Pennwell web 400 170

Is it really about time? Overcoming the barriers to complete oral cancer screening -- part 2

Aug. 20, 2009
In this series, Jonathan A. Bregman, DDS, FAGD, investigates the real barriers dental professionals have to performing a complete oral cancer examination on patients. Here, he uncovers the second resistance factor: unclear about whom to examine.

By Jonathan A. Bregman, DDS, FAGD

From coast to coast the same answer

As I tour the country presenting programs on early oral cancer detection, I ask the same question of all of my attendees: What do you think is the main reason that dentists give for not doing a complete oral cancer examination?

The unanimous response in more than 21 states and close to 40 locations is, “Time!” ... Yes, time!

My next question is always the same: How much time does it take to do a complete extraoral and intraoral cancer examination?

The answer is always the same: “One to one-and-a-half minutes.”

Brief overview of Part I

So, if the time it takes to do this complete oral cancer screening exam is so short, what are the real resistance factors that drive this universal statement?

In the opening article, I discussed what I see as a four part “system of early oral cancer examination” in any dental office. All four parts to this system must be in place for early oral cancer detection to be maximally effective.

The four parts are:

  1. The target population: who do we examine and why
  2. The basic examination: how do we perform and record it
  3. The delivery of a difficult message: verbal skills and seamless referrals
  4. The new tools available for screening: what are they, how do they work, and when are they used


The first resistance factor we discussed was overall lack of confidence in doing the complete oral cancer screening examination. The rationale: “Not doing the exam at all puts me at less risk than doing it and missing something.”

The second resistance factor:Unclear about whom to examine

It’s not the same as even 10 years ago!

Not knowing who needs to be examined, as well as the most recent statistics about the target population shifts for oral cancer risks, can stop many from even doing the complete oral cancer exam. Call it ego. Call it unwillingness to take the time to become better educated. Call it “putting one’s head in the sand.” Is that you?

Let’s get started on a new path of understanding right now!

Having a clear understanding of the target population for early oral cancer screening/examination is critical for two reasons:

  1. Clinical effectiveness: making sure we examine the people who are at risk
  2. Communication with the patients who are to be examined: being able to explain why the oral cancer screening examination is being done for them


Take a look at this chart:

What a significant change has occurred in gender, age, and risk factors over the past 10 years!

Why the changes?

Most all dental health-care providers know the big three etiologic factors for oral cancer from the past right up to the present:

  1. Tobacco use
  2. Excessive alcohol consumption
  3. Family history


The new and deadly epidemic: human papillomavirus

The fourth and newest etiological factor is human papillomavirus, or HPV. More specifically, out of the almost 100 identified HPV viruses, Nos. 16 and 18 are the ones of most concern for causing oral cancer. Interestingly, Nos. 16 and 18 are two among the four HPV viruses most commonly linked to cervical cancer.

HPV is a sexually transmitted disease that is at epidemic levels for women worldwide as a leading cause of death through cervical cancer. In 2007, the New England Journal of Medicine released a study that directly links HPV to the risk of oral cancer without the other risks of tobacco and alcohol.

New target group: much younger

No matter what your personal beliefs or preferences, the statistics are real. Sexual activity begins to significantly increase at age 13 to 14, then spikes again at 16, and again at 18. That is the reason that Gardasil, the HPV vaccine, is recommended for individuals from ages 9 to 12. The vaccine must be received before exposure to the virus for it to be effective for both young women and young men.

So, we must change the patient age when we begin oral cancer screening to age 18. Some practitioners begin their screening at ages 13 to 15.

No matter what age you choose as your beginning point, we are no longer looking primarily at men over age 40.

How do we respond to the patient who says, why me?

Understanding the target population for oral cancer screening examinations and their risk factors now gives everyone in the office the ability to effectively respond to any patient who would commonly say, “I don’t use tobacco; why are you bothering to do an oral cancer screening examination for me?” or, “I am young and healthy; why do this screening examination for me?”

Also, if you have not been doing a complete oral cancer screening examination and begin to perform it now, you have the tools necessary to answer the patient who says, “You never did this before; why are you doing this oral cancer screening exam now?” The growing body of information about risk factors and the huge increase in new cases and deaths from oral cancer provide many reasons to justify oral cancer screening as a part of your routine examination.

With this knowledge of target population and risk factors, plus some practice with verbal skills or scripting, this barrier of not knowing how to respond to our patients’ questions will be eliminated.

“It’s about time ... early oral cancer detection™”

So, eliminate the barriers brought on by misconceptions and misunderstandings about:

  • Who in your practice must have a complete oral cancer screening examination
  • What the necessary knowledge base is for the dentist and every team member to effectively respond to patient questions regarding this critical screening examination


Realize that by doing this important screening that takes, at most, one-and-a-half minutes, you will be:

  • Saving lives
  • Differentiating your practice in the community
  • Creating a “wow” experience for your patients, leading to new-patient referrals


It’s about time!

What’s coming up next?

The third resistance factor:uncertainty about what is required to do a complete extraoral and intraoral cancer screening examination plus necessary documentation.

Jonathan A. Bregman, DDS, FAGD, is a clinician, speaker, author, and trainer who led successful dental practices for more than 30 years. While dedicated to improving the dentist, team, and patient experience, he has a passion for educating dental professionals about early oral cancer detection and laser-assisted dentistry. You may contact Dr. Bregman by e-mail at [email protected] or visit www.bregmandentistry.com. Also be sure to check out his blog at www.oralcanceraware.com.