Oral cancer. These are two words that every dentist hopes that they will never have to say to a patient throughout their entire career. Oral cancer kills one American every hour of every single day. There have even been a number of famous people that have become victims of oral cancer, which include Babe Ruth, Sigmund Freud, Bill Blass, and Jack Klugman. We as dental professionals know that when a lesion is found in the mouth that may be squamous cell carcinoma, there is a 50% to 70% chance that the patient may not live past the next five years.
When you look at other cancer awareness programs, some organizations have done an absolutely outstanding job at creating a very high awareness to all of us for certain types of cancer. Every woman knows how to do a breast cancer self-exam and routinely go for mammograms and everyone over the age of 50 knows that it is time to go for a colonoscopy. These types of self-examinations and screenings have helped to save many lives over the years.
An established self-examination for oral cancer would be a huge help in finding abnormalities or incipient oral cancer lesions early on. This kind of self-examination, much like a breast examination or a skin examination, is easy to do, does not require any special equipment and will help familiarize people with their own mouths. The primary benefit is early detection of any unusual lesions in the patients’ mouth and the secondary benefit would be consumers becoming much more familiar with their mouths which would help stimulate them to receive treatment for oral health issues that they usually ignore.
There is a brand new Website that has been developed for consumers that show people how to do a self-examination for oral cancer. Being that so many American consumers still do not have a regular dentist, there is also a find a dentist section. Dentists who are committed to oral cancer examinations and early detection of oral cancer can sign up to be listed on this web site at www.oralcancerselfexam.com There is an annual fee of $199 to be listed on this site for 12 months, with discounts if the dentist signs up to be listed for multiple years.
By the way, a recent dental patient survey done by the Crown Council revealed that the #1 finding of the survey were patients saying, “Tell us more about oral cancer”. CNN’s Dr. Sanjay Gupta recently did a story on oral cancer. Consumers are ready to get more involved with learning more about their mouths and certainly want to be involved with oral cancer prevention.
I strongly urge all of my attendees of my courses to use some type of oral cancer screening device, whether it is Vizilite Plus or a Velscope. Those that know me know that Vizilite Plus has been the choice in my office for a number of years because of its cost effectiveness, ease of use, and its TBlue stain that comes with this kit. The TBlue staining system that comes with Vizilite Plus is an essential piece of the screening if anything is found and no other system has this. Vizilite Plus will help screen your patients and will help you find suspicious lesions much earlier than you normally would. After that, either a brush biopsy like Oral CDX or a traditional biopsy should be used on the lesion for either histological examination or total removal.
Getting the patients on board to fight this dreaded disease is crucial and well overdue as well as instituting early detection screening into your practice as soon as possible. Patients are looking for dentists who take oral cancer seriously. Let’s all work together because if we as the dental profession don’t take this lead, no one will. It is completely up to us. Show your patients how committed you are to detecting and treating oral cancer. Go to www.oralcancerselfexam.com and sign up to be listed on this Website today!
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Comments (2)
Good Morning,
Recently, I attended a seminar in which this particular subject matter was very thoroughly discussed. Dr. John Kamar, of Ohio State University (I think that was the Oral Pathologist's name who spoke), absolutely indicated that the use of Vizilite was of very little value and was no more effective than a proper routine oral examination by a competent dental professional. He also mentioned that the use of the VelScope was still under investigation as to its usefulness but there was hope for it in the future. Following that seminar, I further investigated his comments by contacting Katrina Cordell, an Oral Pathologist at the University of Michigan, who agreed with the comments of Dr. Kamar.
The "hype" of these oral cancer products seem to be greater than the actual value of their use. The perception is that those dentists who use one of these products are serving patients better than those who don't. It would be wonderful if we had a product that had a clear and concise advantage to discover oral cancer in its earlier stages in order to help decrease the ravages of the disease.
I am an extremely conscientious dentist and am always in a learning mode on this and every other matter in our profession. This particular matter is not the only one for which I have serious concerns. I hope we can resolve this matter especially when there are companies involved who make a profit by selling devices, equipment, supplies, etc. The bottom line for me is obtaining truth by scientific evidence which then allows for the best care possible for the people we serve. If a product, etc is available to help us in this endeavor, all the better--but such a product, etc. should be of actual value (without question) and not just perceived value.
Your comments are well-appreciated on this matter as the goal is to better serve our patients and thereby reduce or eliminate the problems associated with oral cancer.
Respectfully,Marvin Sonne, DDS
International Secretary Alpha Omega Dental Fraternity
President Francis B Vedder Society Crown & Bridge Prosthodontics
Trenton, MI
Posted by Marvin Sonne, DDS | August 18, 2008 10:28 AM
Posted on August 18, 2008 10:28
Hi, Marv, hope you are doing well and good to hear from you.
I am happy to have a long discussion with you about this, we can never get this done in an email but I will give you some of the way I look at this field: As always, there are two sides to every story.
