Be alert for oral cancer

FAILURE to spot intraoral malignancy can have serious repercussions for patients – and also dentists, says MDDUS dental adviser Rachael Bell.

November is Mouth Cancer Action Month – the annual campaign to raise awareness and improve understanding of oral cancer among both the public and the profession. MDDUS has taken this opportunity to remind dentists of the crucial role they play in the early detection of oral cancer through routine screening and educating patients on the risks and warning signs.

The British Dental Health Foundation (BDHF) estimates that over the next decade around 60,000 people in the UK will be diagnosed with mouth cancer and without early detection half will die. Cases involving failure to diagnose and refer patients with oral cancer feature regularly among clinical negligence claims made against MDDUS members and in GDC fitness to practise investigations.

Proper examination and good record keeping are essential for dentists wanting to avoid professional difficulties. Says Bell: "The only defence to a claim made following delayed diagnosis is if adequate examination of the patient was made, backed up with proper notes in the dental record.

"Unfortunately, we are still seeing dental records that amount to ‘Exam SP’, with no mention made of how an examination was carried out and what was examined or found. It is tempting to blame time pressure but carrying out a thorough examination really needs backed up by a good record of that examination and copies kept of referrals made. Otherwise, little can be done in a dentist’s defence."

MDDUS recommends that all practitioners follow current recommendations with regard to examination and dental records, such as those set out in the FGDP(UK) book, Clinical Examination and Record Keeping.

Says Bell: "Where there is an allegation of failure to diagnose an oral malignancy, we would be looking for notes in the records of an extra-oral examination, soft tissues being examined and the findings – even if the findings are that the tissues are healthy. The notes also need to reflect whether smoking cessation and alcohol-related advice has been given and what was said. If there is any doubt about an intraoral lesion then refer early, keep a copy of any referral letter and any response from maxillofacial services."

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