Whether you are a student dentist, new graduate, or experienced practitioner, we are always looking for ways to improve our clinical skills and provide the utmost quality of care to our current and future patients. According to the American Cancer Society, more than 49,000 new cases of cancer will occur in the oral cavity and oropharynx this year, with more than 9,500 deaths occurring as a result. A majority of these malignancies will be diagnosed as oral squamous cell carcinoma. As such, one of our most important duties as dentists is to conduct thorough evaluations to prevent unnecessary suffering and increase the chances of successful cancer treatment.
The American Dental Association’s Council on Scientific Affairs and Center for Evidence-Based Dentistry recently published the “Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant Disorders in the Oral Cavity.” The guideline is an update of recommendations released by the ADA in 2010 and is based on a systematic review conducted by an expert panel of clinicians and researchers from around the country.
Below are a few takeaways from the new guideline. It is important to note that, when it comes to oral cancer evaluation, the ADA encourages patients to communicate their concerns to clinicians and be key players in their own early detection.
Highlights of the Guideline:
1.) Clinicians should always obtain an updated medical, social, and dental history and perform an intraoral and extraoral visual and tactile exam in all adult patients.
2.) If a patient does NOT have any clinically evident lesions—which should be determined by the clinician—no further action is required. If a clinician is unsure if a lesion should be tested, they should follow the idea that if they are wary or suspicious of it, it should be tested!
3.) Patients with an oral lesion that doesn’t appear to be malignant should be periodically followed up with by their clinician to evaluate the progress of the lesion and to determine if further action is needed.
4.) If the lesion does not eventually go away on its own or malignancy is suspected, a biopsy should be conducted as soon as possible or the patient should be referred to a specialist.
5.) Cytologic adjuncts—methods of looking at cells to determine if they are indicative of disease—are not recommended to evaluate potentially malignant lesions. However, if a patient declines a clinician’s recommendation to have a biopsy or does not want to see a specialist, the clinician can use cytologic adjuncts to help with lesion assessment. A positive test result reinforces the need for a biopsy or referral, while a negative result indicates the need for periodic follow-up.
6.) Autofluorescence, tissue reflectance, and vital staining adjuncts are not recommended to evaluate potentially malignant lesions, nor are salivary adjuncts.
The guideline and an ADA-produced video summarizing the guideline’s recommendations are now available. We encourage everyone to utilize these resources to help ensure that patients’ oral cancer evaluations follow the latest evidence-based clinical practices.
~Alexandra Fushi and Adam Parikh, American Dental Association
Alexandra Fushi is a second-year DMD candidate at Midwestern University College of Dental Medicine in Illinois. Before dental school she received her masters’ in public health from the University of Illinois at Urbana-Champaign. In her free time, she enjoys traveling and spending time with family and friends.
Adam Parikh is a third-year DMD candidate at Midwestern University College of Dental Medicine-Illinois. He currently serves as the Midwestern University ADEA Student Chapter President. He hopes to pursue post-graduate training in orthodontics and a career in dental education. In his free time, he enjoys spending time with family and friends.
Source: Lingen, M. W., et al. (2017). Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity. JADA.
This content is sponsored and does not necessarily reflect the views of ASDA.