Mouth Cancer - Is Your Dental Practice Doing its Bit? Summary and Take-Home Message.

July 20, 2015

Thank you for following my 'Mouth Cancer – Is Your Dental Practice Doing its Bit?' series. Here is the summary and take-home message for those who would like all the information in one document.

Who's Responsibility?

So who’s responsibility is it to prevent the next case of oral cancer? The answer is YOURS and MINE! With a 60% escalation in oral cancer across the UK since the 1970’s and the raised public awareness that comes with it, patients are expecting their dentists and teams to thoroughly screen for the disease and do not have an issue with taking legal proceedings if something is missed.

The Issue

The problem is that not only are the cases of oral cancer rising but more importantly that it is not being detected early enough. Early detection is key to saving lives.

“A major problem is that more than half of all oral cancer cases have already metastasized to regional or distant structures at the time of detection which decreases the 5 year survival rate to less than 50% for tongue and floor of mouth cancers”(BDA, 2011).

Oral cancer, skin melanoma and cervical cancer cause about the same number of deaths each year, but oral cancer still has a worse ratio of deaths to cases.

Why are we still seeing this trend?

In May 2015, an article in the British Dental Journal highlighted that despite being aware of their professional duty of care to screen for oral cancer, clinicians said that

time constraints and a lack of experience, knowledge and confidence are barriers to screening and talking to patients about ‘cancer’. The study also reflected on the point that the whole dental team is often not trained in the early detection of oral cancer in general practice as access to CPD, time and funding are also standing in the way.

Outside of the dental world, there is no Government initiative to tackle oral cancer. Youngsters in secondary schools are not being educated about the risk factors as they start to experiment with lifestyle choices that increase their risk of developing the disease. This lack of education is worrying as more and more young people are dying from oral cancer. Only when patient and public awareness is boosted will symptoms for oral cancer begin to present earlier in general practice.

So, what can we do in your general dental practice?

We can make a huge difference in raising oral cancer awareness and detecting it earlier in general dental practice by:-

  1. Developing an oral cancer management strategy for the early detection of oral cancer.
  2. Training the whole team in verifiable oral cancer management CPD – now a GDC recommended/ core CPD topic for clinicians (
  3. Clarifying each team member’s role and responsibilities within the practice’s early detection system.
  4. ‘Triaging’ new patients for oral cancer before placing them on a waiting list.
  5. Ensuring that every patient is screened opportunistically and in line with medico-legal guidance from the BDA.
  6. Establishing a referral pathway with a specialist department with a ‘fast track’ system in place.
  7. Using a custom-made format for documenting screenings systematically.
  8. Following NICE guidelines for the referral of oral cancer.
  9. Ensuring that all staff is knowledgeable and sensitive in speaking to patients during screenings and, particularly, if a referral is made.
  10. Educating patients about oral cancer and self-screening eg advice leaflets, posters, verbal communication.
  11. Offering free screening days and supporting national campaigns (
  12. Contacting your local media about assisting in the promotion of an oral cancer event you might be organising.

The ‘Take-Home’ message.

Within CQC Outcomes 1 and 4, inspectors are now looking for evidence that our teams ‘care’ about safeguarding patients against oral cancer. Not only does an oral cancer management system in practice safeguard your patients’ oral and systemic health but also assists in meeting our professional obligation to do so. The take-home message is definitely “Learn, screen, talk and educate”.