oral cancer screening for oral cancer prevention in Nepal

1. Oral Medicine and Radiology
THEME
MULTIDICIPLINARY APPROACH FOR SCREENING,
DIAGNOSIS AND MANAGEMENT OF ORAL
CANCER
Presented By:
Dr. Abhishek Gupta
Assistant Professor and Incharge
School of Dental Sciences, CMC
17/04/2023
TOPIC
ROLE OF ORAL MEDICINE IN ORAL CANCER
(SCREENING/DENTAL CLEARANCE)

2. ORAL CANCER

3. Oral Medicine and Radiology
CONTENTS
A. TOBACCO CESSATION COUNSELING
• Why, Who and How….??
B. ORAL CANCER SCREENING
• Why?
• When/who requires?
• Who should do?
• How to do?
C. ORAL CARE BEFORE (DENTAL CLEARANCE), DURING AND AFTER ANTINEOPLASTIC
THERAPY
• Why
• What is done…

4. Oral Medicine and Radiology
Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC Information Centre on HPV and Cancer
(HPV Information Centre). Human Papillomavirus and Related Diseases in Nepal. Summary Report 10 March 2023.
*b Rates per 100,000 Men/Year
*c Rates per 100,000 Women/Year
Some Facts……

5. Oral Medicine and Radiology
INTEGRATED FRAMEWORK FOR ORAL CANCER PREVENTION

6. Oral Medicine and Radiology
TOBACCO CESSATION COUNSELLING

7. Oral Medicine and Radiology
WHY??
• > 66% of cases are related to tobacco.*,**
• > 33% of cases are related to Alcohol.***
*Conway D I, Brenner D R, McMahon A D, et al. Estimating and explaining the effect of education and income on head and neck cancer
risk: INHANCE consortium pooled analysis of 31 case-control studies from 27 countries. Int J Cancer 2015; 136: 1125-1139
**Rivera C. Essentials of oral cancer. Int J Exp Pathol 2015; 8: 11884-11894.
***Maasland D H E, van den Brandt P A, Kremer B, et al. Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck
cancer: Results from the Netherlands Cohort Study. BMC Cancer; 14. Epub ahead of print 14 March 2014.

8. Oral Medicine and Radiology
WHO AND HOW SHOULD DO?

9. Oral Medicine and Radiology

10. Oral Medicine and Radiology
ORAL CANCER SCREENING

11. Oral Medicine and Radiology
WHY ORAL CANCER SCREENING?
• Early detection can improve the patient's chances of
successful treatment
• Visual screening of the oral cavity has been widely evaluated
for its feasibility, safety, acceptability, accuracy in detecting
oral potentially malignant lesions and oral cancer, and efficacy
and cost-effectiveness in reducing oral cancer mortality*
• The purpose of screening is not only to detect oral cancer at
early stage but also to detect and manage patients with
OPMDs who are at risk for developing cancer**
*Kharbanda OP, Ivaturi A, Priya H, Dorji G, Gupta S. Digital possibilities in the prevention and early detection of oral cancer in the WHO South-
East Asia Region. WHO South-East Asia J Public Health 2019;8:95-10
**Warnakulasuriya S, Kerr AR. Oral Cancer Screening: Past, Present, and Future. J Dent Res. 2021 Nov;100(12):1313-1320. doi:
10.1177/00220345211014795. Epub 2021 May 26. PMID: 34036828; PMCID: PMC8529297.

12. Oral Medicine and Radiology
WHEN/WHO REQUIRES ??
• Self examination
• Report any changes, such as white/red
patches, lumps or sores
Every Month
• 40+ Age Group
• Tobacco and/or heavy alcohol Consumers
• Human Papillomavirus (HPV)
• Family history of cancer
Yearly
• 20+ Age Group
Once in 3 years

13. Oral Medicine and Radiology
WHO SHOULD SCREEN?
• Self Examination
• By Health Professionals (Dentist)

14. Oral Medicine and Radiology
SELF EXAMINATION

15. Oral Medicine and Radiology
EXAMINATION BY HEALTH PROFESSIONALS
Dental community is the first line of defense in early detection of the oral
cancer
– “Opportunistic” cancer screenings
– Screen all the patients who visit their practices
– Responsibility

