Is the Gauze Helping the Cause?
“Please stick out your tongue so I can look underneath it.” These words have been heard many times a day in dental offices for at least the last 25 years.
It seems no matter how many times patients are asked to perform this task, they always cringe when the gauze is wrapped around their tongue and the tongue is pulled from side to side. Every time this screening is executed the clinician feels the need to explain what they are doing because sticking out the tongue and having it grabbed by gauze is such an odd exercise. Patients are told things like:
Once a suspicious lesion is seen, a referral is made to an oral surgeon and quite possibly the referral comes too late. Until relatively recently, gauze and the naked eye were the only tools available to screen patients for oral cancer.
Medicine has already moved away from visual detection of disease and is embracing the use of screening tools. Examples include mammograms and PAP exams for women and the screening of PSA levels in men. These screening tools are utilized for early detection which results in the saving of lives. While such screening tools are second nature to patients in the medical world, screening tools for oral cancer are not as well known however, the standard of care for detection of oral cancer has begun to shift.
If a cancerous lesion can be seen, anywhere on a body, the cancer is likely in an advanced stage. This is typically true of oral cancer. Consider that, according to the American Dental Association, more than 25% of the approximately 30,000 Americans who get oral cancer annually will die of the disease and on average, only half of those diagnosed with the disease will survive more than five years. Breast cancer was estimated to claim the lives of 22% of those diagnosed with the disease in 2008 and prostate cancer was estimated to claim the lives of 15% of those diagnosed with that disease in 2008, according to the American Cancer Society. It is shocking that the percent of deaths occurring from those diagnosed with oral cancer is higher than those diagnosed with breast or prostate cancer! Those statistics make it evident earlier detection is a must!
Currently there are screening tools available to assist in the early detection of oral cancer. Two of the more popular tools utilize lights to peer below the surface of the mucosa. One tool (Velscope) shines the blue excitation light into the patient’s oral cavity. The clinician views the oral cavity through the hand piece of the device. Normal tissue produces florescence and the tissue appears as an apple green glow. Abnormal epithelial tissue and underlying stromal disruption causes loss of fluorescence resulting in the appearance of a dark area. The other screening tool (VisiLite) uses views the oral cavity under chemiluminescent light, after the patient rinses with a dilute acetic acid solution. Areas of, abnormal squamous epithelium tissue will appear distinctly white.
Offices need to do their own research to determine which of the available tools fit into their practice the best. Regardless of the choice, awareness of the dangers of oral cancer will increase and early detection and referral may follow.
There is some support for screening patients annually, especially those who have an increased risk for oral cancer. This would include patients who:
An annual screening may not only save the life of a patient, it can be a revenue generator for the office. Consider an office that has 1, 500 active adult recall patients. Let us say half of them are identified to have an increased risk and receive an annual screening. If the charge is $50, the result is an increase in production of $37,500 annually simply by providing a service to the patients. Some insurance companies are beginning to pay for oral cancer screening which takes the increased cost to the patient out of the equation. Patients may even be thankful for no longer needing to have their tongue lassoed in gauze and tugged on by the clinician!
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