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| Oral Cancer - Rôle of GDP in Cancer Prevention & Diagnosis |
The dentist (GDP) is in a unique position to help in oral
cancer discovery and diagnosis.
The GDP, by training and experience, knows what the oral
cavity should look like and be aware when oral tissues look
suspicious.
GDP's involvement includes prevention, early diagnosis and
the care of patient post-treatment for cancer.
Prevention:
Case law has already established that a dentist’s duty of
care includes an obligation to examine the whole mouth.
A typical legal complaint might allege failure to recognise
the possibility of a malignancy having noted swollen gums
and loose teeth, for example, with a lack of evidence of
adequate medical and social history-taking and delay in
making a specialist referral.
Dentists need to be sure that they can, if necessary,
answer questions like these:
cancer discovery and diagnosis.
The GDP, by training and experience, knows what the oral
cavity should look like and be aware when oral tissues look
suspicious.
GDP's involvement includes prevention, early diagnosis and
the care of patient post-treatment for cancer.
Prevention:
- Actively discourage smoking & betel nut use
- Encourage moderation of alcohol intake
- Health promotion & education on Oral Cancer
- Provide check-ups for œdentulous ± institutionalised
elderly & otherwise high-risk non-attenders
Case law has already established that a dentist’s duty of
care includes an obligation to examine the whole mouth.
A typical legal complaint might allege failure to recognise
the possibility of a malignancy having noted swollen gums
and loose teeth, for example, with a lack of evidence of
adequate medical and social history-taking and delay in
making a specialist referral.
Dentists need to be sure that they can, if necessary,
answer questions like these:
- Did you know that a particular patient fell into an oral
cancer high risk group and what did you do in the
light of that knowledge?
- Were the medical, social and dental histories taken
appropriately?
- Did you investigate the health of soft tissues
thoroughly enough?
- Was a decision not to refer the appropriate one in the
circumstances?
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| Last Updated 8th February 2012 |
Early Diagnosis:
This presupposes that the GDP is comfortable recognising pre-malignant lesions
and is au fait with them. Shrugging your shoulders or referring any oral pathology
to the OMFS Department are not necessarily the most efficacious or responsible
responses.
Given Continuous Professional Development, there is the expectation that GDP’s
should be more aware and be able to recognise oral lesions.
Also, though not happening yet in this country, failure to recognise such lesions and
act accordingly may be regarded as malpractice or even negligence.
The parallels have already been drawn by the defence unions between the lack of
diagnosis and treatment of periodontal disease and oral cancer.
I don’t believe many GDP’s will biopsy the lesion; no real financial incentives and
also the worry that biopsying the lesion may ‘muddy the pitch’ for further
investigations and treatment.
- Be vigilant & suspicious
- Always examine mucosa as well as teeth
- Refer all high-risk lesions on discovery
- Monitor low-risk pre-malignant lesions
- Perform biopsy appropriately
This presupposes that the GDP is comfortable recognising pre-malignant lesions
and is au fait with them. Shrugging your shoulders or referring any oral pathology
to the OMFS Department are not necessarily the most efficacious or responsible
responses.
Given Continuous Professional Development, there is the expectation that GDP’s
should be more aware and be able to recognise oral lesions.
Also, though not happening yet in this country, failure to recognise such lesions and
act accordingly may be regarded as malpractice or even negligence.
The parallels have already been drawn by the defence unions between the lack of
diagnosis and treatment of periodontal disease and oral cancer.
I don’t believe many GDP’s will biopsy the lesion; no real financial incentives and
also the worry that biopsying the lesion may ‘muddy the pitch’ for further
investigations and treatment.
- Manage simple denture problems after surgery
- Alleviate the effects of post-irradiation dry mouth (eg preventing xerostomia-
related caries)
- Monitor for recurrence, new pre-malignant lesions & second primary tumours
- Monitor for cervical (neck) metastases
- Maintain morale of & provide additional support to patients & their relatives
Theoretically, the GDP should know how to manage a dry mouth and its sequelae
(cervical caries, periodontal disease & candidal infections). The GDP should
have either literature or even the products used in the amelioration of xerostomia.
If the GDP can do a competent oral screening, than monitoring for a recurrence or
a new cancer or a pre-malignancy is no different than the oral screening.
The Oral Cancer Foundation
The Mouth Cancer Foundation
Useful Articles:
Dental Update 2000. The Role of the General Dental Practitioner in Detection and
Prevention of Oral Cancer. A Review of the Literature
Br Dent J 2003. The role of primary healthcare professionals in oral cancer
prevention and detection
Br Dent J 2003. Oral Cancer Prevention & Detection in Primary Healthcare
Dental Update 2005. The Role of the Dental Team in Preventing and Diagnosing
Cancer. 1. Cancer in General
Dental Update 2005. The Role of the Dental Team in Preventing and Diagnosing
Cancer. 3. Oral Diagnosis and Screening
Dental Update 2005. The Role of the Dental Team in Preventing and Diagnosing
Cancer. 4. Risk Factor Reduction - Tobacco Cessation
Dental Update 2005. The Role of the Dental Team in Preventing and Diagnosing
Cancer. 5. Alcohol and the Role of the Dentist in Alcohol Cessation
Family Practice 2009. Conducting Oral Examinations for Cancer in General
Practice - What are the barriers?
BDJ 2010. The Reality of Identifying Early Oral Cancer in the General Dental
Practice
