Dennis M. Abbott, DDS, is the founder and CEO of Dental Oncology Professionals of North Texas, an oral medicine practice dedicated to meeting the unique dental and oral health needs of patients battling cancer. In addition to private practice, he is a member of the dental oncology medical staff at Baylor Charles A. Sammons Cancer Center and Baylor University Medical Center in Dallas. Dr. Abbott is a nationally recognized leader in oral health care associated with cancer care. He regularly publishes articles on the subjects of dental oncology and oral medicine and presents lectures to professionals and patients throughout the North America.

Dr. Dennis Abbott

	Every day is the perfect day to screen for oral cancer, but, as we move into November, now is an excellent time to make preparations for Oral and Head and Neck Cancer (OHNC) Awareness Month coming up in just 6 months.

We set aside each April to increase awareness about this disease that will affect almost 46,000 Americans and kill almost 9,000 in 2015 alone. Do not let these statistics fool you into thinking only less than 20 percent of those affected by OHNC succumb to their disease. The truth is the majority of people with OHNC are diagnosed at a late stage when the tumor is large and the disease has spread to the lymphatic system. At this stage, almost 45 percent of those diagnosed will not live for five years. So why do we rally to raise awareness of this dreaded disease in April? Because early detection saves lives. Like many other types of cancer, when OHNC is found at an early stage, the prognosis is significantly improved: Survival beyond five years approaches 90 percent.

	We need to make others aware of the debilitating and often disfiguring effects of OHNC and emphasize the need to screen for abnormalities in the mouth and oropharynx that are or could become cancer. So how should we begin to plan for having the most effective OHNC month ever? Begin now. Here is a quick guide to help prepare yourself and your team to make this April really count in the war against OHNC.

	Begin by reviewing information about the disease itself. Update your knowledge of current OHNC statistics. Understand the etiologies of the disease: the use of tobacco products, consumption of alcoholic beverages and previous exposure to the human papilloma virus (HPV), the most commonly sexually transmitted infection in the United States. Some studies show at least 90 percent of Americans who are or have been sexually active (including oral sex) have been exposed to HPV. Educate patients on the risks of OHNC and help them see that screening at your April event (or, even better, everyday at your office) should be part of their personal wellness plan just like having a Pap smear, mammogram or colonoscopy, which are other screening procedures to look for cancer in its early stages.

	Agree on a date with your office staff. Let them know this is a great opportunity to give back to the community and their participation is extremely important. Decide if the event will occur during regular office hours and if you will offer “draws,” such as snacks, goodie bags or a raffle. Consider giving tours and highlighting the benefits of your practice and staff at the event. Take advantage of this event to market your practice!	 

	Begin in-house. Notify your patients that your office will be hosting a free oral cancer screening event in April. Ask them to invite friends and coworkers. Post notices on your website and social media. Notify local doctors, nurses, hospitals and cancer centers. Think beyond the obvious by including speech pathologists, nutritionists and other health and wellness professionals. Look at this effort to begin a new conversation with a new audience to expand your office’s reach. Contact the 

 and post your event on its website (Note: OCF will only post events that are free to the public).
	Remember, survivors of OHNC and other cancers are at a higher risk for developing OHNC and should be screened on a regular basis. Reach out to them.

	Review effective head and neck examination skills. Realize the signs of early-stage OHNC. Understand how to palpate lymph nodes and know not only the location of the nodes that drain the head and neck region, but how to differentiate them from other structures in the neck, such as muscles and major vessels. Familiarize yourself with adjunctive devices you might use to detect OHNC at an early stage. Know what questions to ask patients to probe for possible cancer-associated issues and what answers might raise suspicion of oropharyngeal cancers when visual examination is limited or not possible. Review each team member’s role in the event from hospitality to obtaining history and consent to actually conducting the head and neck examinations.

