Be a Hero and Save Your Patients’ Lives!

Oral cancer. Throughout their entire career, these are 2 words that every dentist hopes that they will never have to say in relaying a diagnosis to a patient. Oral cancer kills one American every hour of every single day. A number of famous people have become victims of oral cancer, including Babe Ruth, Sigmund Freud, Bill Blass, and Jack Klugman. You and I both know that when a lesion is found in the mouth, and it turns out to be squamous cell carcinoma, there is a 50% to 70% chance that the patient may not live past the next 5 years. They will also need radical surgery followed by major reconstruction, running the cost of care into hundreds of thousands of dollars. In addition, they must deal with immeasurable pain and suffering. We desperately need to do something different than we have been doing for the last few decades, since the number dying of this dreaded disease every day has not improved.
A recent dental patient survey done by the Crown Council revealed that the No. 1 finding of the survey was patients who were saying, "Tell us more about oral cancer." Consumers are ready to get more involved with learning more about their mouths and certainly want to be involved with oral cancer prevention. Take a look at the popular consumer magazines-cancer prevention is one of the hottest health topics around. Even CNN's Dr. Sanjay Gupta recently did a story on oral cancer. It is high time the dental profession raises the specter of oral cancer and helps to reduce the mortality rate associated with it, which has stayed the same for the last 40 years.

ORAL CANCER AWARENESS

I often wonder why we, as dental professionals, donít take the detection of oral cancer seriously enough. Look carefully at my words. We do take it seriously, but we do not take it seriously enough. I would suggest that one of the reasons is because patients themselves don't take the detection of oral cancer very seriously either; just like many patients donít take their oral health very seriously. I can tell you with certainty that if patients took oral cancer more seriously, then the entire dental profession would do so as well.
When you look at other cancer awareness programs, some organizations have done an absolutely outstanding job in creating a very high awareness in all of us for certain types of cancer. Women know how to do a breast cancer self-exam, and they routinely go for mammograms. Everyone over the age of 50 knows that it is time to go for a colonoscopy. These types of self-examinations and professionally-advised screenings have helped to save many, many lives over the years and have reduced the mortality rate of these dreaded cancers substantially.

The Importance of an Oral Cancer Self-Examination

An oral cancer examination and screening is best done regularly by your dentist. Patients can also perform this self-examination between dental visits to check for any early signs of oral cancer. If you are concerned about any of your findings, immediately see your dentist for an evaluation.

Figure 1. Press along the sides and front of your neck and feel for any tenderness or lumps. Do the same on your face. Normally, your face and neck are symmetrical, so notice any bumps or swelling.

Figure 2. Pull your upper lip up and look for any sores and/or color changes on your lips and gums. Repeat this on your lower lip.

Figure 3. Use your fingers to pull out your cheek and look for any color changes such as red, white, or dark patches. Put your index finger on the inside and your thumb on the outside of your cheeks to feel for any lumps. Repeat on the other cheek.

Figure 4. Tilt your head back and open your mouth wide to see if there are any lumps or color changes.

Figure 5. Grab your tongue with a cotton gauze and examine for any swellings or color changes. Look at the top, back, and each side of your tongue.

Figure 6. Look at the underside of your tongue and the floor of your mouth (Touching the roof of your mouth with your tongue during this portion of the exam will allow you to see these areas better). See if there are any color changes or lumps. Using one finger inside your mouth and one finger on the outside (corresponding to the same place), feel for any unusual bumps, swelling, or tenderness.


Disclaimer: This pictorial guide is not meant to take the place of a comprehensive oral and dental examination/screening by a dental health professional. It is only meant as a guide. The Web site, oralcancerselfexam.com, assumes no responsibility for the oral cancer detection, screening, or examination done by the users of this guide.


