39
Volume2 Issue6
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S
upporting
Y
our
P
ractice
adjunctive tests (
Table4
) focusesonuse inhigh-risk clinics
andpractice settings.
7
Opportunistic screening inconjunctionwith routine
dental andmedical examinationhasbeen suggested,
especially for thehigh-riskpopulationsdescribed
above. Unfortunately, somemembersof thesehigh-risk
populations areunlikely topresent for routinedental and
medical evaluation. Barriers includecost of careand limited
community knowledge.
Diagnosisof benignconditionshas value for thepatient
andcan lead toappropriate treatment and followup,
thus rendering falsepositive results indicatingabenign
conditionauseful outcome for reassuranceand treatment.
Falsenegative resultsmay lead todelayeddiagnosis. In
diagnosisof oral lesions, thechallenge is todistinguish
common inflammatorychanges fromdysplasticand
malignant change. OPMDandevenOSCCarecomplex
processeswithunpredictableprogression, although the
likelihoodof progressionofOPMD tocancer ishigherwith
moreadvancedmolecular changeanddysplasia.
11
Of thecurrentlyavailablediagnosticmethods, theCouncil
onScientificAffairsof theAmericanDental Association
recommends
7
theuseof toluidineblue stainingbyexperts
for high-riskpatients (level I evidence) andexfoliative
cytology (level II evidence) in thesecircumstances, but,
becauseof limiteddata, it doesnot recommend these
testsbynon-expert providersor innon-high-risk settings.
Fluorescence imaginghasbeen suggested for use in
knowncasesofOPMDandOSCC toassist inmargin
delineation.
7
Visual detectionof oralmucosal lesions
andhistologicdiagnosis arevariable, and it appears that
clinical experience, appropriateuseofmethods and
development of new tools anddevices areneeded to
enhancediagnosis.
12,13
Becauseof limited studyof all
adjunctivemethods ingeneral practice settingswhere
falsepositiveand falsenegative rates areunknown, no
recommendations canbemadeandallmethods are
consideredelective.
As inother partsof thebody, progressionof oral lesions
tocancer cannot bepredicted; dysplasiaor evenearly
cancermay resolvewithout treatment, thus complicating
diagnosis and treatment decisions.Whilemorepredictable
tools for diagnosis andmeasuresof lesionbehaviour are
sought, current clinical decisions arebasedonavailable
evidenceandexperience. Distinguishingbetween
inflammatory lesions anddysplasiaandconsistent
clinical followup,withhistopathologywhen indicated,
is thecurrent standard.Management ofOPMD isbased
on limiteddata,withmedicalmanagement andclose
followup indicated, as is thecase for dysplastic lesions
at other sites,while the search formoreeffective therapy
continues.
14,15
Surgerymaybeconsideredmoreoften
with severedysplasia, but riskof progression tocancer
continues and followup isneeded.
Screeningof populations formalignant oral lesions, OSCC
andOPC isnot advocatedbypublichealthauthorities.
However, research isongoing.Meanwhile, opportunistic
evaluationduring standarddental examinations is
suggested, as there isnoadditional economiccost, unless
expensive testingmethods areemployed.
a
References
Complete listofreferencesavailableat:
Theviewsexpressedarethoseoftheauthoranddonotnecessarilyreflecttheopinionsorofficialpoliciesof
theCanadianDentalAssociation.
Table4
Approaches to screening for head, neckandoral
cancer
Currentlyavailablemethods
Developing technologies
–Patient self-examination
–History: risk factors, symptoms
–Clinical examination
– Imaging:
–Light (low-energy light,
fluorescence)
–Diagnostic radiology,MRI,
other imaging
–Tissue staining: toluidineblue
–Exfoliativecytology
–Biopsy: histology,molecular
testing
– Imaging:
–Optical coherent
tomography
–Raman spectroscopy
–Exfoliativecytology+
molecular testing
–3Dcytology
Note:MRI=magneticresonance imaging.
Table3
Recognized risk factors and symptomsof oral cancer
Risk factors
Symptoms*
Tobacco: smoking, chewing
Betel nut: chewing
Alcohol abuse
Sexual activity: pastor current
HPV-16, 18
Immunosuppression:medical
therapy, genetic (e.g., Fanconi
anemia), infectious (HIV)
Priorheadandneck radiation,
chemotherapy
Premalignant epithelial
lesions: e.g., dysplasia, lichen
planus
– White/red lesions,mouth
sores,mass (>2weeks)
– Bleeding:mouth, throat
– Pain/numbness: unilateral
– Limitedmovementof
involved tissue
– Loose teeth
– Neckmass
– Sore throat, dysphagia,
dysphonia
– Weight loss
*Althoughthere isnoevidencethatoralself-examinationprovidesusefulbenefitsor leadstodiagnosis,health
professionalshaveemphasizedthe importanceofpatient-reportedsymptom
Note:HPV=humanpapillomavirus.