Know your game plan in case you find something suspect

	Having a patient in the chair with a suspicious lesion in his or her mouth is not the time to begin thinking about what to do or who to call for a referral. If you are not experienced in performing biopsies on suspected cancerous lesions, this is definitely not the time to start trying. Usually, there is only one shot to obtain a biopsy of diagnostic quality. Ask your oral surgeon or periodontist if he or she is comfortable performing biopsies on suspected cancerous lesions. Invite them to your event. If you perform oral biopsies on tissues that could be cancerous, make sure you have adequate supplies to send these specimen for histological evaluation. (The services of an oral pathologist are highly recommended for this type of evaluation.)

	If your oral surgeon or periodontist is not comfortable performing these services, ask him or her for recommendations or consider using a head and neck surgeon. Have the name of an otolaryngologist (ENT) ready should you need a laryngeal examination with a scope for suspected laryngeal cancer. Decide what information you will give the patient should a biopsy be necessary. Know who will interpret this information to the patient. Have the necessary information ready to help the patient on the first steps of his or her cancer journey. Have a plan, and plan for everything.

	Benjamin Franklin may have said it best: “By failing to prepare, you are preparing to fail.” Do not fail your patients this April by skipping Oral and Head and Neck Cancer Awareness Month. Prepare for the best screening event your office has ever had, and make your way to the front line in the war against oral and head and neck cancer.

	SoproCARE is said to give dental professionals a new visual tool to educate the patient on the importance of good dental hygiene and periodontal health. Utilizing fluorescence technology, SoproCARE illuminates dental tissue to reveal occlusal caries, plaque, tartar and gingival inflammation. It can be used as an intraoral camera, providing the dental professional with all of the necessary tools to perform a complete and time-efficient oral examination.

	The Bio/Screen is a compact unit that reportedly offers biofluorescence visualization with the latest technology. Users can leave the room lights on during the examination, and the unit is said to have no noisy fan. It can be used for 60 minutes with only 90 minutes of charging time. LEDs indicate when the lithium ion battery needs to be recharged with an orange LED 10-minute warning indicator.

	The award-winning Spectra is said to be the only noninvasive caries-detection aid providing both color and numerical indications of the extent of the decay. Spectra reportedly helps eliminate the guesswork in detecting and diagnosing tooth decay and enhances case acceptance through better patient education.

	Carestream Dental’s latest release of the Logicon Caries Detector 5.1 is said to further automate the caries-detection process and produce improved displays of carious sites, making exams and diagnoses even more efficient than in the past. Logicon 5.1, the only commercially available FDA-approved computer-aided radiographic caries diagnosis software, is designed to be a unique and clinically proven tool that helps practitioners detect and treat interproximal caries at an early stage, enabling minimally invasive treatments.

 Instrument Solutions is intended for use by dentists, hygienists and oral surgeons as an effective tool to aid in the early detection of abnormalities that may lead to oral cancer. The intraoral, cordless, handheld device reportedly uses an innovative three-wavelength optical illumination and visualization system that allows dental professionals to identify oral mucosal abnormalities not visible to the naked eye.

	CariVu is a portable caries detection device that uses patented transillumination technology to support the identification of occlusal, interproximal and recurrent carious lesions and cracks, reportedly providing a much more inclusive detection of conditions. CariVu hugs the tooth and bathes it in safe, near-infrared light. On the resulting images, enamel appears transparent while lesions appear as dark areas. This is said to be so the clinician can see “through” the tooth, exposing its structure and the actual shape, position and size of any carious lesions with very high accuracy without the need for removal of bacteria on the tooth surface.

 Vx is said to be an easy-to-use tool designed to aid in the visualization of mucosal abnormalities during oral examinations. From bacterial infections and inflammation to cancer and pre-cancerous lesions, the VELscope’s tissue fluorescence technology reportedly can help point out oral health concerns that may have otherwise been overlooked. Backed by more clinical research than any other visualization device, the VELscope is the market leader in adjunctive screening technology with more than 25 million screenings performed by 15,000 practitioners in 23 countries around world.

	The CariScreen Caries Susceptibility Test is said to be a simple one-minute chairside bacterial test for assessing patients’ caries risk. The patent-pending CariScreen uses ATP bioluminescence to identify oral bacterial load and has been proven to correlate with patients’ risk for decay. The test reportedly is quick and painless and not only allows you to measure your patients’ risk for decay today but also helps measure their progress as they follow the recommended protocols for reducing risk.

