FDI WorDental Daily 30 Aug

Friday&Saturday, 30–31 August 2013 Science & Practice common, particularly the latter, compared with oral lichen planus. I Besides new treatment concepts, preventionremainsthemosteffec- tive strategy against oral cancer. Why do so many dentists still ap- pear to overlook obvious signs of thedisease,anddocurrentscreen- ing procedures have shortcom- ings? The greatmajority of patients ul- timately found to have mouth can- cer will have been referred to a spe- cialist service because a dentist or other dental professional will have noticed something abnormal. He or she might not have known what it was, but they did the correct thing by referring the patient to a special- ist. Screening for possible mouth cancer is straightforward. It is just a matter of examining the neck and mouth carefully. However some- times dentists do not know what to look for, as they have probably never seen more than one type of oral cancer in their professional lives. Similarly, mouth cancer is more likely in socio-economically de- prived groups than the wealthy. So- cially disadvantaged people have a tendency not to attend health care providers, including dentists, on a regular basis nor to take up possi- ble screening opportunities for common diseases and therefore have a variable awareness and practice of disease prevention strategies,whetherconcerningoral health or general health. Clearly, the best option for screening would be opportunistic screening, where health care staff examine patients in risk groups for a particular disease, but this re- quires people to want to attend a clinic and to appreciate the possi- ble benefits of such attendance for their health and well-being. I Is there any evidence that regular screenings could help prevent oral cancer? There is no evidence that a par- ticular frequency of dental exami- nation will lessen the risk of mouth cancer.However,themoreregularly a person is examined, the greater the chance that emerging malig- nant or potentially malignant dis- ease will be detected and that any lesion present will be small. However, overzealous review is likely to be wasteful and thus all pa- tients should be advised that if they become aware of a change in their gingivae or oral mucosa that per- sists for more than three weeks and has no obvious local cause, or ex- ample a sharp tooth or filling, they should seek advice from their den- tist. I In its 2008 policy statement, the FDI stresses the important role of dental professionals in the detec- tion of oral cancer and patient edu- cation. To what extent are dental professionals fulfilling this role? The majority of patients ulti- mately found to have oral cancer will have been identified by a den- tist or other dental professional; thus, dental professionals are ful- filling this role to a great extent. However, dental professionals should also be able to provide ad- vice about oral cancer prevention, for example tobacco and alcohol cessation, and information on where additional advice can be ob- tained, for example tobacco cessa- tion services. The current rule of thumb is that the more people smoke and the longerthathabitthegreatertherisk of mouth cancer. The same applies to alcohol. There are some nuances as regards the type of tobacco or al- cohol that may affect risk but these are really not of notable concern when communicating a disease prevention message. Of signifi- cance is that the risk of cancer de- veloping if someone smokes and drinks is much higher than if some- one smokes or drinks (i.e. there is a synergistic rather than additive ef- fect). Of course, many dentists will in- dicate that they have no experience of having seen oralcancer or having managed any patient who has pre- viously had such disease. However, there are some simple rules. If a le- sionissolitary,hasbeenpresentfor more than three weeks and has no local cause, the patient should be referred. Any lesion that strikes a dental professional as odd and/or destructive warrants referral. Dentists should always keep an accurate and contemporaneous record of what is observed during clinical examination and be familiar with the contact details of local oral cancer specialists (typically oral and maxillofacial surgery or oral medicine). Finally, the patient should be told the truth, i.e. that the dental professional has concerns that a le- sion is possibly malignant or pre- malignant, and is thus referring the patient for further investigation. I Thankyouverymuchfortheinter- view. AD 7www.fdiworldental.org