Extending customary hygiene services past the prophy and toward whole body health is an easily implemented goal when the strategy remains patient-centered care. At front and center, the hygienist plays an integral part in discovering tissue changes, monitoring conditions, and easing discomfort. Hygienists see patients regularly at recare appointments and, through detailed documentation, can hand off information needed to throw a flag on an adverse, precancerous lesion. Through early detection, your team can foul cancer and save lives.
Tools for the tackle
A standard of care for the patient should always be a life-saving oral cancer exam. Regrettably, statistics from the Oral Cancer Foundation show that more than 30,000 Americans will receive an oral cancer diagnosis this year, and a surprising 25 percent of those have no risk factors. A systematic screening of the lips, tongue, mouth tissues, and soft palate performed routinely by your hygienist will note oral areas that show abnormalities of the vulnerable epithelial cells. Precancerous lesions, or dysplastic cells, can be identified and intercepted before they progress to the carcinoma stage.
Establish a consistent, defensive cancer-detection protocol between the hygienist and dentist. Discuss with your hygienist oral areas that you feel are prone to cellular dysplastic activity (e.g., the lateral tongue border and tonsillar arches). Consider sending your hygienist to an oral pathology seminar to refresh her ability to identify cellular changes and perform head and neck examinations.
Once a suspected area is noted on a patient, choices need to be made. Cellular changes can be confirmed with a rinse, an immediate brush biopsy or surgical biopsy, or perhaps the site can be monitored for further changes by having the patient return in a couple of weeks to retest.
Fortunately for the dental community, innovative and proven technology has entered the detection armamentarium. ViziLite™ screening device (Zila Pharmaceuticals) enhances the visual examination and sheds light on potentially harmful abnormalities. Tissue under suspicion is first notated then quantified with ViziLite. Areas that warrant monitoring can be discovered on-site using this device during the recare visit as well as performing the exam on patients with increased risk factors for oral cancer. It's a simple process: The patient is asked to rinse with raspberry flavored 1 percent acetic acid solution for 30 seconds, then expectorate the remains. With operatory lighting dimmed, a light stick is activated and placed in the patient's mouth to scan the tissue. Target or suspected areas will appear white.
When tissue changes are detected, established practice protocol is then implemented. If your office performs in-office Oral CDx site sampling, ViziLite's white highlighted areas of concern could then be carefully swabbed and sent for further lab evaluation. The Oral CDx kit is a painless brush biopsy performed by the dentist. The biopsy is then evaluated by a computer analysis of the sampled cells. Included in the test kit are all the materials needed to perform the examination — a glass slide; small, round biopsy brush; slide fixative to affix cells; and a pertinent data form. When you mail in your test, the computer screens the slide of cells obtained chairside and will recognize the cells for the presence or absence of atypical or cancerous cells. Your office will be quickly notified of the results. Note: The indicating prerinse needed for ViziLite will not interfere with the results from the cell biopsy computer reading of Oral CDx when used in conjunction.
When your office opts to put detection methods into practice, support teams are ready for the assist. ViziLite may offer in-office training with hands-on sessions, along with supportive literature. The Oral CDx kit offers an instructional videotape detailing the product's use. This videotape is appropriate for viewing at team meetings. Useful in-office materials with attractive patient brochures or postcards for patient mailings are also available to raise awareness of oral cancer.
Receiving reimbursement from insurance carriers is a constant challenge. New reimbursement codes for oral cancer screenings, up for American Dental Association revision, will be published in the next version of the Code on Dental Procedures and Nomenclature. With some success, file under Code D0160 (detailed and extensive oral evaluation – problem focused, by report), use accompanying Code D0120 for the ViziLite claim, and attach a "mouth map" of the notated area to the insurance form. For the oral brush biopsy, attach the laboratory Oral CDx test report with claim form under Current Dental Terminology 4 Codes D7286 or D7999 for possible coverage. Also, try submitting the lab fee to the patient's medical plan for coverage.
The comfort blitz of Rincinol P.R.N.
Clinical situations present themselves routinely for oral tissues in need of soothing. When patients experience xerostomia, application of Rincinol P.R.N. may well be the relief they will come to appreciate. Multiple medications causing tissue changes, past and present cancer therapies, and traumatic conditions are but a few full frontal blows encountered by the patient. Rincinol P.R.N., a bioadherent gel, is a front-line defense sure to intercept the discomfort patients experience. This gel finds a niche for recommending relief which was wide open. When palates are red and inflamed, Rincinol P.R.N. can be applied to burning tissues during the appointment and dispensed for at-home recovery.
Providing a comprehensive oral screening service will highlight your commitment to whole body health for your patients. Thankfully, most biopsy results — when performed by in-office brush or referral scalpel methods — will be negative. When your office practices early detection methods, timely intervention may raise your patients' chance for survival. Soothing medicaments may ease discomfort experienced from oral traumas and cancer therapies. When your hygiene team is set to scrimmage, call the play, run a hut-hut on oral lesions, and rule out cancer by using tools for the tackle.
For further reference ...
- ViziLite — Zila, Inc., www.zila.com
- Oral CDx — Contact your local Sullivan-Schein representative or visit www.oralcdx.com
- Sunstar/Butler products — www.jbutler.com
Karen Kaiser, RDH
Ms. Kaiser has been in the dental field since 1986. She graduated from St. Louis, Mo., Forest Park hygiene program in 1994 and practices in Illinois at the Center for Contemporary Dentistry. Ms. Kaiser authors articles, presents, and can be reached at At Your Fingertips: [email protected].