	With oral cancer continuing to rise, Forward Science was founded with a vision to create a simple, efficient and more affordable oral cancer-screening device to save more lives. Given its simple design and lack of per-patient costs, OralID reportedly can be implemented into every hygiene exam, giving clinicians the ability to Shine Light. Save Lives

. With each OralID kit, Forward Science includes a proprietary SmartFilterID

 to easily photo document OralID lesions through any smart device.

	Forward Science Technologies
	855-696-7254  |  

 OSCC is said to be the first and only risk-assessment test for oral cancer. This saliva test is based on the initial discovery and prevalidation work conducted by Dr. David T.W. Wong at UCLA. More than a decade of National Institute of Dental and Craniofacial Research and National Institute of Health-supported research reportedly make SaliMark

 OSCC the world’s most scientifically-validated DNA biomarker test for oral cancer. Simple, accurate and painless, SaliMark

 OSCC is designed to be easily integrated into your oral cancer exam for earlier detection.  

	The Canary System is said to be a precise laser-based system with an integrated intraoral camera that detects cracks and caries not seen with other devices. It reportedly is 25 percent more accurate than bitewing radiographs. The Canary System is reportedly accurate to a depth of 5 mm below the tooth surface and ideal for identifying interproximal decay, caries around and beneath the intact margins of restorations and caries under sealants.

Quantum Dental Technologies
	866-993-9910  |  

 caries indicators reportedly are not made like all the rest. This glycol-based solution is made to facilitate removal of various dentins by making sure the maximum amount of inner dentin is preserved and the infected dentin is removed. Pulp exposure is nothing to fear with Vista-Red

. They help prevent overextracting deep caries.

Vista Dental Products
	877-418-4782  |  

	Visual Solutions (a wholly owned subsidiary of Vista Dental Products), introduced the ESPýOC

 is a said to be a game-changer in the way the dental and medical community visualizes oral cancer. It reportedly is a simple, cost-effective and noninvasive chairside test that provides immediate results for patients with suspicious lesions.

Articles

Every day is the perfect day to screen for oral cancer, but, as we move into November, now is an excellent time to make preparations for Oral and Head and Neck Cancer (OHNC) Awareness month coming up in just 6 months.

The best in oral cancer and caries detection

	Somewhere along the way, something really bizarre happened: The mouth got separated from the rest of the body. After all, we have dentists, and we have physicians. We have dental insurance and we have medical insurance.

The result is the adoption of a notion that what happens in the mouth doesn’t really matter-that they’re just teeth after all … I can always get a denture. But as dental professionals, we understand that it’s not just about teeth. The mouth as part of the gastrointestinal system is home to all kinds of microbes-some helpful and others that are down-right destructive. The challenge is to help our medical colleagues and the patient understand the impact that oral health has on systemic health.

I do not know of any health care provider who would ask a patient with an open wound to take the contents of a petri dish growing P. gingivalis and rub that into the injury, yet the risk for bacteremia is the same in when a patient with mismanaged periodontal disease seeks care for a medical condition without addressing his or her oral health needs. There has been an increased focus in recent years to illustrate the correlation between oral and systemic health and many well designed studies have authenticated this link. Why, then, do we, as a society, continue to dismiss oral health as a second-tier concern?

Some of the areas of medicine where the importance of oral health is obvious are seemingly logical. In the world of oncology, for example, most patients who are planned to be treated with chemotherapy will experience times of immunosuppression where the body is unable to ?ght infection adequately. 

 often go hand and hand with chemotherapy, increasing the risk for a septicemia of oral origin. For patients with head and neck cancer undergoing radiation therapy, poor oral health can lead to increased incidence and severity of oral complications such as 

. Issues like these, when experienced during cancer treatment, can necessitate altering the oncology schedule which can adversely affect the patient’s chance of survival.

“Patients deserve nothing less than oncologists and dentists working for them as a team,” says Dr. David Schwartz, radiation oncologist and chief of the head and neck team at 

University of Texas Southwestern Medical School Radiation Oncology Department

. “The stakes are too high and the interventions are too sophisticated not to have a concerted comprehensive approach to care.”

