‘Remember, Remember,’ Mouth Cancer Awareness This November by Mike Gow BDS (Gla) MFDS RCPS (Gla) MSc Hyp (Lon) PGCert (Edin), Editor, DentaltownUK magazine

by Mike Gow BDS (Gla) MFDS RCPS (Gla) MSc Hyp (Lon) PGCert (Edin), Editor, DentaltownUK magazine

The quote and poem ‘Remember, remember the 5th of November’ has been around since the failed gunpowder plot and subsequent execution of Guy Fawkes in 1605 as a warning to each new generation about the consequences of treason. On Nov. 11 each year the nation also remembers and honours those who sacrificed themselves to secure and protect our freedom.

Every year in November the Oral Health Foundation urges dental professionals to remember about the importance of the early detection of mouth (oral) cancer and of the education of their patients and the general public. Of course, these should be remembered all year round; however, Mouth Cancer Awareness Month gives an opportunity to put this important topic in the spotlight. In this edition’s Students section, we hear from three members of our student board on the topic.

There is a survival rate of up to 90 percent if mouth cancer is detected at an early stage, but this decreases the later the diagnosis is made and, sadly, far too many are still made in the later stages. Oral cancer, which can involve any part of the mouth, affects more people than testicular and cervical cancers combined.

I wanted to share a few details of my own screening protocol in the hope that it can demonstrate how a simple protocol can be easily and routinely implemented in a busy practice by a general dentist. I carry it out with every patient at every check-up appointment.

This editorial will appear online, and I welcome any constructive discussion about my protocol. Please leave comments detailing if you do anything differently and why. Please also see the Oral Health Foundation ‘Mouth Cancer Check’ video here.

Whatever the order or exact screening process you follow, it should be systematic and help you identify, record, follow up on and appropriately refer any abnormalities, including any suspicious ulcers (especially any that have been present for more than three weeks), any red or white patches, and any unusual lumps or swellings.

I start with the head and neck, checking for any asymmetry as I look and feel for any lumps or swellings. I feel behind the ears, along the lower border of the mandible, under the chin and down the neck (including along the sternocleidomastoids) and larynx. I ask patients to swallow, and while they do I watch for any deviations or abnormalities in the way their larynx moves.

I then check the commissures and the vermillion borders of the lips. I retract the lower and upper lip in turn, checking for any ulcers, red or white patches, and other changes in colour. I feel for any unusual lumps, swellings or altered texture by squeezing and rolling with my thumb and forefinger (one inside the mouth, the other outside). I note any tenderness experienced.

I retract each cheek in turn and repeat a similar investigation as in Point 2.

To gain the best view of the roof of the mouth I ask patients to tilt their head back and then I adjust the light so I can view the tissues, looking for any unusual lumps, swellings or colour changes on the roof of the mouth and using my index finger to feel for lumps or swellings.

I ask patients to stick out their tongue and examine the surface for any unusual ulcerations, swelling, or oddness in colour or texture. I ask patients to move their tongue to one side—I say ‘one side’ rather than saying ‘left’ or ‘right’ because many patients find this surprisingly difficult! I may assist the movement by holding and gently pulling the tongue with a sterile swab, if the patient’s movement is insufficient. I then ask the patients to move their tongue to the other side, and finally to place the tip of the tongue on the roof of the mouth and check the underside of the tongue. Remember to feel the tongue as well for any lumps or swellings.

The floor of the mouth can also be checked while the tongue is raised. Again, I look for any changes such as ulcers, colours and texture. This area, too, can be palpated with an index finger. The back of the mouth and pharynx can be more easily visually checked by asking the patient to say ‘Ahh’. The gums are also then checked for any abnormalities.

I then repeat Stages 2–8, but on my second screening I wear a pair of Goccles (from Dental Sky). These are a fantastic investment and are very effective, easy and quick to use. Patients often gratefully remark on the fact that we as a clinic have invested in this technology. You can watch a video here to learn more about what Goccles are and why they are of benefit. If you use other oral cancer detection technology, please tell us about it in the comments section.

Importantly, patient education is obviously essential, and I will briefly outline what I understand to be some of the key points.

• Amount and frequency of alcohol and tobacco consumption should be recorded, and patients should be informed of the appropriate risks of mouth cancer, with advice and support offered to help reduce or cease consumption.
• HPV status should be recorded, and consideration should be given to discussing the benefits of and reasons to consider vaccination for young males and females alike. Diet should be discussed as a risk factor as well as exposure to UV light.

I nearly didn’t write this month’s editorial about this topic, because I certainly don’t purport to be an expert in mouth cancer, its detection or patient education. It then suddenly struck me that this was exactly the reason why I should write on the topic. Mouth cancer screening and patient education is firmly in the realm of every general dentist and their practice.

It is vital that we all ‘remember, remember’ the importance of, and our role in, the early detection of and education about mouth cancer.

Mike Gow BDS (Gla) MFDS RCPS (Gla) MSc Hyp (Lon) PGCert (Edin), Editor, DentaltownUK magazine