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August 2008 | DPR The MID Report | Oral cancer detection Finding it early Understanding how cells work and how to spot problems is key to oral cancer prevention and early detection.
Minimal Intervention Dentistry involves a philosophy of understanding when, how, and to what extent intervention in dental pathology needs to happen. Therefore, to honor the art and science of dentistry, clinicians must honor the smallest part of the human body: the cell. Cells are made up of small components that are vital to the discipline of medicine. But they don’t seem to get much respect in the dental community, even though various cell types make up the oral cavity’s soft tissue. This makes cells part of the oral healthcare professional’s realm — especially when it comes to diagnosing oral cancer, and diagnosing it early.
Similar cell types make up different layers, with the epithelium layer most directly exposed to the environment. Occasionally, a cell in the epithelium will go haywire, mutating and dying with little consequence to the surrounding cells. In rare instances a cell may mutate and survive, with the mutated cell dividing away and eventually creating a mass of mutated cells known as a tumor, mass, cytoma, neoplasm, carcinoma, or one of a number of other terms, depending on the type of cell mutated, the type of resultant mutation, or the location of the mass.
Sooner rather than later
Traditionally, dentistry hasn’t had an eye toward soft-tissue disturbances; rather, a wayward glance at soft-tissue anomalies. Dentists and dental hygienists are educated to observe tissue that is abnormal, and at some vague point to do something about it. That “something” has conventionally been referral to an oral surgeon for biopsy and definitive diagnosis.
Operating on this protocol—waiting for a scary lesion–distinguishes oral cancer as the only cancer that hasn’t seen a death rate decrease in recent decades. This lack of progress often is attributed to late diagnosis. Looking at the ADA’s list of signs (see “Give me a sign,” lower left) it’s easy to see how this can happen. The reality is 10% of people have some kind of common oral spot, and 4% of those will show up as dysplasias when tested.
Because MID centers around early detection and early intervention, a traditional oral cancer screening (with mention that one is being done) is the first order. Feeling for masses always is good practice. Visualization of the oral soft tissue using magnification with auxiliary lighting comes next.
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