Global Health Nexus, Millennium Issue
Practicing for LifeSM: Preventing Disease Is Our Business
Alan N. Queen, D.D.S.
In the often frenzied world of private practice, it's sometimes easy to overlook the dentist's role in a patient's overall health. But your role as a dentist is far more important than your duties as an insurance form signer, OSHA compliance manager, hazardous waste generator and tracker, photographic chemical analyzer, and all-purpose paper-pusher (even with electronic claims filing).
As we all learned in school, there are a lot of systemic diseases with oral manifestations, ranging from vitamin deficiencies to diabetes and leukemia. Since many people see a dentist more often than they see a physician, we are frequently the ones who can help diagnose these problems early, sometimes with life-saving results.
A thorough medical history is an indispensable aid to proper dental treatment (as well as risk management). Not only do you need to know what is wrong with your patient and what drugs or medications she or he is taking in order for you to perform proper dental treatment, sometimes the information elicited during the discussion can give you insights into other, possibly undiagnosed, medical problems.
Establishing a rapport with your patient is something that's overlooked in the fast-paced world of modern dental practice. But a few minutes chatting with the patient can give you a feeling about what the patient is like as a person, which will help with management of the treatment to come.
When you examine a patient, it's also important to do a thorough examination for oral cancer. The short time you spend doing a thorough oral cancer exam can literally save your patient's life.
Oral cancer is a disease that often progresses silently until it's far advanced. Over 8,000 people die every year from oral cancer, according to the American Cancer Society (ACS), and 30,000 new cases are diagnosed every year.
The main factor affecting the outcome is early diagnosis, which is another way we can save lives by spending a few precious extra moments with our patients. Oral cancer has a five-year survival rate of 80 percent with early diagnosis. But ACS figures show only a 20 percent five-year survival rate once it has spread.
Physicians rarely examine patients for oral cancer. Although they may look down a patient's throat, they usually completely overlook the mouth, and rarely, if ever, actually examine the tongue, which is the primary site of oral cancer. We are our patients' main line of defense against this scourge. As a profession, it is our responsibility to educate our patients and examine our patients more thoroughly.
In the coming months, the U.S. Surgeon General is slated to release the first report on oral health in America. One of the primary focuses of this report is expected to be oral cancer. Currently, only 7 percent of Americans report having had an oral cancer examination in the past year, a shockingly low figure.
Many believe that the reason for this low figure is that people do not realize they are being checked for oral cancer during their regular dental exams. Tell them what you are doing as you examine them. You'll be surprised how grateful your patients will be to know you're doing such a thorough examination.
Once the subject has come up, educate your patients. Tell them to report nonhealing ulcerations or other unusual lesions right away. A patient I recently saw had a squamous cell carcinoma on her tongue that she thought was a "canker sore." She had been rinsing with warm saline for several months before she came in for an annual checkup. (She has had the lesion removed -- it was still very small and localized -- and is recovering well.)
Use the explanation of your examination as a means of discussing the harmful effects of smoking on your patient's overall health: "Yes, Mrs. Jones, those cigarette stains on your teeth are bad, and we can remove them, but I can't do anything about the deposits in your lungs."
It's an extremely rewarding experience to diagnose cancer or help a patient decide to quit smoking, knowing that you may have saved his or her life. In addition, most people will be pleased about the concern you've shown for their overall health and well-being. This can be a catalyst for referrals, an added incentive to spend the extra time with your patients.
Many resources are available to us for information about oral cancer. NYU Dentistry Dean Michael Alfano has made oral cancer awareness a priority, and a Web site (http://www.oral-cancer.org) and refresher courses are available to alumni. The American Cancer Society and the National Cancer Institute have information available as well.
The forthcoming release of the Surgeon General's Report on Oral Health is bound to create more interest in oral cancer and oral health. It's up to us to take advantage of the public's interest to educate people about their oral health.
Dr. Queen, Class of 1985, is the immediate past-president of the Queens County Dental Society. He has been the editor of the QCD Bulletin for the last 12 years and is also a member of the Advisory Council of the American Cancer Society's Queens office.