The Most Important 5 Minutes of a Dentist’s DayApril 4, 2016 | Category Total Health
Cancer is possibly the world’s least favorite word. No doctor wants to have to say it. No patient is ready to hear it. But turning a blind eye (or ear) doesn’t save lives. Consistent, comprehensive oral cancer screening protocols may. As a dental school professor, this is what I teach my students, but it’s also the process I use in my private practice with every new patient (including emergency patients) and at every recall visit.
PART I Comprehensive Patient History
- Establish the chief complaint, the reason for the patient’s visit.
- Review the patient’s medical history, making note of any systemic diseases linked to lifestyle choices that may need to be discussed. Ask about the health of each system/organ.
- Review the patient’s social history (lifestyle), including occupation tobacco and alcohol use, dietary habits, and sexual history if appropriate. Make note of any factors which may increase, or decrease, the patient’s risk of oral cancer. If the patient has a history of tobacco use, I employ the First Method, the 5 A’s, to counsel my patients on tobacco use. This assistance with smoking cessation has been highly valued by my patients and is likely the greatest impact I can have on their overall health.
This comprehensive patient history should be recorded and updated at each recall visit.
PART II Oral Cancer Exam
- Before performing a comprehensive visual and tactile head and neck examination, I explain that this includes an oral cancer screening and answer any questions they may have about this disease.
- Complete an extra-oral visual and tactile exam including but not limited to the palpation of the lymph nodes.
- For the intra-oral examination I examine every millimeter of mucosa (this includes gently pulling out the tongue), noting any white, red, mixed red and white patches, bumps, growths or ulcers (sores) that might be suspicious for oral cancer or precancer, and also paying attention to tobacco-related oral consequences, such as staining of the teeth, periodontal diseases or other condition that may be offer an opportunity to encourage lifestyle changes, such as tobacco cessation.
- At the end of the exam I review and discuss abnormal oral changes with the patient including the need for additional diagnostic steps if applicable. I record all details, including photographs if possible.
This may sound like more than 5 minutes, but once you incorporate this routine opportunistic examination into your practice and use it consistently, the steps will come naturally and the process will move quickly. Patients do notice the difference, and appreciate the time spent. Statistically you may only discover a handful of oral cancers during your dental career, but if you find them early you will have the power to save lives.
Dr. Ross Kerr received his DDS from McGill University in Montreal, Canada, and his MSD and certificate in Oral Medicine at the University of Washington. He is a Diplomate of the American Board of Oral Medicine and Clinical Professor in the Department of Oral & Maxillofacial Pathology, Radiology & Medicine at New York University College of Dentistry where he is the director of the Oral Mucosal Disease Service and an attending at the NYU Oral Cancer Center. He serves as a member of the Scientific Advisory Board for the Oral Cancer Foundation.