The mortality rate for oral cancer has not gone down in FORTY years. Most other cancers have seen a deep decrease in its mortality rate due to cancer screenings.
The gold standard in detecting oral cancer has been an oral examination. I have very seriously been questioning this "gold standard" within the oral pathology community. We know one thing for sure, the gold standard of oral examinations does not work considering the mortality rate.
Let's also be honest, you are an extremely conscientious dentist, I know that about you, Marv. However, I have to tell you the vast majority of dentists I speak to every year just do not take oral cancer seriously and are only doing cursory examinations and not doing proper oral cancer examinations. Dentists I speak to are relatively surprised to hear that they should be doing a manual palpation intraorally and extraorally on every single patient. They are surprised to hear that an 18 year old patient is now considered increased risk for oral cancer because of the HPV virus. There is certainly a psychological element at play here as well to get practicing dentists doing what they should be doing and more.
Vizilite Plus and products like it have a big advantage - it gets the dentist and their team sit up and take notice of the oral cancer arena once again. Vizilite Plus is well studied (see below). Some oral pathologists may not agree with these studies, but they are in well respected peer reviewed journals. The other products may be promising but I agree are not at all well studied. Vizilite Plus with TBlue is also the easiest screening device to implement into an office right away without a big capital purchase so it makes the most sense for most dental offices.
Is Vizilite Plus a perfect product? No but it is certainly the best we have right now and this is a company that is involved in constantly trying to make it better. Just because it may not be perfect doesn't mean we shouldn't be screening patients. We must add screening in addition to our examinations because after forty years, it is clear the examination is not enough.
ViziLite Plus with Tblue was chosen by one of the nation’s foremost head and neck cancer specialists to be the oral cancer screening technology of choice. The coordinating center for the study is The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University. The Protocol Chairman is Joseph Califano, M.D., of the Department of Otolaryngology-Head and Neck Surgery.
Over 30 clinical investigators at key academic research institutions and cancer research centers are scheduled to participate in the study. The Phase II study is anticipated to enroll and evaluate approximately 60 patients over a three-year period. Patients will be evaluated clinically and biopsies will be taken pre- and post-treatment. The biopsies will be analyzed histopathologically, but will also be analyzed for genetic changes using Zila's proprietary LOH assay. The assay is the only validated method for identifying biomarkers consistent with oral premalignencies and oral cancer.
I have found in speaking to oral pathologists that they are generally a very insular group and they do not look at the bigger picture because they do not see patients on a daily basis. When you only deal with the "science", and don't deal with real everyday dentistry, there is a real disconnect between the two. I think it is our job as real and practicing dentists to do the best we can for our patients and adding screening in addition to our examinations is extremely important. I have had many discussions with some of the biggest names in oral pathology and when I am done with them, they do rethink their positions on this topic. Much more to say here, feel free to call me.
Marv, you have been around long enough, if you wait around for scientific proof that something is agreed upon by everyone, you would still be using a hammer and chisel and gold foil to practice dentistry with. Right now, there is not a single area in dentistry that you and I practice in our offices where there is not scientific controversy - amalgam is bad, composites contain questionable ingredients, surgical or non surgical perio, endodontists fight as to the best way to obturate, implants, ortho, you name it, there is no pure scientific proof. We as practicing dentists have to see what works best in our hands and our practices to achieve the best outcome. It is certainly time to take a new look at oral cancer with the screening technologies we have available.
Hope that gives you some more insight where oral cancer screenings are. This is also the reason that the www.oralcancerselfexam.com website is so important. All the best, see you in November, talk to you before then.
Thanks and have a great day!
Louis Malcmacher DDS MAGD
Epstein JB, Silverman S Jr, Epstein JD, Lonky SA, Bride MA. Analysis of oral lesion biopsies identified and evaluated by visual examination, chemiluminescence and toluidine blue. Oral Oncol. 2008 Jun;44(6):538-44. Epub 2007 Nov 8.
Huber MA, Bsoul SA, Terezhalmy GT. Acetic acid wash and chemiluminescent illumination as an adjunct to conventional oral soft tissue examination for the detection of dysplasia: a pilot study. Quintessence Int. 2004 May;35(5):378-84.
Kerr AR, Sirois DA, Epstein JB. Clinical evaluation of chemiluminescent lighting: an adjunct for oral mucosal examinations. J Clin Dent. 2006;17(3):59-63.
Zhang L, et al. Toluidine blue staining identifies high-risk primary oral premalignant lesions with poor outcome. Cancer Res. 2005 Sep 1;65(17):8017-21.
Epstein JB, et al. The efficacy of oral lumenoscopy (ViziLite) in visualizing oral mucosal lesions. Spec Care Dentist. 2006 Jul-Aug;26(4):171-4.
Posted by Louis Malcmacher | August 18, 2008 10:33 AM
Posted on August 18, 2008 10:33