Oral Cancer – Role of GDP

The dentist (GDP) is in a unique position to help in oral cancer discovery and diagnosis.

The GDP, by training and experience, knows what the oral cavity should look like and be aware when oral tissues look suspicious.

GDP’s involvement includes prevention, early diagnosis and the care of patient post-treatment for cancer.

Prevention:

Actively discourage smoking & betel nut use
Encourage moderation of alcohol intake
Health promotion & education on Oral Cancer
Provide check-ups for œdentulous ± institutionalised elderly & otherwise high-risk non-attenders

Case law has already established that a dentist’s duty of care includes an obligation to examine the whole mouth.

A typical legal complaint might allege failure to recognise the possibility of a malignancy having noted swollen gums and loose teeth, for example, with a lack of evidence of adequate medical and social history taking and delay in making a specialist referral.

Dentists need to be sure that they can, if necessary, answer questions like these:

Did you know that a particular patient fell into an oral cancer high risk group and what did you do in the light of that knowledge?
Were the medical, social and dental histories taken appropriately?
Did you investigate the health of soft tissues thoroughly enough?
Was a decision not to refer the appropriate one in the circumstances?

Always examine mucosa as well as teeth
Refer all high-risk lesions on discovery
Monitor low-risk pre-malignant lesions
Perform biopsy appropriately

This presupposes that the GDP is comfortable recognising pre-malignant lesions and is au fait with them. Shrugging your shoulders or referring any oral pathology to the OMFS Department are not necessarily the most efficacious or responsible responses.

Given Continuous Professional Development, there is the expectation that GDP’s should be more aware and be able to recognise oral lesions.

Also, though not happening yet in this country, failure to recognise such lesions and act accordingly may be regarded as malpractice or even negligence.

The parallels have already been drawn by the defence unions between the lack of diagnosis and treatment of periodontal disease and oral cancer.

I don’t believe many GDP’s will biopsy the lesion; no real financial incentives and also the worry that biopsying the lesion may ‘muddy the pitch’ for further investigations and treatment.

Alleviate the effects of post-irradiation dry mouth (eg preventing xerostomia-related caries)
Monitor for recurrence, new pre-malignant lesions & second primary tumours
Monitor for cervical (neck) metastases
Maintain morale of & provide additional support to patients & their relatives

Theoretically, the GDP should know how to manage a dry mouth and its sequelae (cervical caries, periodontal disease & candidal infections). The GDP should have either literature or even the products used in the amelioration of xerostomia.

If the GDP can do a competent oral screening, than monitoring for a recurrence or a new cancer or a pre-malignancy is no different than the oral screening.