Why did the Mouth Cancer Accreditation Scheme begin?
The scheme was the brainchild of the Mouth Cancer Foundation’s founder Vinod Joshi. He realised that in the light of the alarming increase in rates of mouth cancer among all sectors of the population there was a pressing need for dental professionals to become better educated in the skills of early detection and introduce robust screening protocols in their practices. Work to introduce the scheme began about 18 months ago.
How did you become involved with the scheme?
I had already been lecturing on mouth cancer and its early detection for nearly 10 years. At last year’s BDTA Showcase event I met representatives of the Mouth Cancer Foundation who asked if I would help develop the scheme.
What are the advantages for dentists who do mouth cancer screenings in their appointments?
The list is almost endless but in my view the most important benefit for clinicians is the knowledge that they are providing a potentially life-saving service for their patients. Other advantages include professional satisfaction in knowing a thorough examination is being offered, the ability to help increase survival rates from 50 per cent when lesions are discovered late to better than 90 per cent with early detection, and following on from that the ability to refer patients at a stage when treatments are likely to be far less invasive and unpleasant. There are other advantages too; patients get to know their practice is taking the very best care of them and as a result tell family and friends which tends to lead to an increase in practice profile and growth within the community.
How are you making both patients and dentists more aware of the importance of mouth cancer screening?
The Mouth Cancer Screening Accreditation Scheme includes a wealth of training materials; everything from recognising lesions to counselling patients. First, the whole practice team needs to get together to discuss the importance of screening and how to both implement it and audit results. When everyone is pulling in the same direction the rest is easy. We’re promoting the scheme itself by word of mouth, in the dental press and at conferences as well as through our website. It’s gratifying to find there has been a huge surge of interest among the profession in this subject recently but there’s no room for complacency; much of the population is still unaware of the rising incidence, the risk factors and how to avoid them and even the symptoms of mouth cancer. The Mouth Cancer Screening Accreditation Scheme aims to address this by advising dental professionals about what to say to patients without being alarmist and how to spread the word to the wider community.
As a dentist yourself, how easy is it to fit mouth cancer screening into a regular appointment?
Very easy! With a little practice a thorough extra-oral and intra-oral examination can be completed within two minutes. We recommend this is done at least once a year; I find it most convenient to carry out the screening at the routine examination appointment. After a while it becomes second nature, just like examining the gums or the teeth.
What kind of symptoms should dentists be looking for and what should they do if they see them?
We should look for anything unusual; anything that shouldn’t be there. This will include red or white patches on the mucosa, lumps, altered texture, teeth which have become loose in the apparent absence of periodontal disease, ulcers that persist for more than three weeks; that sort of thing. In addition we should question our patients about anything unusual they’ve noticed themselves; any changes in sensation, persistent sore throats or hoarseness, bleeding from the mouth or throat, stiffness of the neck, difficulty swallowing or lumps under the skin for example. A full list of symptoms can be found on the Mouth Cancer Screening Accreditation Scheme website. Clinicians should also be aware of anatomical structures that may look suspect like lingual tonsils or even tori. That’s where education comes in, and as well as our own CPD there are now many other courses being run through deaneries and other outlets where colleagues can obtain a great deal of information about oral anatomy and pathology with the early detection of mouth cancer in mind.
Once we identify lesions that we feel might have an innocent cause we should review again in about three weeks to see if they have resolved. If not, or if at initial examination a lesion looks seriously suspicious we should refer to our local Maxillofacial Unit immediately.
How important is communication with the patient regarding a screening?
It’s absolutely essential, even before the screening. Cancer is a scary word and patients should be informed before the appointment that they are about to undergo a routine test and that even if anything unusual is found the chances are that the cause is innocent. They should be advised however, that in order for the practice to be completely thorough in the care it is offering it is essential patients should attend review appointments or referral appointments when arranged.
As well as this information about the extra-oral palpation should be given in advance as many patients are not used to receiving this at a dental practice and may otherwise wonder what is going on.
Most importantly the information we give patients before a screening helps raise their awareness of the condition with the result that they will be more conscious about self-examination in the future and may share this information with others.
What advice would you give to dentists who want to start making mouth cancer screening part of their check-up routines?
Just do it! The Mouth Cancer Screening Accreditation Scheme can offer lots of information and support and confers recognition in the form of certificates and plaques to demonstrate your commitment. Whether or not you join the scheme attend lectures and look for online and printed resources. Engage other team members. Everyone can use their eyes and even non-clinical team members may well spot a skin lesion to draw to your attention. Make sure everyone understands the importance of screening and hold a practice meeting to define roles.
None of us were born dentists or hygienists. We were born human beings and I can’t think of anything more worthy for any human being than possibly being instrumental in saving the life of another.