For more on this topic, go to www.dentaleconomics.com and search using the following key words: Smile, oral cancer detection, symptoms, morbidity, prevention, detection, exam, protocols.
Asmile can be the most eye-catching feature of a face. Even the most subtle change in a smile can make a dramatic difference in the way someone feels about himself or herself. Therapies for the treatment of oral cancer are often extensive and disfiguring.They may involve removing parts of the face, tongue, cheek, or lip, causing changes in appearance that can be especially difficult to live with in a society that values physical beauty.
Victims must deal with the debilitating side effects of radiation and chemotherapy as well as the fear of death. An annual oral cancer prevention exam may be the most important cosmetic procedure dentistry provides.
A brochure from the Oral Cancer Foundation (www.oralcancerfoundation.org),“Oral Cancer: What You Need To Know,” lists signs and symptoms of early and advanced cancer (see Box 1). This delineation is important. Statistics show the death rate associated with oral cancer is particularly high not because it is hard to discover or diagnose, but because the cancer is routinely discovered late in its development, with 70% not found until Stage III or IV.
Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient and it can frequently develop without producing pain or symptoms that are readily recognized.
A 1990 survey of the knowledge of U.S. adults on the risk factors and signs of oral cancer showed there was extensive misinformation and a general lack of knowledge. In 1997, the Oral Cancer Working Group, including the American Dental Association, American Association of Dental Research, Association of State and Territorial Dental Directors, Centers for Disease Control and Prevention, International Society of Oral Oncology, National Institute of Dental Research, and Oral Health America, first met. Their strategic plan (see Box 2) lists 10 priorities to turn the tide in the mortality and morbidity of oral cancer.
Late in 2002, the American Dental Association (ADA) received a grant of $1.2 million from the National Cancer Institute to develop and implement a continuing-education program for oral health-care professionals in the fight against oral cancer. Some of the goals of the Oral Cancer Working Group have been accomplished, but not enough.
In addition to these efforts, the dental industry brought new tools to the marketplace for the detection and prevention of oral cancer.
Oral CDx: First and only test of its kind
Mark Rutenberg originated a set of neural network algorithms that were used for discriminating the target from clutter in missile defense applications. In 1997, Rutenberg founded CDx Laboratories, now Oral Cancer Prevention International (www.brushtest.com, Suffern, N.Y.) and applied those same imaging algorithms distinguishing oral cancers from nonmalignant lesions. The tool, called the OralCDx®, is a specialized brush that samples just a few layers of epithelium, stopping at the basement membrane.
The small sample is then sent to the laboratory, where “Star Wars” algorithms are used and interpreted by a pathologist who specializes in oral cytopathology to distinguish abnormal tissue from normal. In 1999, OralCDx became commercially available. The BrushTest is a quick and painless method used to test the common small white and red oral spots that most people have in their mouths at one time or another. It is the only noninvasive way to determine if a common oral spot contains abnormal cells (dysplasia) that, if left alone for several years, may develop into oral cancer. Red and/or white discolorations are early indicators.
The ADA announced a nationwide awareness campaign, urging people to see their dentists regularly for oral cancer examinations. This three-year, nationwide, public-service campaign was kicked off in November of 2007 by the ADA (www.ada.org) in collaboration with OralCDx Laboratories. It is a follow-up to the 2001 billboard campaign to raise public awareness of oral cancer.
There is no fee to the dental office from Oral CDx® Lab. The dentist may bill dental insurance and/or medical insurance. The 2007-2008 CDT code for reporting this procedure is D7288 and it covers all locations in the oral cavity.
Oral CDx also provides both CPT and CDT coes with each kit and offers a continuing-education course titled “Preventing Oral Cancer,” and it is available at the ADA's Continuing Education Online site.
ViziLite Plus with TBlue630
In late 2001, ViziLite became available to dentists in 2002. ViziLite Plus with TBlueTM was introduced at the ADA Annual Session in 2005. ViziLite Plus is an advanced biophotonic light technology, and TBlue630 is a marking system using Zila® tolonium chloride, the only patented pharmaceutical-grade form of toluidine blue used in marking lesions. Vizilite Plus (www.vizilite.com) is manufactured by Zila Pharmaceuticals.
In the CDT 2005 version, the dental insurance procedure code that applies to the ViziLite Plus exam, D0431, was established. Medical insurance companies may also cover the ViziLite Plus exam. There also are several medical insurance codes that have been used to obtain insurance reimbursement for the ViziLite Plus exam.
Two online continuing education courses are available: “Oral Cancer: Update for the Oral Health Care Provider” and “Oral Cancer: Incidence, the Diagnostic Process, and Screening Techniques.” You can find these courses on the ViziLite Web site.
PreViser Oral Cancer Risk
In 2005, PreViser Corporation (www.previser.com) began offering its Internet-based tool to assess the risk for oral cancer. The tool is a component of the company's Oral Health Information SuiteTM software. PreViser provides Web-enabled diagnostic-decision support tools for dental professionals. Oral Cancer Risk Assessment requires no expensive or unusual testing.
