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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:

  • 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?
Last Updated 14th January 2020
Early Diagnosis:

  • 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.
After Treatment:

  • Manage simple denture problems after surgery


  • 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.
Useful Websites:

The Oral Cancer Foundation

The Mouth Cancer Foundation

Oral Cancer LDV

Oral Cancer Recognition Toolkit


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

BDJ 2010.  Study of the Experience of Primary Care GDP's in the detection & Management of Potentially Malignant
Lesion. 1. Factors influencing detetction & the Decision to Refer

BDJ 2012.   Oral Cancer – Improving Early Detection & Promoting Prevention.  Are you up to date?

Dental Update 2012.  Oral & Dental Management for Head & Neck Cancer Patients Treated by Chemotherapy &
Radiotherapy

Dental Update 2012.  Oral Cancer - Comprehending the Condition, Causes, Controversies, Control &
Consequences.  18. Dental Management

Dental Update 2012.  The Role of the General Dental Practitioner in Managing the Oral Care of Head & Neck
Oncology Patients

Dent Update 2013.  Early Detection of Oral Cancer - How Do I Ensure I Don’t Miss a Tumour

BDJ 2013.   Why do GDPs fail to recognise Oral Cancer. The Argument for an Oral Cancer Checklist

BDJ 2016. Dentists Can Help Turn The Tide On Oral Cancer

Dent Update 2016.  Mouth Cancer for Clinicians Part 9.  The Patient & Care Team

Dental Update 2017.  Head & Neck Cancer Patients − Information for the General Dental Practitioner

Dental Update 2017.  Let’s Talk about Mouth Cancer − The Story & the Facts

British Dental Journal 2018.  The Dental Management of a Mouth Cancer Patient

BDJ 2018.  Mouth Cancer - Presentation, Detection and Referral in Primary Dental Care

BMJ 2018.  Referring patients with suspected oral cancer to dentists may delay diagnosis, say GPs

Dental Update 2018.  The Role of the General Dental Practitioner in the Detection of Squamous Cell Carcinoma of
the Maxillary Antrum

Oral Health in Cancer Therapy - A Guide for Health Care Professionals, 3rd edition