16. Oral Medicine and Radiology
HOW TO DO?

17. Oral Medicine and Radiology
Areas to be screened:
• Lymph nodes
• Lips and vestibule
• Buccal mucosa
• Gingivae
• Dorsal and ventral surfaces of the tongue
• Lateral borders of the tongue
• Hard and soft palate
• Oropharynx
Hook H. It's not just about the teeth: The importance of screening for oral cancer and raising awareness. BDJ Student. 2021;28(3):28–9. doi:
10.1038/s41406-021-0224-4. Epub 2021 Aug 31. PMCID: PMC8407134.

18. Oral Medicine and Radiology
CHAIR SIDE METHODS AND ADVANCEMENTS IN THE DIAGNOSIS OF
ORAL CANCER:
Types Examples
Clinical Methods • Vital tissue staining
Cytopathology Examination
• Exfoliative cytology
• Brush Cytology/ Oral CDx
Visualization Adjuncts Tissue Auto
fluorescence
• VELscope
• In Vivo Confocal Microscopy
• Chemiluminescence (Vizilite)
Photo diagnosis
• Auto fluorescence Spectroscopy
• Fluorescence Photography
Babu NA. chair side diagnostic aids in early detection of oral cancer For general dental practitioners. European Journal of Molecular & Clinical
Medicine. 2020 Dec 16;7(10):668-73.

19. Oral Medicine and Radiology
ORAL CARE BEFORE ANTINEOPLASTIC THERAPY
• Complete dental examination and evaluation:
- Clinical examination of all oral and dental structures and palpation
- x- ray examination of teeth and supporting bony structures of the maxilla
and mandible
- Surgical removal of any remaining root tips or alveolar hyperplasia
• Criteria for pre- radiotherapy extractions of teeth :
- Caries (nonrestorable )
- Active periapical disease (symptomatic teeth )
- Moderate to severe periodontal disease
- Lack of opposing teeth ,compromised hygiene
- Partial impaction or incomplete eruption.
- Extensive periapical lesions (if not chronic or well localized )

20. Oral Medicine and Radiology
ORAL CARE DURING ANTINEOPLASTIC THERAPY
1. Dental Prophylaxis
2. Extensive hygiene instructions - brush training and adequate home care
maintenance
3. Custom made flexible mouthgaurds are fabricated from dental casts
4. Use of fluorides
5. Various mucosal guards and stents can be constructed as requested by
radiotherapist
6. Candida infection
7. Use of saliva substitutes should be encouraged to lubricate dried mucosal tissues
and decrease the chance of traumatic ulceration
8. Patients should be advised soft diet and cautioned to avoid spicy, acidic or
mechanically irritating foods
9. Good oral hygiene and daily fluoride use must be reinforced
10. Trismus prevention exercises should be reviewed
11. Denture wearing should be discouraged

21. Oral Medicine and Radiology
ORAL CARE AFTER ANTINEOPLASTIC THERAPY
• Recall once or twice during the first month followed by 3-4 month recall schedule
• Goal is to prevent radiation caries and periodontal disease, decrease the risk of
development of osteoradionecrosis and manage some of the chronic side effects
such as xerostomia
1. Oral mucosa: examined for irritation or ulceration
2. Adherence to oral hygiene and fluoride protocol needs to be reinforced
3. The interarch distance should be measured
4. Encourage to continue jaw opening excercises and physiotherapy (prevent
trismus)
5. Check for calculus and areas of demineralization or caries
6. Gentle scaling and root planning and polishing can be performed
7. Carious lesions and areas of demineralization need to be treated immediately
8. Post radiation extractions must be performed with careful handling of soft
tissues, alveolectomies, primary wound closure and antibiotic coverage
9. High risk of developing osteoradionecrosis: hyperbaric oxygen pre/post
operatively

22. Oral Medicine and Radiology
THANK YOU!