Ivan Zamorano

Acupunture Treatment

How to Check Patients for Oral Cancer

How to Check Patients for Oral Cancer

This video contains the latest
recommendations from the 2017 ADA clinical practice guideline on the
evaluation of oral mucosal abnormalities. This video offers step-by-step
instructions for evaluating adult patients for potentially malignant
disorders or PMDs and oral cancer during a routine dental exam in your clinic.
First begin the exam by asking your patient if any new dental issues have
emerged since their last visit or appointment, during the medical history
recollection pay attention to risk factors such as being male, older, smoking,
and alcohol consumption with the patient’s response in mind next perform
a conventional visual and tactile intraoral and extra oral exam. Throughout
the exam use inspection and palpation to look for any changes in color, contour,
consistency and function begin the extra oral exam by examining the head and face
with both the front and back taking note of any asymmetries and the presence of
pigmented lesions for such lesions use the American Cancer Society’s ABCDE rule
to assess for melanoma risk look for asymmetry border irregularity color
changes diameter greater than six millimeters and evolution of the lesion
over time. Next observe and palpate the neck on both sides
if lymph nodes are identified pay attention to the size consistency
whether they are painful and whether they freely move or are fixed in place
when evaluating the lips note any change in the Vermilion border, mucosa and chemisiers as well as the lips color, contour consistency, and function look for in
durations and ulceration ask your patient to open their mouth and
begin the intra oral exam by inspecting the cheeks, retract the tissue with your
thumbs and gently pinch the cheek between your fingers looking for a
hidden masses use a mirror to examine the alveolar
processes and gingiva look for changes in color, consistency, or a tooth with bone
loss out of proportion with the rest of the arch pay special attention to the
presence of a lesion with a history of poor healing. Carefully inspect and
palpate the hard and soft palate looking for abnormalities while depressing the
tongue with the mirror ask the patient to say ah to have better access to the
uvula and tonsillar pilers using gauze move the tongue to the left and to the
right to examine the entire dorsal tongue pay attention to the lateral and
ventral tongue as well complete this assessment palpating the tongue and
nearby salivary glands this aspect of the exam is important as nearly half of
all potentially malignant lesions are usually found in this area ask the
patient to touch their top front teeth with the tip of their tongue so that the
floor of the mouth can be inspected and palpated. Use two hands when palpating
this area after the exam clinicians should consider two potential clinical
scenarios either the patient exhibits no lesions or has some type of mucosal
abnormality. For patients without a lesion no further action is necessary
although light base and salivary test adjuncts have been proposed to evaluate
mouths without lesions none of these tools have been proven effective and as
a result they aren’t recommended for use. For patients with a lesion the majority
of these lesions will be innocuous some common causes of innocuous lesions
include trauma para functional habits and dental restorations these innocuous
lesions require periodic followup with the patient to provide therapy and/or
monitor the lesion in instances in which an innocuous lesion does not resolve or
in instances in which a lesion is suspected to be a PMD immediate biopsy
or referral to a specialist is recommended many adjuncts have been
proposed as tools to assess PMT’s sooner rather than later
unfortunately current evidence doesn’t support the use of adjuncts because of
their high frequency of false positives which results in unnecessary
complications and costs. When evaluating patients for PMD’s and oral cancer please remember get to know your patient during your patients exam update
their history and have a conversation about oral cancer risk factors keep in
mind that this could be a stressful situation for the patient and maybe even
for the clinician conducting the exam time is important for potentially
malignant lesions biopsy or refer the patient immediately be skeptical of the
use of adjuncts current evidence does not support the use of these tools in
the general population please monitor and critically appraise the literature
for the emergence of new evidence in this field look to the ADA’s most
current recommendations for insights for more information on the ADA’s clinical
recommendations for PMD and oral cancer evaluation please visit ADA.org/oralcancer

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