Most information can be provided by the patients themselves on a printed data input form while they wait to see the doctor. The clinician can complete the assessment and immediately produce a printed report for the patient with a numeric score and recommendations targeted to each risk factor to prevent or detect the disease in its earliest stages. New users can try PreViser for free, including unlimited Oral Cancer Risk Assessments.
LED Medical Diagnostics Inc. developed the VELscope System (www.velscope.com) in partnership with the British Columbia Cancer Agency. The VELscope handpiece emits a safe, visible blue light into the oral cavity, which excites mucosal tissue and causes it to fluoresce. The clinician can examine the oral cavity in real time and quickly identify suspicious tissue which may require further investigation.
Typically, healthy tissue shows up as a bright green color, while suspicious tissue can cause a loss of fluorescence, appearing dark. The VELscope examination can also be submitted under CDT Code D0431. Information on a six-hour participation CE course titled “Incorporating Fluorescence Visualization and Other Diagnostic Technologies into Your Practice” is available on the VELscope Web site.
Late in 2007, Orascoptic (www.orascoptic.com) introduced the Orascoptic DK™ system. This system is a three-in-one dental device that employs a battery-powered, handheld LED light source and three unique, interchangeable diagnostic instruments. The DK oral lesion screening instrument works in conjunction with a mild acetic acid rinse to improve the visualization of oral lesions.
Define your protocols
Industry has created adjunctive tools to assist us. Industry also has created courses to educate us. Industry assists us with dental benefits. But, the rest is up to each individual practitioner.
Clearly defining and redefining oral cancer prevention/detection protocols — including adjunctive technologies for your dental practice — can make a difference. The difference might not be limited to preventing and detecting oral cancer.
While conducting an oral cancer exam, the practitioner may detect signs of lymphoma — both Hodgkins and non-Hodgkins type; pathologies of salivary glands, pharynx, tonsils, larynx, and mucosa; and signs of systemic disease.
The former owner of Implant Support Systems Inc. and founder of the Oral Cancer Foundation, Brian Hill; Pennsylvania dentist Jerry Wilck; and New York dentist Larry Hamburg are all oral cancer survivors. Their message is that prevention and early detection saves lives. As Dr. Hamburg said in his blog:
“Why would you worry more about finding a cavity than cancer? We have many different ways of finding not just cancerous lesions, but precancerous lesions! How can we justify motivating patients to have a crown done, but not referring them for a ‘suspicious area' or maybe not even looking for it?
My hope is that I can motivate just one more dentist or one more hygienist to look closer than you did yesterday when you do your oral cancer screenings .... Get the necessary armamentarium to find these lesions earlier, and take better care of yourself. You don't know how important and how loved you are until you get this kind of wake-up call. You and I have the power to change the world … one patient at a time!”
For more information on this topic, go to PennWell's Oral Cancer Prevention Center at www.dentaleconomics.com/oralcancer.
Patti DiGangi, RDH, BS, is a speaker, author, practicing dental hygiene clinician, and American Red Cross authorized provider of CPR and first aid training. She can be contacted through her Web site at www.pdigangi.com.
Oral Cancer: What You Need To Know1
- Red and/or white discoloration of the soft tissues of the mouth
- Any sore that does not heal within 14 days
- Hoarseness which lasts for a prolonged period of time
- A sensation that something is stuck in your throat.
- Numbness in the oral region
- Difficulty in moving the jaw or tongue
- Difficulty in swallowing
- Ear pain which occurs on one side only
- A sore under a denture, which even after adjust-ment of the denture, still does not heal
- A lump or thickening which develops in the mouth or on the neck
Oral Cancer Working Group Strategic Plan1
- Establish a mechanism to implement and monitor progress regarding the recommended strategies developed during the 1996 national conference.
- Urge oral health professionals to become more actively involved in community health concerns.
- Require instruction in preventing and controlling tobacco and alcohol use at all levels of training in dental, medical, nursing, and related health-care disciplines.
- Encourage Medicaid, Medicare, traditional insurance plans, and managed-care entities to make oral cancer examinations an integral part of comprehensive physical and oral examinations.
- Designate federal funding for a national program of oral cancer prevention, early detection, and control.
- After assessing local needs, develop, implement, and evaluate statewide models to educate all relevant groups.
- Develop and conduct a national campaign to raise public awareness of oral cancer and its link to tobacco use and heavy alcohol consumption.
- Develop health-care curricula that require competency in prevention, diagnosis, and multidisciplinary management of oral cancer.
- Sponsor and promote continuing education for health-care professionals on the multidisciplinary management of all phases of oral cancer and its sequelae.
- Strengthen organizational approaches to reducing oral cancer by developing cooperative and collaborative arrangements, funding formal centers, and involving commercial firms.
1Gall, T. “The Best Cosmetic Service Our Profession Can Provide,” Journal of California Dental Association. August 2001.