Risk assessments to detect oral cancer

 

Deborah Lyle stresses the importance of being diligent when assessing patients for oral cancer

Identifying oral cancer early is imperative to successful recovery and even though screening takes just a few minutes, research shows that more needs to be done in dental care settings to implement effective risk assessments, screenings and treatment plans (Burkhart and DeLong, 2009).

Within the UK, over 60% of dentate adults regularly attend a dentist (nationalsmilemonth.org, 2015), putting dental professionals in an ideal position to provide patients with information on health-related topics, screen patients and refer on to specialists, so that individuals get the care they need to fight cancer sooner.

 

Signs and symptoms

Patients with known risk factors should be screened at every visit and encouraged to perform self-examinations, reporting any abnormality (Burkhart and DeLong, 2009). The main symptoms of oral cancer include:

  • Red or white patches on the lining of the mouth or tongue
  • One or more mouth ulcers that do not heal after three weeks
  • Swelling in the mouth that lasts for more than three weeks
  • A tooth, or teeth, becoming loose for no obvious reason
  • A persistent pain in the neck
  • Earache
  • A hoarse voice
  • Pain when swallowing
  • Unexplained weight loss
  • Unusual changes in a patient’s sense of taste
  • Swollen lymph nodes (glands) in the neck (www.nhs.uk, 2014).

 

Cancer therapy complications

For those that are suffering from cancer, the severity of therapy often means that several clinically significant short and long-term adverse effects are likely to be experienced. Some are temporary, like mucositis, xerostomia, the loss of taste, infections, sensitive or painful soft tissue, impaired nutrition, osteoradionecrosis of the jawbone and radiodermatitis. Other complications are more permanent in character, such as trismus, atrophy of the jaw muscles, aggressive dental caries, impaired healing, candidosis, oesophagitis and changes of the bacterial microflora and proteins. The salivary glands are often affected, resulting in a reduction in quantity (hyposalivation) and quality of saliva, along with rapid deterioration of dental hard tissue.

Perhaps one of the most significant results of radiation treatment is osteoradionecrosis, which denotes the denudation of soft tissue and both exposure and necrosis of bone (Sonis and Costa, 2003). Although this typically occurs within the initial three years after radiotherapy, patients remain at an indefinite risk. A number of risk factors have been identified that augment osteoradionecrosis, which can be treatment or patient related.

 

Advice and support

Identifying these risk factors is vital and providing patients with advice and support on managing those that can be influenced – such as oral hygiene, smoking cessation and periodontal maintenance – can reduce the likelihood of the patient developing osteoradionecrosis.

Dental professionals must remain diligent when assessing patients and consider all of the risk factors. For those patients suffering from oral cancer, a comprehensive treatment plan should be provided and advice given on keeping teeth and gingiva as clean and healthy as possible.

 

Deborah Lyle has 18 years’ clinical experience in dental hygiene in the USA and Saudi Arabia, with an emphasis on periodontal therapy. She has written numerous evidence-based articles on the incorporation of pharmaco-therapeutics into practice, risk factors, diabetes, systemic disease and therapeutic devices. Deborah has presented continuing education programmes to dental and dental hygiene practitioners and students and is an editorial board member for the Journal of Dental Hygiene, Modern Hygienist, RDH and Journal of Practical Hygiene, and conducted several studies that have been published in peer-reviewed journals. Currently, Deborah is the director of professional and clinical affairs for Waterpik.

 

 

Oral cancer will be covered at CPD Dentistry UK by Philip Lewis at CPD Dentistry UK. View the full line-up.

SM-PhilipLewis-CPD-Den-UK4

 

*This article was originally published in DH&T magazine.