint of the patient. But isn’t potentially saving the patient’s life the most important priority? Isn’t this the onus when checking for blood pressure prior to starting treatment? Many times, it’s not about preventing a patient from potentially fainting in the dental chair, but about educating him or her about the deleterious effects of being hypertensive. Dentistry is evolving. Providers are taking advantage of the adage “The mouth is the window to the body” by treating pathologies other than those related to teeth and gums. As an example, snoring and oral appliance therapy to combat obstructive sleep apnea (OSA) is becoming more prevalent. The first step is to have the patient fill out an Epworth Sleepiness Scale form. After evaluating the results, do we become alarmed when a patient answers 8 out of 10 when asked if they fall asleep at the wheel while driving? Some practitioners may even schedule the patient for a sleep study immediately that week.
ADDITIONAL READING |Before you look at the teeth, look at this: our responsibility to detect and treat oral cancer
But how urgently are we checking for oral cancer? Clearly not urgently enough, when there are 42,000 new cases diagnosed each year. The easy rationale is that oral cancer is difficult to detect because of the minute size of hidden lesions. Or because the lesions are asymptomatic. That rationale becomes a languorous excuse when thousands of lives are lost annually because oral cancer was not detected early enough. These are individuals who are nonsmokers and under age 50 who succumb to oral cancer by the thousands each year. A priority needs to be made to use magnification when doing intraoral and extraoral exams. It’s not just the soft tissue in the mouth. It’s the hard palate — keratinized tissue in the posterior of the oropharynx … areas of edema around the tonsils. Externally, it’s the angle of the lip. Any areas of skin cancer could be missed by a dermatologist because of its proximity to the mouth. Many times, primary care physicians may leave oral cancer detection up to the dentist. But are they really leaving it up to us? Are we doing enough not just to diagnose and treat what we can bill out routinely? Or are we just going through the motions? It’s time to be as meticulous about oral cancer as we are about the margins of our crowns and the collections of our claims.
Iman Sadri, DDS, is a cosmetic dentist, columnist, and lecturer. He is a 2008 graduate of the NYU College of Dentistry and maintains a private practice in Orange County, Calif.