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TitleEarly Detection of Oral Cancer
TagsTypes Instruction manuals
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Total Pages37
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Page 1

Occasionalnpaper

EARLYnDETECTIONnAND
PREVENTIONnOFnORAL

CANCER:n

anmanagementnstrategy
forndentalnpractice

PUBLISHED BY THE BRITISH DENTAL ASSOCIATION

Editors: Paul Speight, Saman Warnakulasuriya and Graham Ogden

Page 2

EARLY DETECTION AND PREVENTION OF ORAL CANCER:
a management strategy for dental practice

British Dental Association

64 Wiimpole Street, London W1G 8YS

Tel: 020 7935 0875 Fax: 020 7487 5232

www.bda.org

[email protected]

Copyright © November 2010 All rights reserved

ISBN 978-1-907923-00-5

Early detection of oral cancer needs more than just

understanding of the signs and symptoms of disease.

The process must be managed effectively and handled

sensitively. Every member of the dental team has a

part to play and protocols should be developed for

effective delivery of:

1. regular examination of the oral cavity of patients

attending the practice

2. management of detected mucosal lesions with

appropriate referral

3. management of patients with lifestyles that

contribute to an increased risk of oral cancer.

The aim of this Occasional Paper is to develop a

clinical guideline and offer realistic advice for dentists in

primary care who now seek to adopt best practice in

oral cavity examination and case detection.

Oral cancer deaths will be reduced only if the disease

is recognised earlier, avoiding delays in diagnosis, and

treated sooner.1 Greater public awareness, Continuing

Professional Education and improvements to the health

(referral) systems, we believe, will help us to achieve

this objective.

This care pathway is a revised version of BDA

Occasional Paper issue number 6, released in April

2000, and includes advances in knowledge made since

the previous publication.

BDA Occasional Papers are published under the

editorial control of the BDA. The present paper was

edited and updated for the BDA by Professor Paul

Speight (University of Sheffield), Professor Saman

Warnakulasuriya (King’s College London & WHO

Collaborating Centre for Oral Cancer, UK) and

Professor Graham Ogden (University of Dundee).

© BDA November 2010 2

Page 18

Communication
pathways

Oral cancer detection
The central role of the dentist

© BDA November 2010 18

Page 19

Medical history
taking

It will help if a practice adopts a common

approach to medical history taking - a common

form so that a dentist seeing a colleague’s

patient in an emergency knows what to find in

a record envelope, and a common way of

explaining the form to patients. The BDA’s

model does not have to be followed exactly

but the BDA’s advice is that all history forms

should now include lifestyle questions in some

form (see page 15).

Patients can be asked to fill the form in on

their own because the answers will always be

seen by the dentist, who can clarify and ask

follow-up questions if necessary. Nurses

should not assess whether any of the medical

history needs to be drawn to the dentist’s

attention but they can check for omissions and

ask for information on tobacco and alcohol use

if this is not volunteered.

A practice procedure will also be needed for

updating the medical history sheet - showing

previous answers to the patient and asking

them whether the information is still correct.

People who have given up smoking since the

last visit can be encouraged and

congratulated. People who have taken up the

habit can be advised to think again and

offered further assistance and counselling to

quit.

Clinical recordsA soft tissue examination takes about three
minutes to carry out, if the oral mucosa is

healthy. In that event, all that is needed is a

note on the patient record of negative findings.

This can be brief provided there is a practice

protocol for ensuring that all practice members

know what any notes or abbreviations mean,

and a practice protocol for carrying out the

examination. For example, the dentist might

list to the nurse the parts of the mouth being

examined, in turn and in a particular order. If

they are healthy nothing more than a general

note need be recorded but it would be clear -

and witnessed - that a full examination had

taken place. The sequence might be:

� mucosa - labial/commisures/buccal
mucosae

� gingival or alveolar mucosae including
edentulous areas

� tongue - dorsal/ventral/lateral
� floor of mouth
� palate (soft and hard)
� pharynx - tonsils/pillars of the fauces
� neck - lymph nodes
� salivary glands -

parotid/sublingual/submandibular.

Patient records should also note responses to

any lifestyle advice and any commitment - or

refusal - to reduce risks. Consider putting

identifying “flags” onto the records of patients

found to have suspect soft tissue lesions.

For some patients, you will notice things that

are a little worrying - not enough to refer, but

something you would like to check up on when

the patient next visits. Mouth maps are then

helpful. There are two types - either a

simplified three-dimensional drawing of an

open mouth or a more stylised flat drawing of

the oral mucosa around the teeth. The second

type of map can also be shown against half

centimetre grid markings so that the location

of lesions can be shown quite precisely. Mouth

mapping, especially using the map in

Appendix 3, is the simplest way to monitor a

soft tissue condition - where it is and how big -

so that you can check for any change at the

next visit. Also note colour, texture, and

mobility.

Data protection laws give patients access to

mouth maps, as to any other health records.

Administration

Opportunistic oral mucosal examination is less

of a burden the better the supporting

administrative systems. Medical history sheets

that include lifestyle questions and soft tissue

charts (map of the mouth) can save a lot of

time for dentists and nurses. Mouth maps will

help with soft tissue monitoring. It will also be

helpful to flag up patients who are “at risk” on

their records.

© BDA November 2010 19

Page 36

© BDA November 2010 36

Appendix 3. Mouth Map

You can purchase the BDA mouthmap from BDA Shop.

Tel: 0207 563 4555

Online:www.bda.org/shop/records.aspx

SA
MP

LE

Page 37

British Dental Association 64 Wimpole Street London W1G 8YS Tel: 020 7935 0875
E-mail: [email protected] www.bda.org © BDA November 2010

Occasional paper

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