SELF-EXAMINATION

An established self-examination for oral cancer would be a huge help in finding abnormalities or incipient oral cancer lesions early on. An oral self-examination, much like a breast or skin self-examination, is easy to do and does not require any special equipment. In addition, it will help familiarize people with their own mouths. The primary benefit is early detection of any unusual lesions. The secondary benefit would be consumers becoming much more familiar with their mouths, which would then help stimulate them to receive treatment for oral health issues that are usually ignored.
My children, David Malcmacher and Shana Meystel, have heard me lecture about oral cancer a number of times. They, being much more technologically advanced than I, have developed a Web site (oralcancerselfexam.com) for consumers and dentists that has posted a demonstration on how to do a self-examination for oral cancer. Since so many American consumers still do not have regular dental care, there is also a section to help them find a dentist. Dentists who are committed to oral cancer examinations and early detection of oral cancer can sign up to be listed on this Web site. There is a low sign-up fee to be listed and this goes to market and administer the Web site and to heavily market the Web site to consumers.
This Web site was launched in May of this year and the response has been nothing short of incredible from dentists and especially consumers. The benefits are enormous! Imagine consumers finally looking in their mouths and becoming more knowledgeable and involved in their oral health. Consumers from around the world have already come to this Web site to learn about oral cancer and the oral cancer self-examination.
This Web site will be heavily marketed to consumers in order to make the oral cancer self-examination part and parcel of what people normally do to help find these lesions much earlier on. The fact that the number of oral cancer cases per year has not gone down in the last 40 years tells the story that what we have been doing until now has not been working.

EARLY SCREENING TECHNIQUES

I strongly urge all of my lecture attendees to use some type of oral cancer screening device, whether it is ViziLite Plus (Zila Pharmaceuticals) or a VELscope (LED Dental). Those who are personally familiar with me know that ViziLite Plus has been the choice in my office for a number of years because of its cost effectiveness, ease of use, and the Tblue stain that comes with this system. The Tblue staining kit that comes with ViziLite Plus is an essential piece of the screening if anything suspicious is found. No other system uses this staining technique. ViziLite Plus will help screen your patients and will assist you in finding suspicious lesions much earlier than you normally would. After that, either a brush biopsy like OralCDx (OralCDx Laboratories) or a traditional biopsy should be used on the lesion for either a histological examination or total removal.
Let me be clear about one thing, as this is the concern by the leaders in oral pathology, many with whom I have personally spoken—an oral cancer screening is always done in conjunction with a thorough oral cancer examination and should never stand alone. It is always adjunctive to a complete examination.

Getting consumers on board to fight this dreaded disease is crucial and well overdue. Early detection is crucial in this fight, and it is incumbent on all of us who do not currently practice early detection screening methods, to do so immediately. Patients are looking for dentists who take oral cancer seriously. Let's take it seriously enough to change the way we practice. Letís all work together, because if we as dental professionals don't take this lead, no one will. It is up to us!

CONCLUSION

Join the many dentists who have already started to help their patients learn about oral cancer self-screening exams. Get your office listed on oralcancerselfexam.com, download the self-exam instructions, start teaching your patients how to do a self-exam for oral cancer (Figures 1 to 6), and show your patients how committed you are to detecting and treating oral cancer. They will then say the 9 magic words that every dental office wants to hear, "Wow, no one has ever taught me that before!" Your patients will appreciate the fact that you are now really concerned about their general health. They will finally come to realize that you can not only give them a great smile and a healthy mouth, you can even help them save their lives!


Dr. Malcmacher is a 1981 graduate of Case Western Reserve University School of Dentistry. He holds fellowships in the International Association of Dental Facial Esthetics, the World Clinical Laser Institute, and a mastership in the Academy of General Dentistry. He is a practicing general dentist in Bay Village, Ohio. He is an internationally-known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for Clinicians Report (formerly Clinical Research Associates), Dr. Malcmacher has served as a spokesman for the AGD and is a consultant to the Council on Dental Practice of the ADA. He works closely with dental manufacturers as a clinical researcher in developing new products and techniques. For nearly 30 years, Dr. Malcmacher has inspired his audiences and consulting clients to truly enjoy doing dentistry by providing the knowledge necessary for excellent clinical and practice management. His group dental practice has maintained a 45% overhead since 1988. He can be reached at (440) 892-1810 or dryowza@mail.com, and his lecture schedule is available at commonsensedentistry.com, where you can find information about building the best dental team and sign up for his monthly consulting programs, teleconferences, audio CDs, and a free monthly e-newsletter.



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