by Kristine A. Hodsdon, RDH, BS
We're all familiar with the current diagnostic protocols for breast, prostate and cervical cancer, which begin with manual intervention examination techniques. But it does not stop there. We are accustomed to, and oftentimes the medical model dictates, corresponding adjunctive technologies, which are a mammogram, PSA test and Pap smear, respectively. If abnormal cells/tissues are detected, then biopsies are performed. These standards of care are accepted in the medical community and expected by patients.
So why are there still so many oral care providers who will not change their attitude or behavior to perform more than just a cursory oral cancer screening? Why aren't more hygienists and dentists implementing adjunctive technologies that are simple, non-invasive, fast and painless?
On Wasting Time
The No. 1 reason I hear clinicians give as to why they don't complete three- to five-minute head and neck plus adjunctive technology oral cancer screenings is "lack of time." Yet many providers spend their precious time chatting about frivolous issues, only to find that the appointment time and level of care has dwindled!
How do we become masters of the time we lose or waste? The answer is effective appointment management and communication. Now is the time to stop calling it "appointment time" and begin calling it "life saving time."
Manual and Adjunctive Techniques
Here are some tips for consistently implementing a head and neck screening during hygiene services. First, execute a protocol that is reassuring and relaxing to the patient. Develop an introductory phrase such as, "This is kind of like a facial massage."
Next, revisit the clinical skills needed for a basic extraoral and intraoral assessment. These include using your eyes to look for abnormal lesions, and using your ears to question the patient about tobacco use. Discover what types (cigarettes, chew, snuff, cigars), how long, how often, and if they have tried to quit. This will provide you with information to determine risk level and the patient's willingness to begin a cessation program. Finally, use your fingers to palpate for anything that might feel abnormal.
The armamentarium for a conscious oral soft tissue exam has changed little over the years. It includes 2x2 gauzes (dampened), mouth mirror, tongue blades, incandescent patient light, magnification, air/water syringe, and our eyes. Yet similar to the expectations in the medical protocols, patients deserve the advanced technologies that augment a manual exam.
The primary goal of adjunctive technologies is to accelerate a diagnosis by identifying lesions that may have gone undetected through conventional means. If pathology is undetected and treatment is delayed, the likelihood of a poor outcome increases. As I said, patient acceptance for the use of adjunctive technologies in medicine is very high. We must give our patients the same benefits by providing advanced technologies in oral hygiene.
Dental and dental hygiene professionals must change our attitudes about delivering manual head and neck screenings supported by adjunctive technologies. Once this is accomplished, it will free us up to provide our patients with what we know to be a comprehensive fight against oral cancer.