A.D.P.I.E.D.
Assessment: The clinician will review the medical/dental history to check for possible family history of cancer, the patient’s overall health status, their perception of health, and possible risk factors. The most common risk factors include tobacco use, alcohol use, male sex over the age of 40 are more common, increased sun exposure, any HPV infections, diet, and family history. The chief complaint will be addressed in relation to any suspicious areas the patient presents with. The clinician will perform an intra-/extra-oral examination including the oral cancer screening. Some common symptoms to take into consideration can include white or red patches in the mouth, sores that will not heal, bleeding, loose teeth, difficulty or discomfort when swallowing, any palpable swellings, and/or an ear ache. Any suspicious areas will be recorded including measurements, color, texture, and presence of pain.
Note- Oral cancer most commonly can be found on the tongue and lips. Other areas are also susceptible to cancer however, including inside of cheeks, gum tissue, floor of mouth, and palate.
Diagnosis: A Clinical diagnosis is performed by a dentist or oncologist and includes a biopsy with a smear sample for histological examination, radiographic examination, and visible clinical findings.
The doctor may order an MRI or CT scan for further evaluations if the above examinations do not lead to a definitive diagnosis. A chest x-ray and blood testing should also be done to determine a diagnosis and also detect for metastasis. With these tests the clinician will be able to determine if the cancer is in the early stages (I and II with no metastasis) or later stages (III and IV which include metastasis to the lymph nodes and other places in the body).
Planning: Determination of the proper course of treatment will take in to account the patient’s overall health status, the location of the primary tumor, the size of the tumor, and whether it has metastasized. The most common options for treatment are surgery for removal of the tumor, radiation therapy for small tumors or persons that can not undergo surgery. Sometimes radiation is used pre-surgery to shrink the tumor, and also post-surgery to destroy any remaining malignant cells. Chemotherapy is another treatment option and is most often used in conjunction with radiation treatment.
Some patient’s with oral cancer are given a target therapy which is a drug that binds to oral cancer cells and interferes with the growth and metastasis abilities. This is not a common treatment due to the extreme side effects. Rash, fever, vomiting, diarrhea and possible allergy to the medication are some of the side effects.
The dental hygienist can take several specific roles in aiding in planning for treatment of the cancer. The hygienist can make sure the patient is educated on side effects of treatment and also provide specific therapies to limit those effects. Some common side effects of cancer treatment that the dental hygienist can educate their patient about is xerostomia, tooth decay, sore and bleeding gums, infection, delayed healing, jaw stiffness, denture problems, taste alterations, and disfiguring deformities.
Implementation: For every patient the dental hygienist encounters, an oral cancer screening will be implemented and the patient should be educated on how to do the exam at home to aid in early diagnosis.
In the case for patient’s that have been diagnosed with oral cancer, the dental hygienist can educate and perform specialized therapies pre and post cancer treatment. Some pre-treatment therapies for the cancer patient include education on the side effects of the treatments used, fluoride trays for at home treatments during cancer treatment, a xerostomia rinse, gentle brushing with a soft toothbrush and fluoride toothpaste should be done on a regular basis. Care to avoid swollen or painful areas while brushing and flossing should be taken into account to decrease bleeding. The dental hygienist can show the patient tools to prevent and reduce jaw stiffness with special exercises, and if any dental treatment needs done, it should be completed one month prior to cancer treatment. If necessary the dental hygienist can also recommend that the patient utilizes a cancer support group to ease their situation and provide help to unknown questions.
Some post-treatment regimes would include regular dental hygiene appointments, the use of a xerostomia rinse if needed, education on how to clean any prosthetic devices used to replace any surgically removed tissues after treatment, and the use of a chemotherapeutic rinse if needed.
Evaluation: Evaluation of the patient should be done at every dental appointment following treatment. Education should be given to help the patient lower their potential risk factors and monitoring of the oral cavity in case of any recurrence should be completed. Possible oral hygiene instruction can be modified at each visit on a case to case basis with each patient and what their needs may be.
Documentation: The patient consents to medical/dental treatment. All findings are thoroughly documented and the narrative is signed by the dentist.
Note- Oral cancer most commonly can be found on the tongue and lips. Other areas are also susceptible to cancer however, including inside of cheeks, gum tissue, floor of mouth, and palate.
Diagnosis: A Clinical diagnosis is performed by a dentist or oncologist and includes a biopsy with a smear sample for histological examination, radiographic examination, and visible clinical findings.
The doctor may order an MRI or CT scan for further evaluations if the above examinations do not lead to a definitive diagnosis. A chest x-ray and blood testing should also be done to determine a diagnosis and also detect for metastasis. With these tests the clinician will be able to determine if the cancer is in the early stages (I and II with no metastasis) or later stages (III and IV which include metastasis to the lymph nodes and other places in the body).
Planning: Determination of the proper course of treatment will take in to account the patient’s overall health status, the location of the primary tumor, the size of the tumor, and whether it has metastasized. The most common options for treatment are surgery for removal of the tumor, radiation therapy for small tumors or persons that can not undergo surgery. Sometimes radiation is used pre-surgery to shrink the tumor, and also post-surgery to destroy any remaining malignant cells. Chemotherapy is another treatment option and is most often used in conjunction with radiation treatment.
Some patient’s with oral cancer are given a target therapy which is a drug that binds to oral cancer cells and interferes with the growth and metastasis abilities. This is not a common treatment due to the extreme side effects. Rash, fever, vomiting, diarrhea and possible allergy to the medication are some of the side effects.
The dental hygienist can take several specific roles in aiding in planning for treatment of the cancer. The hygienist can make sure the patient is educated on side effects of treatment and also provide specific therapies to limit those effects. Some common side effects of cancer treatment that the dental hygienist can educate their patient about is xerostomia, tooth decay, sore and bleeding gums, infection, delayed healing, jaw stiffness, denture problems, taste alterations, and disfiguring deformities.
Implementation: For every patient the dental hygienist encounters, an oral cancer screening will be implemented and the patient should be educated on how to do the exam at home to aid in early diagnosis.
In the case for patient’s that have been diagnosed with oral cancer, the dental hygienist can educate and perform specialized therapies pre and post cancer treatment. Some pre-treatment therapies for the cancer patient include education on the side effects of the treatments used, fluoride trays for at home treatments during cancer treatment, a xerostomia rinse, gentle brushing with a soft toothbrush and fluoride toothpaste should be done on a regular basis. Care to avoid swollen or painful areas while brushing and flossing should be taken into account to decrease bleeding. The dental hygienist can show the patient tools to prevent and reduce jaw stiffness with special exercises, and if any dental treatment needs done, it should be completed one month prior to cancer treatment. If necessary the dental hygienist can also recommend that the patient utilizes a cancer support group to ease their situation and provide help to unknown questions.
Some post-treatment regimes would include regular dental hygiene appointments, the use of a xerostomia rinse if needed, education on how to clean any prosthetic devices used to replace any surgically removed tissues after treatment, and the use of a chemotherapeutic rinse if needed.
Evaluation: Evaluation of the patient should be done at every dental appointment following treatment. Education should be given to help the patient lower their potential risk factors and monitoring of the oral cavity in case of any recurrence should be completed. Possible oral hygiene instruction can be modified at each visit on a case to case basis with each patient and what their needs may be.
Documentation: The patient consents to medical/dental treatment. All findings are thoroughly documented and the narrative is signed by the dentist.