PROSTHODONTICS - American College of Prosthodontists

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Figure19ConclusionsTheprosthodonticpatientmaybeathigherriskthanaverageforundetectedprecancerousandmalignantorallesions,becauseofthefeaturesthatputpatientsatrisk(age,sunexposure,tobacco,alcoholandothers)andbecauseedentulouspatientsmayseekdentalcarelessfrequently.Allpatientsshouldhaveanoralcancerexaminationatleastonceperyearandpreferablytwiceperyear.Anyunexplainedfindingsorlesionsthatfailtoresolvewithintwoweeksshouldbestronglyconsideredforbiopsy.Withestablishmentofacarefulroutine,thedentistisinanexcellentpositiontodetectcancerearlyandsavelives. 462010 CDEL Re-recognition of the Specialty Report 230 of 279
MANAGEMENTOFSUSPICIOUSORALLESIONSIntroductionTheultimateresponsibilityfororalscreening,diagnosisandfollow‐uprestswiththedentist.Ifageneraldentistoraspecialistdeterminesthathis/herpatientrequiresabiopsyorsomeotherdiagnostictestingthenitisrecommendedthattheappointmentbemadewhilethepatientisstillintheoffice.Aconfirmationletter,fax,ore‐mailsubsequentlyshouldbesenttothereferredspecialist,anoralandmaxillofacialpathologist,outliningthereferringdentist’sconcernsandarequestforthereferredspecialisttosendawrittenreportofthespecialist’sevaluationofthepatient.Itisrecommendedthatbiopsyspecimensoftheoralcavity’sindigenoustissuesandcontiguousstructuresshouldbesubmittedtooralandmaxillofacialpathologistsforevaluationwheneverpossible.Somegeneralmedicalpathologistsareunfamiliarwiththehistopathologicalsubtletiesofodontogenicandoraltissues,whichcanleadtomisdiagnoses.Allofficesperformingbiopsiesshouldhavereasonablepoliciesandproceduresinplacetoensuretimelyreview,documentationandfollow‐upactionsforreturnedbiopsyreports.Noninvasivescreeningtechniques(e.g.exfoliativecytologysmear,liquidbrushcytology,brushbiopsy,chemiluminescence,autofluorescence)shouldnotbeconsideredasubstituteforgold‐standardsurgicalbiopsyofarchitecturallyintacttissuewhenthereisaconcernaboutmalignancy.BiopsyindicationsItisgenerallyviewedbythecourtsasanindicationthatadiagnosticbiopsyneedstobeperformedassoonaspossibleifthereisnoimprovementintheclinicalfeaturesofalesionortheclinicaldiagnosisbecomesuncertaininthejudgmentofareasonableandprudentdoctor.Thereforebiopsyalesionif:Thereisnoidentifiableetiologyandtheareaofconcernspersistsformorethan10‐14daysdespitelocaltherapy.Itisfeltthattheareahasmalignantorpremalignantcharacteristicsduetothefollowingcharacteristics:• Theareahasgrownorisgrowingrapidlyfornoobviousreason• Theareaisared,whiteorpigmentedmucosallesionorcombinationoftheseforwhichacauseordiagnosisisnotevident• Thesuspiciousareafeelsfirmlyattachedorfixedtoadjacentstructures• Theareaofconcernislocatedinahigh‐riskareafordevelopmentoforalcancer(e.g.,floorofmouth,tongue)• Thereisaneedtoconfirmaclinicaldiagnosticsuspicion• Theareadoesnotrespondtoroutineclinicalmanagementoverareasonableperiod• Theareaisasourceofextremeconcerntothepatient(i.e.,patient’sfearaboutapersistentlesionisgreaterthantheconcernaboutundergoingaminorsurgicalprocedure)ManagementofleukoplakiafollowingbiopsyLeukoplakiasinlow‐riskareaswithnohistologicevidenceofdysplasiamaybeobservedforaslongastheyarepresent.However,ifchangesdevelopsuchasredness,ulcerationorpebbledsurfacemorphology,thenasecondbiopsyshouldbeimmediatelyscheduled.Alesionwithmilddysplasiamaysometimesbeobservedclosely,however,ifitisinahigh‐risksiteand 472010 CDEL Re-recognition of the Specialty Report 231 of 279
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COUNCIL ON DENTAL EDUCATION AND LIC
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A. General InformationThe American
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The American College of Prosthodont
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Changes in Scope of PracticeThe Ame
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ReferencesThe American College of P
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ENVISIONED FUTURE~ 10-30 YEAR HORIZ
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Prosthodontists will provide prosth
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GOALS AND OBJECTIVES~ 3-5 YEAR PLAN
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E4. Create effective linkages to fu
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Journal of ProsthodonticsImplant, E
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December 2005, Supplement, Volume 1
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28 Cllas$caizon of Complete Edentul
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30 Clmsjfication ofCom&e Edentulirm
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32 Clarszjicatwn ofcomplete Edeiitu
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Figure 14. Class Ipatient. (A) Pano
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38 Clm$cation of Cumllete EdClass 1
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184 Classification System Jor Parti
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186 Classification Systemfor Partia
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Figure 4. Class IV palienl. Edenlul
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I192 Classification Sy stemfor Part
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74 Classification System for the Co
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76 Classification System for the Co
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Page 185 and 186: ORALCANCERSCREENING,EXAMINATIONANDB
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Page 199 and 200: THEPROCESSOFONCOGENESISIntroduction
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Page 241 and 242: CPE Course History From 2000-2010Da
Page 243 and 244: COUNCIL ON DENTAL EDUCATION AND LIC
Page 245 and 246: Accreditation Standards forAdvanced
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Page 249 and 250: Mission Statement of theCommission
Page 251 and 252: PrefaceMaintaining and improving th
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Page 255 and 256: Educationally Qualified: An individ
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Page 259 and 260: STANDARD 2 - PROGRAM DIRECTOR AND T
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Page 263 and 264: STANDARD 4 - CURRICULUM AND PROGRAM
Page 265 and 266: Intent: Students will have in depth
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Page 271 and 272: STANDARD 6 - RESEARCHAdvanced speci
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PROSTHODONTICS - American College of Prosthodontists

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