PROSTHODONTICS - American College of Prosthodontists
PROSTHODONTICS - American College of Prosthodontists
PROSTHODONTICS - American College of Prosthodontists
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THEORALCANCERSCREENINGEXAMINATIONTheimportance<strong>of</strong>oralcancerscreeningOnepersondies<strong>of</strong>oropharyngealcancerintheUSAeveryhour.Thisdiseasestrikesabout30,000<strong>American</strong>seachyear,andkillsnearlyhalf<strong>of</strong>themwithin5years.Theoralcancerpatienthasamuchgreaterchance<strong>of</strong>acureand<strong>of</strong>livinganormallifeiftheirdiseaseisdetectedearly.Forthisreason,thedentistisdefinitelyinapositiontosavelives.Thedentistmaybetheonlypractitionerthattheedentulouspatientvisits;thispatientmayotherwisegodecadeswithoutahealthpr<strong>of</strong>essionalexaminingtheiroralregion.Alsotheedentulousandpartiallyedentulouspatientismorelikelytobeanoldermale,andasmokerorformersmoker,importantconsiderationsintheassessment<strong>of</strong>risk(<strong>American</strong>CancerSociety).Whatisthepurpose<strong>of</strong>oralcancerscreening?Thepurpose<strong>of</strong>theOralCancerScreeningExamistodetectanytissueabnormalitiesthatcouldpotentiallybeorbecomeamalignancy,noworinthefuture.Itneedstobepart<strong>of</strong>thedailyroutineinthedentist’s<strong>of</strong>ficeforanumber<strong>of</strong>reasons:ethical,health‐related,economic,andlegal.Detection<strong>of</strong>oralcancerandindeedsystemicdiseasesisarecognizedpart<strong>of</strong>thelegalscope<strong>of</strong>dentalpractice,andfailuretodiagnoseisafrequentcause<strong>of</strong>malpracticeclaims.Oralcancerscreeningisnotremuneratedwellundercurrentfeestructures,butpatientsarefrequentlyimpressedandpleasedbythethoroughnessandthoughtfulness<strong>of</strong>thedentistthatwatchesoutfortheirhealthinthismanner.Whoshouldbescreenedfororalcancer?Theoralcancerexamshouldbeperformedatanypatientatriskfororalcancer.Inpracticalterms,thisincludeseverypatientseenatthedentist’s<strong>of</strong>fice.Thehigh‐riskpatientfororalcancerisgenerallyolder,male,andasmokerorex‐smoker,andotherriskfactorsincludefrequentuse<strong>of</strong>alcohol,use<strong>of</strong>betelnutproducts(morelikelyintheAsianpatient),poordiet,andahistory<strong>of</strong>apreviousheadandneckcancer.However,justaboutanyprosthodonticpatientcoulddeveloporalcancer;agrowingnumber<strong>of</strong>oralcancerpatientsareyoungerandlackthetraditionalrisk(Cancer).Doesoralcancerscreeningreallymakeadifference?ArecentstudyinLancetlookedat168,000patients,<strong>of</strong>whomabout87,000receivedoneormorevisualscreenings.Overa9‐yearperiod,thescreenedgroupdemonstrateda32%reductioninmortality,andtheauthorssuggestthatvisualscreeningalonehasthepotentialtosaveatleast37,000livesannually.(SankaranarayananR,etal.).WhatshouldaclinicianlookforThepurpose<strong>of</strong>theexaminationistodetectanyareathatlooksout<strong>of</strong>theordinaryandforwhichthecliniciandoesnothaveadefiniteclinicaldiagnosis.AhandychecklististolookforChangesinColor,Contour,Consistency,andFunction.Changes:Howlonghasthelesionbeenpresent?Isitstable?Cancerisaggressive.Thus,amalignancytendstobegrowingandchangingovertime.Occasionallyamalignancymayariseinapreviouslybenignorpremalignantlesion,soalongstandinglesionthatwaspreviouslystableandhasbeguntochangeincolor,contour,consistencyorfunctionshouldringalarmbells.Ofcourse,inanidealworldwewoulddetectandremovethelesionsbeforethemalignanttransformationtakesplace,soanyunusual 312010 CDEL Re-recognition <strong>of</strong> the Specialty Report 215 <strong>of</strong> 279
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