After my oral cancer diagnosis, my Mom went for her dental check up and you can bet she wanted to be sure she was getting a proper oral cancer screening. When it never happened, she said something to her dentist. “My daughter had oral cancer and I want an oral cancer screening.” He replied that he always takes a good look for that.
That wasn’t good enough. He didn’t pull our her tongue. He didn’t palpate her neck. He didn’t ask her to go Ahhh. Needless to say, that was the last time she went to him.
In my interactions with the many dental professionals I have met over the years through speaking, I have learned about the variations in the coursework on oral cancer required at dental schools. There has been no standard but that is going to change.
According to ADA guidelines adopted in August 2010 and required to be implemented by July 2013, it states:
All graduating students must be competent in providing oral health care within the scope of general dentistry, as defined by the school, including:
a. Patient assessment, diagnosis, comprehensive treatment planning, prognosis, and informed consent.
b. Screening and risk assessment for head and neck cancer.
c. Recognizing the complexity of patient treatment and identifying when referral is indicated.
I have lectured in the past to an audience of both dental professionals and students. When I ask how many perform an oral cancer screening on all their patients, usually about two-thirds of the audience raises their hand. However, I have noticed students’ jaws drop because they can’t imagine there are dentists who don’t do a screening! They are learning how important it is to save a life. They are learning the value of recognizing the early signs of oral cancer.
Change is happening and we can only continue to improve.
Having a competency in screening is going to be helpful although I’m sure all the oral path instructors at dental schools in the U.S. teach basically the same technique components.
The problem for this standard as well as all the others is a very simple basic human fact – – you can teach, show, learn and they can demonstrate proficiency on a certain day or up to graduation day BUT the trick is for each graduate to remain diligent, committed, and consistent in private practice. What looks good on paper for accreditation is not necessarily what happens during and after school. I will state again, one of the most basic problems in my view of dentists as well as those that teach them is that there is entirely too much emphasis on the teeth (and the gums and bone immediately around them) and techniques to improve them but very little interest or zeal for anything else that may be in the vicinity. One only has to look at the computer software for dental practices to see that all of the forms, etc. are laid out for marking and charting teeth and bone level around them but nothing for any soft tissue findings seen throughout the mouth. Likewise the software is setup to dovetail with all of the digital radiographic programs for the teeth (and bone around the teeth) but not for digital images taken of any of the surrounding soft tissue.
You have to go the extra inconvenient yard to document in text and images any pathology seen for example in the floor of the mouth, tongue, oropharynx, etc.
Michael Kahn, DDS, Oral Pathology, Tufts University School of Dental Medicine