Overview of Extra and Intraoral Examinations: The Foundation for Oral Cancer Detection

Evidence is ever-increasing pointing to the notion that a dental hygiene appointment, is more than simply looking at the teeth.  A dental hygiene visit may in fact save your client’s life.  The dental hygienist, a key member of the oral healthcare team, is extensively trained in completing assessments of the head and neck region and conducting an overall appraisal of a client’s health status.

            Oral cancer is an example of a life threatening disease that may be detected by a dental hygienist. With early detection and timely treatment, morbidity from oral cancer could be dramatically reduced.  The five-year survival rate for those with localized disease at diagnosis is about 80 percent compared with only 19 percent for those whose cancer has spread to other parts of the body.  Early detection of oral cancers is often possible. Tissue changes in the mouth that might signal the early signs of cancer often can be seen and felt easily. It is a known fact that early detection saves lives.

The extraoral and intra oral examinations are a physical, systematic examination of the head and neck area outside and inside the oral cavity.  The examination involves palpation or physical manipulation and detailed visual inspection of the structures of the head and neck region followed by careful documentation of significant findings.  The examination only takes a few minutes and enables the clinician to detect early changes in structure, which may be indicative of disease. 

Here are some tips to completing efficient, yet thorough extra and intraoral examinations:

·      Follow a consistent sequence

·      Use an effective palpation technique

·      Have a good knowledge and understanding of the location of all lymph nodes and anatomic landmarks

·      Document all findings accurately

            This brings us to documentation of findings.  The manner in which findings are documented is vital as assessment findings are used as baseline findings for which all other future visits are compared.  It is also commonplace, that more than one clinician will treat a client during their care.  A consistent documentation technique ensures a uniform language amongst clinicians.  A clinician should be able to pick up a client record and gain a true picture of the client’s oral health status.

 I would like to propose a uniform method of documentation of oral lesions among all dental hygiene clinicians.  I particularly like the ABCDT format that is outlined in the Patient Assessment Tutorials text by Jill Nield-Gehrig.

ABCDT is an acronym for:

·      Area

·      Border

·      Colour

·      Diameter

·      Type

The dental hygienist is adept at the recognition of conditions that are beyond his/her scope of practice.  Upon recognition of those conditions, a referral to the appropriate health care professional is indicated.  Please note that if a suspect lesion does not resolve after 2 weeks, a referral should be made to an appropriate specialist.  A prudent dental hygienist will follow up to determine the status of the lesion and what the appropriate course of action may be. 

This now brings us to variants of normal such as linea alba, mucoceles, fordyce granules etc… I propose that these findings are documented using the ABCDT format as well, with the appropriate name in parenthesis following the description. 

As a clinician myself, I can share the sentiment that there would not be enough room in the chart, or enough time in an appointment to document in this manner.  It is important to note that client and dental team education is key.  Perhaps the initial examination could be lengthened?  Note that at subsequent appointments the clinician would just complete an update, which is an abbreviated version of the initial exam.  Another thing to consider is whether standardized assessment forms for all dental hygienists could help? What do you think? I would love to hear your thoughts!

Reference List:

Darby, Michelle Leonardi, and Margaret M. Walsh. (2010) Dental Hygiene Theory and Practice Third Edition. St. Louis, MO: Saunders Elsevier.

Nield-Gehrig, J.S. (2007). Patient Assessment Tutorials: A Step by Step Guide for the Dental Hygienist . Baltimore, MA: Lippincott Williams & Wilkins.