Screening by a Dentist

The Mouth Cancer Foundation recommends all dental practices and individual dental professionals carry out a thorough head and neck cancer screening on all practice patients at least once a year at routine appointments. Early diagnosis is the key to ensuring patients have the best possible outcome.

The charity encourages all dental practices to carry out a thorough head and neck cancer screening of their patients. The charity views this as a whole team approach so all members of the practice team are familiar with the signs and symptoms to look out for. In addition a constant effort is required to demonstrate a visible commitment to increasing public awareness of mouth cancer.

It takes less than 2 minutes to carry out a comprehensive mouth cancer screening and every dental practice should be doing this.

A Simple Head and Neck Cancer Screening

The Mouth Cancer Foundation has developed a simple Mouth Cancer Screening protocol to ensure that dentists are able to standardise the process for all patients over the age of 16 years.

This examination can be carried out in the dental chair using gloved hands, a mirror and good lighting. Before the examination, communicate to your patient what you are doing and looking for. The time after the examination is ideal for giving appropriate advice to those at risk.

Extra-Oral Examination

1. Observe the face and neck looking for swellings, skin abnormalities, moles and asymmetry.

2. Look for any changes in the colour or texture of the vermillion border of the lips and mouth.

3. Palpate the lymph nodes in the neck feeling for any enlargement or abnormality. Most intra-oral lesions present with enlarged nodes in the submandibular and submental and upper jugular regions of the neck. These can be palpated in the submandibular region below the lower border of the mandible and just an-terior to the sternocleidomastoid muscle.

Intra-Oral Examination

Ask denture wearing patients to remove them at this stage.

1. With the mouth half open, examine the labial mucosa and sulcus.

2. Then observe the maxillary and mandibular sulci on one side.

3. Then, retract the cheek and examine the buccal mucosa on that side. Look for changes in colour and texture.

4. Repeat stages 2 and 3 on the other side.

5. Then, examine the tongue at rest and protruded for changes in colour, texture, symmetry. mobility and distribution of papillae.

6. Holding the tip of the tongue and alternately retracting the cheeks, inspect and palpate the lateral borders of the tongue.

7. Lift the tongue and inspect and palpate the ventral surface and the floor of the mouth.

8. Depress the tongue and examine the soft and hard palates. Ask the patient to say “Ah” and inspect the oropharynx, uvula and pillars of the fauces.

All accessible structures and soft tissues should be palpated.

This systematic screening should be carried out by dental practitioners on every patient at each routine check up.

It takes just two minutes to carry out a full head and neck cancer screening. See how easily it can be done in this demonstration by Dentist and Mouth Cancer Foundation Ambassador Dr Philip Lewis.

Philip demonstrating mouth cancer screening.

Using an Adjunctive Screening Tools

Some practices may choose to screen patients with an adjunctive tool. If this is the case please specify which one it is. The practice should describe indications for its use and each clinician must demonstrate evidence that they have been trained in the use of the adjunctive screening technique of choice that will be used to further secure their patient’s oral health.

The visual and tactical examination remains the internationally accepted gold standard examination for any mouth cancer examination. Examples of adjunctive screening tools are as follows:

Oral CDx

The Oral CDx is a tool which is a specialised brush that samples just a few layers of epithelium, stopping at the basement membrane. The sample is sent to a laboratory where an oral cytopathology specialist analyses it to distinguish abnormal tissue from normal. The brush test is quick and painless and is commonly used to test white and red oral spots for dysplasia changes. (https://www.cdxdiagnostics.com/oralcdx)

Vizilite Plus with TBlue630

Vizilite Plus is an advanced biophotonic light technology and TBlue630, a toluidine dye marking system Used together these tools are effective as an adjunct for use in high risk populations and suspicious mucosal lesions. (https://www.denmat.com/)

VELscope

The VELscope system emits a safe, visible blue light which excites mucosal tissue and causes it to fluoresce. The clinician can examine the soft tissues and identify suspicious lesions. Typically, healthy tissue shows up as a bright green light while suspicious lesions cause a lack of fluorescence and appear dark in colour. (https://apteryx.com/velscope/)

Identafi

The deep penetrating light of the hand-held Identafi tool is designed to enhance diagnostic efficacy for oral cancer. It uses multi-spectral fluorescence and reflectance technology to enhance visualisation of mucosal abnormalities such as dysplasia and premalignant lesions. Identafi uses 3 distinct colour wavelengths to make lesion morphology and vasculature easier to distinguish. (www.dentalez.com)

Orascoptic DK

This system is a three-in-one, hand-held, battery powered device that uses an LED light source and three unique, interchangeable diagnostic instruments. This tool uses a mild acetic acid mouth rinse to improve the visualisation of oral tissues. (www.orascoptic.com)