Originally published July 2009 in Trojan Today.
It’s about time… Only 18% (2009 statistics) of all dentists in the United States do a complete oral cancer screening examination. A shocking statistic!
My ‘unscientific’ survey of ADMC consultants at our 2008 annual meeting in San Antonio matched the scientific survey almost exactly. It is true. It is also true that the number two reason for malpractice claims against dentists in this country is lack of diagnosis or delayed diagnosis of oral cancer with the average payout of one million dollars! So, besides not doing what they know to be “best practices in dentistry,” dentists are also putting themselves and their practices at huge risk. What could possibly be the reasons behind this trend?
Over the past eight months, I have asked hundreds of attendees at my courses on early oral cancer detection why they think the percentage of dentists doing a complete oral cancer screening examination is so low. They respond, in unison, “time.”
Time!
That is their answer. Somehow, no matter what the dentist and team were taught about the importance of early oral cancer detection and the specifics of a complete examination, or their understanding of the malpractice risks, the answer is “time.” They somehow don’t have the time, or make the time, or see the time spent as important enough to focus on it.
But, think again.
It’s about the short amount of time…it actually takes to do the complete early oral cancer screening examination.
It’s about the time needed…so we clearly understand the changing patient population we need to examine.
It’s about time…we understand the new tools we have for enhanced oral cancer detection and begin to use them.
It’s about time…for us to learn not only how to deliver the difficult message of a positive finding upon our screening examination but also create a seamless referral process with follow-up monitors.
AND
It is truly about the time…it takes for mildly abnormal cells (mild dysplasia) to turn into a significantly life-threatening cancer when left undiagnosed or untreated.
What is really stopping dentists?
There is no one true barrier. There is a group of barriers that stop dentists/dental team members from doing what they know is the right thing to do. Early oral cancer detection in an office is a part of a ‘system’ not a ‘singular event’. To me, this system encompasses all of the following:
- Buy-in by the entire team (and an agreed upon living mission statement on the topic)
- A clear understanding of the target populations that are at risk and why
- Assurance that the “parts and pieces” of extra-oral and intra-oral examination are being done correctly, efficiently, and effectively
- An understanding of who does the oral cancer screening exam for the patients
- An agreed upon recordkeeping system that can stand up medically/legally for new patients as well as preventive re-care patients
- A set of verbal skills to deliver the message if something abnormal has been found in the screening examination
- A seamless referral and follow-up process whose foundation is a clear set of understandings between the referring dentist and specialist
- A business team with not only a clear understanding of the clinical procedures and systems but also with a comfort level to discuss vital issues and necessary phone and personal verbal skills
Not having any of the above-mentioned system pieces in place can become a barrier or excuse for not performing the oral cancer screening examination. Ego, uncertainty, and fear get in the way of better judgment and training.
Once the screening is put in place, if any part of this system is weak, misunderstood, or becomes ineffective, early oral cancer screening will lose momentum and stop altogether.
Become part of a nationwide effort
Every hour of every day of every week of every month of every year, someone dies as a result of oral cancer in our country. The average five-year survival rate is 50% and has not changed in almost 40 years. On top of that, there’s been an increase of 8-11% of people diagnosed with oral cancer each of the past three years.
It’s about time!…for all of us to
- Understand the significance and ravages of this disease
- Look beyond the ‘event’ of the early oral cancer screening exam and look at the system of early oral cancer screening within dental offices
- Ensure the entire system is firmly in place to break through the barriers to performing effective early oral cancer screening
Make a commitment today. Make it a priority today because lives are at stake.
Jonathan A. Bregman, DDS, FAGD, CAFL is a dental consultant and speaker.
FMI: https://www.bregmanconsulting.com/