Our dento-legal advisor Dr Jane Merivale outlines what it means to be vigilant for oral cancers in the context of the COVID-19 pandemic.
As dental professionals we are acutely aware that our routine oral, head and neck examinations can be lifesaving. Our training means we are equipped to look for the unusual and check for oral cancers. However, with restricted access to our patients as a result of the pandemic, these routines have been disrupted and patients have lacked the benefit of this critical service.
As many as
19 million dental appointments may have been missed during the first lockdown. We have no idea how many cases of mouth cancer will have gone undiagnosed as a result. Now dental practices are working tirelessly to increase their capacity, under enhanced infection control measures, which is putting dental professionals under immense pressure. However, this
Mouth Cancer Action Month it is more important than ever that we look for signs of the disease in our patients.
1. Keep up-to-date with your training
Over many years working as a dento-legal advisor, I have encountered too many horrific cases of a patient suffering disfigurement or even tragically, death as a result of oral cancers. It only adds to the tragedy when, upon learning of the result, the first thing the practitioner asks is: “Did I miss it?”
Hence it is vital that our understanding of this subject up-to-date. The BDA’s
oral cancer detection toolkit, developed in conjunction with Cancer Research UK is an excellent resource that I hope all dental professionals make use of it. The BDA also offers an
Oral Cancer CPD course and is soon to host a fully-booked
webinar on oral cancer detection. We are fortunate that there is such a strong array of online oral cancer training available to us and we should all continue to utilise it and ensure our knowledge and awareness is thorough and current.
2. Communicate with your patients
When undertaking the routine oral, head and neck examinations, take the time to tell the patient what you are doing and why you are doing it. Try and raise their awareness of oral cancer. Patients will be familiar with the ‘mirror and probe’ inspection of their teeth, but the palpation of their neck and the adjacent lymph nodes will need prior explanation. I also advise you seek consent to avoid any misunderstanding.
As part of Mouth Cancer Action Month, the Oral Health Foundation has developed an array of
content that you can use on your website or social channels to help raise awareness. I encourage all dental professionals to take part and share these messages where you can. Our patients trust us to look after their oral health, but a patient may go some time between check-ups. So it’s important that we too try and educate them on the signs of oral cancer.
3. Be thorough and take your time
As dentists, it is our duty to undertake a thorough and systematic review of our patients, both extra and intra-orally, and to act promptly on any suspicions. This level of vigilance can be difficult to bring to every single appointment. However, it is essential to oral cancer detection.
One patient’s story exemplifies this difficulty. The patient had a socket which failed to heal following an extraction. They saw a sequence of different dentists, fitted in each time as an emergency, and each time had the problematic socket irrigated and dressed with Alvogyl. Meanwhile, the clock ticked on. It was only when one practitioner stopped to review all the notes and questioned why the socket had still not healed, that a referral was made. We would all like to think that we are that dentist. But when rushed and under pressure, we may not be.
Vigilance is the key to oral cancer detection. Vigilance with non-healing extraction sockets is particularly important and requires a careful and thorough review. One oral cancer study identified dental extractions as the most common pre-diagnosis treatment performed. The average delay from dental treatment to surgical assessment was just over eight weeks, by which time all patients were found to have stage IV squamous cell carcinoma.
4. Keep detailed notes and documentation
Detailed notes and documentation will help you to demonstrate your checking, detection and referral methodology for oral cancers. When evaluating cases from a dento-legal perspective, we review all of the clinical notes, looking for details of the patient’s social history, as well as evidence of negative and positive findings from the extra and intra-oral checks. With today’s technology, the records can also include photographs and diagrams mapping sites and the dimensions of areas of concern. The referral process will be evaluated to assess the practices’ systems and protocols to help us assess whether the patient was seen by the right expert at the right time.
As a profession we aim to provide treatment in accordance with good clinical guidelines and with our patients' best interests as our priority. However, as high numbers of oral cancer cases may have gone undiagnosed this year, this Mouth Cancer Action Month, it is particularly important to remind ourselves of what it means to be vigilant.
We must ensure that we are always doing our best when it comes to checking, detecting and referring for oral cancer.
Dr Jane Merivale
Dento-legal advisor, BDA Indemnity