Is It Really About Time? Overcoming the Real Barriers to Complete Oral Cancer Screening

July 2, 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 first resistance factor.

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 to 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."

This is the first in a series that investigates the real barriers.

Is it really the one-and-a-half minutes it takes to do a complete extraoral and intraoral examination that is the barrier? What is the real reason for this resistance to something that every clinically trained dental health-care provider was taught and promised to do on each and every patient?

After giving a great deal of thought to this issue, I have come to the conclusion that the resistance to the oral cancer exam is due to lack of confidence in or knowledge of some aspect of what I call "the system of early oral cancer detection." Unlike adding a new restorative material, early oral cancer detection or screening is truly a "system" that takes many forms within the dental office. And it involves every team member.

What is this 'system' of early oral cancer detection?

The way I see it, there are four parts to this "system":

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
If the dentist or dental team is uncomfortable with any aspect of these above mentioned parts, the exam is not performed. To me, that summarizes why more than 75% of all dental offices do NOT perform a complete oral cancer screening examination. Yes, 75%!

So, it's about time we understand how to eliminate each resistance factor so that, ultimately, all dental offices will be maximally effective in doing a complete oral cancer screening examination on every patient.

The first resistance factor: Lack of confidence in doing the complete oral cancer screening exam

Better off not doing the oral cancer screening exam

"I am better off not doing any oral cancer screening exam than to do it and miss something when it comes to malpractice liability."
Huh? Yes, you heard that right. Some dentists think that if they do the oral cancer exam and miss something that they increase their malpractice liability compared to not doing the exam at all. This could not be farther from the truth!

The number two reason for all malpractice suits against dentists in the United States is lack of diagnosis or delayed diagnosis of oral cancer with an average claim pay-out at almost $1 million. It is also impossible to defend if the oral cancer screening exam is not performed. When the complete oral cancer exam is performed and systematically recorded, then there exists a very good malpractice defense that will stand up in almost any court of law.

What is really the issue here?

The complete extraoral and intraoral cancer screening exam has not changed for 40 years or more. The way every dentist, dental hygienist, and dental assistant was trained to do it still remains sound standard of care in the profession.

So what is really at issue is:

1. A lack of willingness to open up any text that includes a section on oral cancer screening and review the necessary steps for this exam
2. An ego that stops an individual from saying, "I need help to resharpen my skills when it comes to the complete oral cancer screening exam"
3. A misunderstanding of malpractice risks
"It's about time ... early oral cancer detection"™

So, throw away the misconceptions regarding malpractice risk and the oral cancer screening exam. Realize that by doing this important screening that takes, at most, one-and-a-half minutes, you will be saving lives besides lowering your malpractice risk. It's about time!

What's coming up next?

The second resistance factor: not understanding the changing target population for oral cancer screening

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 Also be sure to check out his blog at