Dental Tribune United Kingdom Edition

7InterviewOctober 2013United Kingdom Edition more likely in socio-economi- cally deprived groups than the wealthy. Socially disadvantaged people have a tendency not to attend health care providers, including dentists, on a regu- lar basis nor to take up possible screening opportunities for com- mon diseases and therefore have a variable awareness and prac- tice of disease prevention strat- egies, whether concerning oral health or general health. Clearly, the best option for screening would be opportunis- tic screening, where health care staff examine patients in risk groups for a particular disease, but this requires people to want to attend a clinic and to appreci- ate the possible benefits of such attendance for their health and well-being. Is there any evidence that reg- ular screenings could help pre- vent oral cancer? There is no evidence that a par- ticular frequency of dental ex- amination will lessen the risk of mouth cancer. However, the more regularly a person is ex- amined, the greater the chance that emerging malignant or po- tentially malignant disease will be detected and that any lesion present will be small. However, overzealous review is likely to be wasteful and thus all patients should be advised that if they become aware of a change in their gingivae or oral mucosa that persists for more than three weeks and has no ob- vious local cause, or example a sharp tooth or filling, they should seek advice from their dentist. In its 2008 policy statement, the FDI stresses the important role of dental professionals in the detection of oral cancer and patient education. To what ex- tent are dental professionals fulfilling this role? The majority of patients ulti- mately found to have oral can- cer will have been identified by a dentist or other dental profes- sional; thus, dental professionals are fulfilling this role to a great extent. However, dental profes- sionals should also be able to provide advice about oral cancer prevention, for example tobacco and alcohol cessation, and infor- mation on where additional ad- vice can be obtained, for exam- ple tobacco cessation services. The current rule of thumb is that the more people smoke and the longer that habit the greater the risk of mouth cancer. The same applies to alcohol. There are some nuances as regards the type of tobacco or alcohol 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 developing if someone smokes and drinks is much higher than if someone smokes or drinks (i.e. there is a synergistic rather than additive effect). Of course, many dentists will indicate that they have no expe- rience of having seen oral cancer or having managed any patient who has previously had such dis- ease. However, there are some simple rules. If a lesion is soli- tary, has been present for more than three weeks and has no lo- cal 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 contemporane- ous record of what is observed during clinical examination and be familiar with the contact de- tails of local oral cancer special- ists (typically oral and maxillofa- cial surgery or oral medicine). Finally, the patient should be told the truth, ie that the dental professional has concerns that a lesion is possibly malignant or premalignant, and is thus re- ferring the patient for further investigation. DT Regular screening increases the chance of detecting oral lesions early