|
|
|
Dental Care Providers > Standards of Care
|
Standards of Care
|
Until recently, systematic oral health examinations were rarely
part of standard dental practice. Thanks to the efforts of
community–based oral cancer prevention programs,
as well as the activities of cancer support and advocacy
groups, the situation is changing. As dentists and oral
hygiene professionals become more involved in the fight
against oral cancer, they are supported by advances in
technology, such as convenient brush biopsy tests, and
handheld visualization tools that enhance the practitioner's
ability to view oral anomalies. The following is a list of
frontline tools and techniques, many of them complementary,
used in the detection and/or diagnosis of oral cancer.
Oral Examination:
Regular oral examinations within the dental office setting
are widely held to be the first line of defense against oral
cancer. During oral examinations, oral health professionals
look for suspicious spots and lesions in the mouth. Oral
cancer, presenting in red or white patches, can easily be
confused with common non-cancerous tissue. Because many benign
lesions mimic oral cancer, additional and complementary
diagnostic methods are required.
X-ray:
Oral cancers, unlike many other malignancies, can usually
be seen with the naked eye. Some, however, are located in
deeper tissue, making their detection difficult. X-rays
can assist in determining the potential growth of a
tumor into bone.
CT Scan:
CT scans provide a dynamic view of the affected soft
tissue areas of the oral cavity, with much greater detail
than a simple x-ray.
MRI, PET and Radiography:
Like x-ray and CT, MRI, PET and radiography scans are
largely used for the confirmation of oral cancer, or for
measuring its extent. The best indicator of tumor involvement
remains the clinical assessment, in conjunction with biopsy.
Surgical Biopsy:
The gold standard for oral cancer diagnosis is the pathology
assessment of a biopsy specimen. Oral biopsy, however, is
not easily performed in the dental office setting. To improve
the early detection of oral cancer, dentists require convenient
methods for the differentiation of cancerous and non-cancerous
patches. Fast, pain-free, and minimally invasive,
OralAdvance™ is one such method.
Conventional Exfoliative Cytology:
Diagnostic oral exfoliative cytology is a useful tool in
the diagnosis of oral dysplasia and carcinoma. Cells can be
obtained from suspicious areas via a cytology brush, and
deposited on a microscope slide for a conventional
cytopathology assessment. Studies have shown, however,
that liquid-based cytology provides better sensitivity and
specificity to oral cancer.
Brush Biopsy:
In the United States, conventional cytology assessment,
empowered by image analysis technology, is also offered
using "Brush Biopsy."
In the United States, conventional cytology assessment,
empowered by image analysis technology, is also offered
using "Brush Biopsy."
Visualization Technologies:
In recent years, several technologies have emerged to
address the limitations of white light examination of the
oral mucosa. Based on properties of human tissue such as
fluorescence and chemiluminescence, these hand-held optical
devices are designed to identify tissue changes before they
become apparent under white light examination. Although
clinical studies have yet to be performed, there is perceived
potential for the complementary pairing of visualization
technologies and cytology-based detection products such as
OralAdvance™.
Oral Cancer Treatment
Whether a patient has surgery, radiation and surgery,
or radiation, surgery, and chemotherapy, is dependent on
the stage of development of the cancer.
Curative Surgery:
Surgery offers the greatest chance of cure for oral cancer,
especially when the cancer is detected before it metastasizes.
When the early-stage disease is still localized, surgery
may be able to remove the cancer in its entirety. Surgery
may be used along with chemotherapy, pre- or post-operative
radiation therapy, or intraoperative radiation therapy.
Radiotherapy:
Radiotherapy may be used to treat localized solid tumors,
such as those cancers associated with the oral environment.
Internal radiotherapy is sometimes used for cancers of
the tongue. Exposure of the oral cavity to radiation commonly
produces mucositis, which resolves after the radiation
treatments are complete. Another radiotherapy-associated c
omplication is xerostomia, a permanent loss of salivary
function. New techniques such as IMRT (intensity
modulated radiotherapy), minimize damage to the salivary
glands.
Chemotherapy:
Unlike surgery and radiotherapy, chemotherapy is used to
treat widespread (metastatic) cancer. While chemotherapy
is an important and effective modality, its use will hopefully
diminish as more oral cancers are found before they have
a chance to metastasize.
|
|
|
|
