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Updated: Feb 1

Originally Published May 3, 2021, AAOSH

Written by Cris Duval, RDH

Detecting oral cancer in its earliest stages saves lives, eases suffering, reduces morbidity, and ameliorates post-surgery recovery.

hygienist exam and protocols

Remember when you took driver’s education in high school? I do!

When I grew up, driver’s education students in Washington State were required to watch “shock” highway-safety films.[i] These videos, depicting the aftermath of drivers’ actions, showed actual accident scenes, complete with audio recordings of victims’ screams and color close-ups of mangled bodies. My bet is that, if you have ever watched one of these videos, you have never forgotten it.[ii]

For me, when I saw these videos, I thought about my family and my friends. I know that I have a family that loves and cares about me, and thus, I owe it to them to avoid doing something stupid behind-the-wheel. I never want one of my loved ones to have to go through the pain of seeing me hurt.

This means to me that my driver’s license is more than just a “key” to get behind the wheel. Rather, as a website for traffic safety in Texas states, a driver’s license signifies that the driver possesses the “essential knowledge, skills, and experience to perform reduced-risk practices in [a] total traffic environment.” In other words, the driver is accountable to himself and other drivers.[iii]

My response to these driver’s education videos is akin to my reaction to videos that I watched at the Pacific Northwest Head, Neck & Thyroid Cancer Symposium in April 2011. During this event, 13 different physicians presented videos on advanced head and neck/oral cancer treatment and reconstruction. A need for this Symposium clearly existed; many patients initially present large tumor load, “necessitating a multimodality treatment course… [requiring] the coordination of many specialists across multiple disciplines to achieve the best outcome, with the least amount of side effects.”[iv]

To me, these videos, depicting the aftermath of failing to screen for oral cancer, captured real patients with real split mandibles, cut-out tongues, and missing cheeks: basically, patients who no longer had recognizable faces.

My bet is that, if you ever see one of these real-time videos, you will never forget it. Watching these videos is not for the faint of heart. It shows you the consequences of what patients and their families endure if you fail to look.

On that day at the Symposium, as a member of the audience watching these videos, I wanted to stand up and shout out: “Wake up, People. We can prevent this tragedy with early detection!” Through my association with the Oral Cancer Foundation, I have learned that detecting oral cancer in its earliest stages saves lives, eases suffering, reduces morbidity, and ameliorates post-surgery recovery.

As oral health providers, we cannot prevent all patients from developing oral cancer; some patients are predisposed to the disease because of lifestyle choices and genetic factors. However, we can help all patients survive oral cancer “whole.” By detecting oral cancer in its earliest stages, we can alleviate the effects of this disease. “Historically the death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development.”[v] To avoid tragedy and to prepare patients for total health and wellness, the hygienist must conduct oral cancer screenings on every patient at every visit.[vi]

In fact, the dental hygiene oath mandates that hygienists undertake this protocol, stating: “I will render a full measure of service to each patient entrusted to my care.” Thus, like a driver’s license, the oral health provider’s license is more than just a permit to remove calculus from teeth. It signifies that the hygienist, like the licensed driver, possesses the knowledge, skills, and experience to perform reduced-risk practices in a total clinical environment.

Today’s hygienists use a three-step method to screen for oral cancer: first, hygienists conduct an extra- and intra-oral inspection of the tissue; second, hygienists palpate the tissue to feel for abnormalities; finally, hygienists employ an adjunctive screening tool (i.e. the Velscope) to identify subsurface, cellular changes.[vii] Like seat belts and airbags for drivers, which have significantly reduced injury and death from automobile accidents, this three-step examination could significantly reduce deaths from oral cancer. Unfortunately, despite rising death rates from oral cancer, early detection is under-utilized. Indeed, less than 14% of people who visit a dentist or hygienist report that they have had an oral cancer screening.[viii]

To prevent this disease, you must actively engage in oral cancer screenings rather than passively accept oral cancer’s high death rate.

Please, for your patients’ sake, do not remain nonplussed. Oral cancer is gruesome, and it takes the lives of those you love. You cannot afford to be complacent. Don’t be afraid of what you might find. Be concerned about what you might miss.

[i] E.g. “Mechanized Death” and “Signal 30 [ii] For example, an anonymous commentator on a website about shock videos said: “[The driver’s education instructor] showed this film to us in the fall of 1989 as part of our driver’s ed program. I thought my generation was very insensitive to violence, most of us growing up with MTV and video games, but the thing I remember the most is the LONG silence after the instructor shut off the firm, followed by a mass exodus to the bathroom. [That said,] I can say that we had a safer group of drivers than my friend’s class across town…” ( [iii] [iv] [v] [vi] Duval, Cris. “Getting Your Shift Together.RDH Magazine. Publication Pending as of 03/10/2012. [vii] [viii]

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