A recent posting on the American Dental Association web site describes an interesting study conducted by a panel convened by the ADA Council on Scientific Affairs, a sub-group of the American Dental Association.
The panel, in conjunction with the ADA Center for Evidence-Based Dentistry (EBD) staff, reviewed five systematic reviews and four clinical studies to determine if dentists could detect oral cancers early through routine dental examination.
The study panel examined four distinct questions in the detection of oral squamous cell carcinomas during routine dental exams:
1. Does routine dental screening reduce the likelihood of potentially malignant lesions on the tongue, cheeks, lips, gums and other parts of the oral cavity?
2. Do specialized treatments help dentists identify potential cancers during routine examinations?
3. Compared to examinations without specialized detection tools, can dentists identify trouble spots or should dentists use these specialized tools for the early detection of squamous cell carcinomas in the mouth?
4. Are there specific groups which benefit more from detailed, dental examinations – groups such as seniors, smokers, men, women and other groups within the larger study group?
According to the panel’s report, “…while oral cancer screenings may detect potentially malignant and malignant lesions, clinicians are urged to remain alert to signs the lesions may become cancerous or early stage cancers while performing routine visual and tactile examinations in all patients, particularly those who use tobacco or consume alcohol heavily.”
It’s been shown that any kind of tobacco use is a cause for potential oral cancers and, when combined with alcohol, people who use tobacco and alcohol in conjunction, are 15 times more likely to be one of the 30,000 men and women diagnosed with tongue cancer or some other form or oral cancer this year.
In plain English, the panel set out to determine if dentists who examine patients for early signs of cancer increased chances of early detection and the conclusion, reported on the ADA web site, is that, indeed, dentists are often in the best position to detect potential cancerous lesions during routine dental examinations.
Dr. Michael Rethman, who undertook the study, stated, “”What’s most important is that this (review) points to the need for more research on the natural history of squamous cell carcinomas in the mouth and the epidemiology of oral cancer.
We still don’t understand the answers to a lot of fundamental questions like the progression of the disease and whether intervention helps. It’s plausible that early diagnosis helps, but we don’t even know that.
There’s an incredible need for more research on this topic,” Dr. Rethman concluded.
What Is Evidence-Based Dentistry?
EBD is a systematic approach to the delivery of dental care involving four main considerations:
- the evidence of a problem through a visual examination and a tactile examination by the dentist; this may or may not include special procedures designed specifically to detect oral cancer early
- evidence produced through viable studies undertaken by specialists in a particular medical field, i.e., are the study results solid evidence that can be used by dentists and other dental professionals
- the clinician’s professional skills and judgment, a clear indication that dentists must remain current on the latest in early oral cancer detection
- the patient’s needs and preferences, making the patient a partner in deciding the best course of treatment when squamous cell lesions are detected through a dental exam.
No one of these considerations is more or less important in determining the course of treatment that offers the most positive outcomes and, through the engagement of the patient, EBD creates a more effective partnership between medical and dental professionals and patients. The concerns and needs of patients with regard to quality of life are just as important as the up-to-date treatment options recommended by an oncologist (specialist in treatment of cancer) after oral cancer is detected by a dental professional.
EBD also entails a highly-detailed, systematic approach to the review of studies conducted in the field. This, too, provides the “evidence” dental professionals employ in the practice of EBD. These studies, like the one published on the American Dental Association web site, undergo extensive evaluation with an objective analysis of the way studies are conducted and how study results are interpreted.
EBD relies heavily on number crunching, using statistical data to help medical professionals to formulate courses of treatment for their patients. This “numbers-based” approach eliminates professional bias and offers more predictable outcomes based on evidence gathered in the field.
In other words, EBD relies on real-world statistical data to remove some of the “guess work” out of the early diagnosis of cancerous lesions by dentists. A dentist might overlook a lesion as a possible start of a cancer except that the patient fits one or more of the statistical groups most likely to experience oral cancer. Using EBD, the numbers drive the early diagnosis, not the medical or dental professional’s opinion.
A Systematic Review Increases Diagnostic Specifics
In scientific research, systematic reviews by peers are used to determine the quality of the data collected during the study and to identify possible misconceptions or illogical conclusions drawn by researchers based on the information they gather.
This peer review qualifies the information collected and collated by researchers and provides authority to findings when the systematic review synchs up with the data contained in a collection of studies.
- Do results from similar studies make sense?
- Is there an identifiable pattern to results across numerous studies?
- Are the results founded on quality research and scholarship?
- Can the results lead to logical, evidence-based conclusions, i.e. tobacco is a leading cause of oral cancers. The studies uniformly back up this conclusion, giving this cause of oral cancer more “weight” than less specific evidence.
- How were study groups selected? Undiagnosed, diagnosed, a combination? Exactly what groups were a part of each study?
- How can the evidence be best used by the dental or medical professional in making a diagnosis and designing the optimum course of treatment?
The objective of any systematic review is specificity: while the study may be broad in scope, the on-going review by professional peers is designed to focus on narrow questions that may or may not be answered by a particular study. This is the reason a systematic analysis is undertaken. The more researchers and clinicians study data, the more reliable that data becomes.
Talk to Your Dentist
Evidence-based dentistry starts with you – your preferences and practices. You’re the best advocate you have so take a moment to talk to your dentist during your next visit.
Ask questions and be truthful. If you smoke, tell your dental professional (s/he’ll probably know by the discoloration of your teeth). If you consume alcohol, be straightforward. Explain your view of evidence-based dentistry and how important it is to you that your dental professional remain up-to-date on the latest in systematic reviews and on-going research.
Finally, ask your dentist to perform a visual and tactile examination for early signs of squamous cell carcinoma during each visit.
What? You haven’t seen your dentist in a while? Still smoking? Using snuff? Then you aren’t advocating for good oral health. You’ve heard it before: see your dentist twice yearly for a cleaning and a complete examination based on the latest evidence available to these professionals.
It starts with you. It starts with you making that appointment.
It’s time to pick up the phone and the evidence proves it. Make the call. Today.