I applaud the ADA for its leadership role in the war on oral cancer. The "Combating Oral Cancer" special supplement to November JADA was a powerful statement and a nicely assembled introduction to the subject. Having been involved with the early detection of oral cancer for over 18 years, it is gratifying for me to see this issue rise toward its appropriate place among dentists’ priorities.
I did want to comment on two aspects of the supplement. First, some of the articles squarely addressed the appearance of early oral and oropharyngeal squamous-cell carcinoma. While the literature supports the presence of persistent erythema as the most significant and ominous mucosal alteration, this often is overshadowed by the attention generally paid to leukoplakia. While we all agree that no persistent mucosal alteration should ever be ignored, a continued emphasis on white changes may not be the most productive approach.
White lesions are easier to spot, simpler to follow and far less likely to harbor malignancy than are red lesions and those with red components. The expertise of dentists is truly needed to identify the subtle red changes that are often difficult to distinguish from normal oral mucosa. The yield of efforts to increase early detection of oral and oropharyngeal cancer is likely to be improved by widening the focus from leukoplakia to all persistent mucosal changes—red, mixed red and white, white and others.
Second, dentists play an important role in the treatment planning and oral health maintenance of patients diagnosed with oral cancer. While this was addressed briefly in the supplement article "Current Management of Oral Cancer: A Multidisciplinary Approach," by Drs. Robert A. Ord and Remy H. Blanchaert Jr., the dental community should be better-educated on this issue.
Dentists must be prepared to ensure that meaningful and appropriately timed interventions become the rule rather than the exception for patients about to undergo treatment for oral and oropharyngeal cancer.
Finally, against the backdrop of the [just-concluded] campaign to heighten awareness and improve oral cancer outcomes, there should be a baseline of knowledge that every patient can expect from his or her dentist on this subject.
During the 1980s and 1990s, a number of states responded to the emergence of a different critical issue by requiring specific continuing education on infection control as a condition for license renewal. It is now time for state boards to follow New York’s lead and consider mandating some oral cancer education for dentists.
The dental community has been handed the primary responsibility for the early detection of oral cancer. We must accept that very serious responsibility by committing to our own education. Our patients expect it. We owe it to them and to ourselves.
Armed with information, motivation and diagnostic tools such as toluidine blue, the brush biopsy and, potentially, the use of chemoluminescent light, dentists are poised to bring about the first positive change in oral cancer survival statistics since data became available. Over a quarter century of dismal statistics with no progress can be turned around by a concerted effort by the dental community to participate in primary prevention and take responsibility for early detection of this disease.
The ADA has risen to the occasion and taken a strong stand. It is time for all of us to get on board.
