As dental hygienists, we are also patients, depending on other oral health care professionals to provide us with safe, ethical, evidence-based care. However, what happens when the care we have received falls short of the standards of care? How does one diplomatically deliver the appropriate feedback to their personal oral health care provider that there are gaps in their assessment practices and that they are missing opportunities to identify extra and intraoral abnormalities, including head and neck cancers, because they are not performing a comprehensive extraoral and intraoral examination (COE)?
When faced with this dilemma, we may often let it pass, not wanting to offend a fellow colleague. We can say nothing or find another dental practice. After all, as dental professionals ourselves, we often try to self-monitor our oral health. However, considering that we are only one of many patients being treated by this provider, there is an ethical responsibility to discuss the issue.
The statistics related to oral and oropharyngeal cancer continue to rise. Individuals continue to be diagnosed at a later stage, impacting treatment options, prognosis, and long-term side effects. Since these cancers present in the head and neck, we have a professional responsibility to screen for them. There are numerous resources available to refresh our memories about how to perform, along with the need for a COE at every appointment.1,2
All aspects of the COE are important. The extraoral examination has the same priority as the intraoral examination. Considering what is known about the presentation of HPV+ oropharyngeal squamous cell carcinoma (OPSCC), palpating the cervical lymph nodes is a critical component for detecting this cancer, yet many clinicians never touch a patient’s neck or assess patient reported symptoms such as difficulty swallowing, persistent hoarseness, and unexplained ear or oropharyngeal pain. Simply examining the TMJ does not allow for discovery of nodal involvement throughout the head, neck and scapular areas. A comprehensive visual and tactile head and neck examination only takes a few minutes of time, yet it is often skipped by both dental hygienists and dentists.3
Frankly, we have heard all the excuses. Time, other procedures take priority, someone else in the office will perform this procedure, “I’m not really sure how to perform a COE”, and so on. Yet, imagine being the patient for whom cancer was discovered at a later stage. How might that person feel knowing that an early detection could have occurred? It is time to stop the excuses and make a concerted effort to incorporate a COE at every patient appointment. What takes only minutes to perform, saves lives. We have all seen the reports from patients and their dental hygienists who diligently performed a COE and discovered a cancerous disease or even a benign condition with a potential negative impact on their health. These patients are so grateful to that person who examined them thoroughly before moving on to other procedures. We want you to be that person. The champion of true prevention.
The updated ADHA Standards for Clinical Dental Hygiene Practice provide guidance for assessments, including a COE of the head and neck, oral cavity, skin integrity, swallowing ability, and assessment of the TMJ.4 When examining the patient, look for hard and soft tissue pathologies such as periapical pathology, bony growths, ulcerations or changes in the mucosa, soft tissue swelling, tumor formation, presence of infection, salivary gland abnormalities or dysfunction and more. These findings may require a referral for further evaluation. The clinician should also assess for risk of disease based on the health history including low, moderate, high and extremely high risk for oral cancer. Findings of this nature may change the planned appointment so that individuals are fully educated to understand their condition, steps they can take to mitigate risk, and whatever follow-up or referral that is needed to determine a definitive diagnosis and appropriate treatment.
Maybe we are preaching to the choir. Or maybe this examination does not rank high on your priority list for care in a day full of patients and procedures. But ask yourself, if the patient on the schedule was your parent, spouse, child, or close friend, would you want this assessment skipped? Would you want this examination to be omitted if you were a patient in that practice? Let’s all agree that we are the oral health care professionals who can change the devastation associated with oral cancer and other pathologies. The best reason may be the simplest—we all deserve a higher standard of care!
The comprehensive oral examination is more than a procedure: it is a promise. A promise that every patient who trusts us with their health will receive our full attention, our best judgment, and our unwavering commitment to prevention. Dental hygienists have always led with purpose. This is our moment to lead again. When we choose to perform a COE at every appointment, we choose early detection over missed opportunity, courage over complacency, and leadership over habit. Let’s be the health care professionals who raise the standard of care and never look back. Because just a few minutes of our time can change the entire course of someone’s life. And that is the kind of impact worthy of our profession.
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