Comment
The Best Cosmetic Service Our Profession Can Provide
Teran J. Gall, DDS
Copyright 2001 Journal of the California Dental Association.
Dentistry is riding a wave of public interest in pursuing a healthy smile. Cosmetic dentistry procedures and services are promoted widely in numerous magazine articles, on the radio and in TV infomercials. Many of us promote quite boldly our ability to perform cosmetic dental procedures. Specialized clinics for one-time bleaching are even spotting the landscape. All of this activity has obviously been quite beneficial for our profession.
However, there is a cosmetic procedure that many of us may not be providing as part of our daily practice routines. An annual oral cancer exam should be the most important cosmetic evaluation we provide. Why? Oral cancer accounts for 2 percent to 4 percent of all cancers in the United States.1 Every year, this accounts for more than 30,000 cases diagnosed with a resultant 8,000 deaths. It has a greater incidence than cervical cancer. The five-year survival rate for people with oral cancer is 81 percent for those with localized disease, 42 percent for patients with regional disease, and 17 percent for those with distant metastases. 2 Clearly, early detection is a critical intervention in the management of this disease.
I would venture to say that all of us in this profession have seen the ravages of oral cancer. Although our experiences may not be direct, we have certainly seen the results of ablative surgery in journals and textbooks throughout our careers. I had direct experience in the management of head and neck cancer patients during my tenure as a hospital dentist at the University of California in San Diego Medical Center. UCSDMC is a Regional Cancer Center. It was there that I followed the diagnosis, treatment, and post-treatment trials and tribulations of these unfortunate patients. I witnessed not only the physical ravages of oral cancer but the psychosocial and financial ravages as well.
Ablative surgical procedures and/or head and neck radiation drastically influence quality of life and place significant financial burdens on those who have such treatment. Postoperative sequelae include xerostomia, dysphagia, social isolation, depression, unemployment, financial hardships, and eventually premature death. This is yet another reason early detection is such a tremendous benefit not only to the patient but also to the treatment team and all of us who finance health care.
Oral cancer is not the only disease state one may identify when conducting such an exam. Diseases such as lymphoma (both Hodgkins and non-Hodgkins type); pathologies of the salivary glands, pharynx, tonsils, larynx, and mucosa; and even oral signs of systemic disease can all be detected by dentists. Although definitive diagnosis of such diseases may not always be made by the dentist, we can certainly initiate timely referrals to rule out pathology or obtain a definitive diagnosis.
Given this scenario, it is imperative that we as oral health professionals rise to the challenge and responsibility to educate our patients about risk factors for oral cancer as well as provide annual screenings to detect early signs of this devastating disease. Consider this issue of the Journal of the California Dental Association to be an important reminder of our role and responsibility as oral health professionals in preventing, diagnosing, and/or treating all oral diseases and particularly oral cancer. We have a tremendous opportunity as dentists to reduce the incidence of late-stage oral cancer by conducting routine oral cancer screenings and educating those at risk about the consequences of their actions or behaviors.
In the summer of 1996, the Oral Cancer Strategic Planning Conference was held in Chicago. One of the recommendations from this meeting was to establish an Oral Cancer Working Group.
This recommendation came from the fact that a concerted effort in controlling oral cancer was lacking. The following is taken from the proceedings of this Working Group as reported in the Morbidity and Mortality Weekly Report:2
The Oral Cancer Working Group, a multidisciplinary group that attended the 1996 Oral Cancer Strategic Planning Conference, met in the fall of 1997 to identify 10 strategies from the 1996 meeting recommendations to receive immediate attention and implementation by the agencies they represented. The Oral Cancer Working Group considered political and scientific changes that had occurred after the 1996 conference (e.g., the Food and Drug Administration had been given regulatory authority over tobacco, legal cases involving tobacco had been settled in several states, national tobacco legislation had been proposed, and four comprehensive oral cancer research centers had been funded by National Institute of Dental Research) and selected strategies the group could effect (as opposed to strategies already under way as a result of the leadership and support of other groups). Leadership at the 1997 meeting was shared by representatives of the American Dental Association, the American Association of Dental Research, the Association of State and Territorial Dental Directors, the Centers for Disease Control and Prevention, the International Society of Oral Oncology, NIDR, and Oral Health America. The 10 priority strategies are as follows.
Advocacy, Collaboration, and Coalition Building
* Establish a mechanism to implement and monitor progress made regarding the recommended strategies developed during the 1996 national conference.
* Urge oral health professionals to become more actively involved in community health concerns.
Public Health Policy
* Require instruction in preventing and controlling tobacco and alcohol use at all levels of training in dental, medical, nursing, and related health-care disciplines.
* Encourage Medicaid, Medicare, traditional insurance plans, and managed-care entities to make oral cancer examinations an integral part of comprehensive physical and oral examinations.
* Designate federal funding for a national program of oral cancer prevention, early detection, and control.
Public Education
* After assessing local needs, develop, implement, and evaluate statewide models to educate all relevant groups.
* Develop and conduct a national campaign to raise public awareness of oral cancer and its link to tobacco use and heavy alcohol consumption.
Professional Education and Practice
* Develop health-care curricula that require competency in prevention, diagnosis, and multidisciplinary management of oral cancer.
* Sponsor and promote continuing education for health-care professionals on the multidisciplinary management of all phases of oral cancer and its sequelae.
Data Collection, Evaluation, and Research
* Strengthen organizational approaches to reducing oral cancer by developing cooperative and collaborative arrangements, funding formal centers, and involving commercial firms.
This strategic plan should serve as a tremendous opportunity for CDA and California dentists to assume their roles in turning the tide on oral cancer. This issue of the CDA Journal should also serve as a call to action for our profession through our state association to embark on a formal and concerted effort to educate oral health professionals, the public, and policy makers about the ravages of oral cancer and its risk factors. It is both timely and necessary that the dental profession take a leadership role in promoting and performing oral cancer screenings as well as providing preventive education to the public. This can be best accomplished in conjunction with state and federal health agencies, our dental schools, and health promotion advocacy groups such as the American Cancer Society.
For now, we should provide the greatest cosmetic service we can provide for our patients -- conduct a thorough annual head and neck exam and provide education about known risk factors for oral cancer.
Author
Teran J. Gall, DDS, is the former director of the Special Projects Department of the California Dental Association.
References
1. Gloeckler Ries LA, Kosary CL, et al, SEER cancer statistics review, 1973-1994. US Department of Health and Human Services, Public Health Service, National Institutes of Health, Bethesda, MD, 1997. NIH publication no. 97-2789.
2. Preventing and Controlling Oral and Pharyngeal Cancer Recommendations from a National Strategic Planning Conference. MMWR Aug 28, 1998 / 47(RR14).
To request a printed copy of this article, please contact/Teran J. Gall, DDS, 25556 Meadowview Circle, Salinas, CA 93908-9393.
