Int J Evidence-Based Practice Dent Hygienist 3 (2017), No. 2 10. July 2017
Background: Head and neck cancer (HNC) is the sixth most common cancer in the world and causes significant morbidity and mortality. In the United States, approximately 9,750 HNC-related deaths were expected in 2016. Most cases of HNC are found in advanced stages, resulting in poor long-term prognosis and significant morbidity. There are multiple risk factors for HNC, many of which are associated with biologic factors, socioeconomic status (SES), access to care, behavioral factors, and age and gender. Intra- and extraoral screening examination is the standard of care for the practicing dental hygienist; however, there is concern with the frequency, consistency, and thoroughness of both in daily dental practice. The purpose of this study was to assess clinically practicing, registered dental hygienists' intra- and extraoral cancer screening examinations, techniques, and referral patterns.
Methods: This cross-sectional study surveyed a convenience sample of 170 dental hygienists from Michigan, Illinois, Arizona, and Washington, DC. The electronic survey consisted of 20 multiple choice, open-ended, and yes/no questions.
Results: A total of 78 responses were received for a response rate of 46%. Binomial proportion 95% confidence intervals (CI) were reported. Of the respondents, 81% (95% CI: 70% to 89%) indicated performing intraoral screening exams at a patient's first and recall visits, while 72% (95% CI: 60% to 81%) reported performing an extraoral screening exam at both the first and recall visits. A vast majority examined all of the high-risk OC areas. Forty-nine percent (95% CI: 37% to 60%) reported referring a patient with a suspicious lesion, and the tongue was cited as the most commonly confirmed cancerous site location (53%; 95% CI: 36% to 69%). While nearly all hygienists performed tissue observation/description (99%; 95% CI: 93% to 100%) and palpation (92%; CI 84% to 97%), only 28% (95% CI: 19% to 40%) utilized adjunctive screening devices. When it came to intraoral risk factors, tobacco (94%; 95% CI: 86% to 98%), alcohol use (82%; 95% CI: 72% to 90%), and human papillomavirus (77%; 95% CI: 66% to 86%) were assessed. Sun exposure (90%; 95% CI: 81% to 95%) was the most commonly assessed extraoral cancer risk factor.
Conclusion: Dental hygienists were performing intra- and extraoral screening examinations for HNC 81% and 72% of the time, respectively. There is still need for improvement when it comes to the frequency, consistency, and thoroughness of these exams. Further research is recommended to determine whether the results from this study are similar nationwide and how best to address the shortcomings.
Keywords: extraoral screening, head and neck cancer, intraoral screening, oral cancer, preventive education, referral patterns, risk factors