Discussion Topic Six

_about_oral_cancer_1 x

As a hygienist, would it be beneficial to provide patients with a “tell, show, do” method for oral cancer screening? Tell, show, do is equivalent to describing oral cancer, and its locations, demonstrating how to perform an oral cancer exam, and having the patient perform an exam on himself or herself. How would this benefit the patient the sources must be academic

About Oral Cancer

An oral cancer screening involves observing and palpating (feeling) the head and neck. While observing and palpating, the hygienist is noting any deviations from normal. A systematic, methodical approach is necessary to avoid missing a lesion. The most common areas where oral cancers occur are on the lateral border of the tongue, the floor of the mouth, and the throat. The most common type of cancer found is squamous cell carcinoma. The hygienist first begins with the extra-oral (outside the mouth), then moves to the intra-oral (inside the mouth) structures.

Oral cancer is found most often in men than women, and among those who use tobacco and alcohol regularly. In 1993, it was estimated that over 20,000 men were diagnosed with oral cancer, and over 9,000 women were diagnosed.

The most common signs of oral cancer include the following:

· Swelling, lump, growth, or area of induration or hardness anywhere in or about the mouth or neck, which is usually painless.

· Erythroplakia patch (velvety, deep red patch)

· Leukoplakia patch (white or red/white patch)

· Any sore (ulcer, irritation) that does not heal after 2 weeks

· Repeated bleeding from the mouth or throat

· Difficulty in swallowing or persistent hoarseness

According to the American Cancer Society’s Facts and Figures report, the survival rate for all stages of squamous cell cancer or the oral cavity was approximately 52% in 1993. The National Cancer Institute data collected from 1973-1984 showed those persons with a small localized oral squamous cell cancer had a 72% 5-year survival rate, compared with only 34% for a late stage oral cancer.

Dental hygienists can participate in several activities to help prevent oral cancer through educational programs for school children, participation in community health fairs or public education seminars, and assisting or implementing tobacco education and cessation programs.

Clinically, a dental hygienist can screen a suspicious lesion through the use of toluidine blue dye to help detect malignant lesions. Studies indicate that carcinomas stain dark blue with a topical application of this dye. There is a 2-6.7% false negative rate, but this is less than the percentage with subjective clinical judgment alone. The dye is not diagnostic, however, and a suspicious lesion must be biopsied to confirm malignancy.

As stated earlier, tobacco is considered the number one carcinogen in the United States, and although the percentage of adult cigarette smokers has dropped in the past few years, the incidence of smokeless tobacco users, especially among adolescents and young men, and the popularity of cigar smoking has increased. One cigar contains approximately the same amount of nicotine as found in one pack of cigarettes.

The use of smokeless tobacco products or “dipping snuff” exposes the body to levels of nicotine equal to or exceeding those of cigarettes. These products contain high levels of carcinogens, heavy metals, and other toxic agents, as well as sugars to help sweeten the flavor to enhance compliance.

Young children in 4th through 6th grades are especially vulnerable to the use of smokeless tobacco because they are beginning to participate in team sports and they like to emulate the professional athletes who are often seen on television with a “quid” or “pinch” of tobacco in their mouth. Coaches of these young children must be taught about the dangers of smokeless tobacco use as well, so they do not promote or allow the use of tobacco among their players.

For more information about smokeless tobacco, click on the following links.

Oral Cancer Foundation

University of Iowa Virtual Hospital Cancer Center: Smokeless Tobacco