The need for cooperation between physicians and dentists does not just apply to oncology. Cardiovascular disease, autoimmune issues, organ and tissue transplants, diabetes, immunosuppressive disease like HIV/AIDS, infections and even pregnancy can all bene?t from a combined approach to health care with medicine and dentistry/oral medicine working together. And the list goes on…

Now is the time to bridge the gap that has existed for so long between these two silos of health care. Now is the time to realize the undeniable link between medicine and dentistry. Now is the time to reconnect the mouth to the rest of the body. Our patients deserve it, and many are beginning to demand it. Now is the time to form alliances with medical colleagues in your community and be a part of taking health care to the next level.

 Somewhere along the way, something really bizarre happened: The mouth got separated from the rest of the body. After all, we have dentists, and we have physicians. We have dental insurance and we have medical insurance.

Oral cancer: Come together, right now

	April is Oral and Head and Neck Cancer Awareness Month, a time to pause to consider the ravages of this disease and rededicate our efforts as oral health care providers to do our part to find oral and oropharyngeal cancers at an early stage.

Hopefully, by now, each of us is well aware of the importance of our role to search for signs of oral and head and neck cancer in each of our patients and how we can make a significant impact in the staggering statistics associated with this disease: One American dies each hour of every day from oral cancer.

When found at an early stage, the survival rate is between 80 and 90 percent; but, unfortunately, most oral cancers are discovered at an advanced stage and, as a result, 43 out of every 100 people with oral cancer will die from their disease within five years of diagnosis.

But is that it? Is that all we need to know about oral cancer…to know the stats, and recommit to doing thorough head and neck examinations for all of our patients only to all back into our once-in-a-while-when-I-think-about-it screenings by mid-May? I hope not! This year, I challenge you to learn more about oral and head and neck cancers. Realize that you are a soldier on the front lines against a disease that forever changes the lives of those who are diagnosed with it. Make your commitment against oral cancer last 12 months-not 12 days-then recommit each and every April to do more to make an positive impact on the health, not just the oral health, of your patients.

So, as you strive to learn more about oral and head and neck cancer, here are five things to get you started: my top five reasons to really think about oral cancer:


	With the increased prevalence of infections of the human papilloma virus (HPV), we are seeing occurrences of oropharyngeal cancers in younger and younger patients-sometimes in young adults in their 20s or 30s. HPV is the most common sexually transmitted infection in the U.S. and can be transmitted through genital contact including oral sex. According to 

Centers for Disease Control and Prevention (CDC)

, almost every sexually active person will acquire HPV at some point in their lives. For most, the virus is cleared naturally by the immune system, but in others, it becomes a catalyst that leads to cellular changes causing cancer. Many people with HPV-related oropharyngeal cancers are otherwise healthy and do not match the long-accepted demographic profile of an older male with a history of smoking tobacco and drinking alcohol. For this reason, it is imperative that a thorough head and neck exam be completed for each patient who may be sexually active. Know the warning signs for oropharyngeal cancer as they are sometimes difficult to observe clinically without the aid of nasal endoscopy or a flexible laryngoscope. Even though it may be an uncomfortable discussion, make sure your patients are aware of the risks of HPV-related oropharyngeal cancer and that the causative factor is a sexually-transmitted infection. For more information about HPV, visit the CDC site at 

4. New weapons to help wage war against cancer

 has provided new tools for dentists and hygienists to aid in conducting the most advanced and individualized thorough head and neck examinations ever. A chairside test built upon more than a decade of research from the

 National Cancer Institute’s Early Detection Research Network

 is now on the market. The test measures salivary mRNA transcriptome markers that are discriminatory for oral squamous cell carcinoma. By utilizing information regarding certain gene expression in the presence of cancer, specifically oral squamous cell carcinoma that accounts for approximately 90 percent of all oral and head and neck cancer, the test can detect the presence of early stage squamous cell carcinoma-even carcinoma in situ-and hopefully avoid unnecessary biopsies, or, even better, prompt an urgent biopsy of a lesion that previously might have been approached with a wait-and-see attitude.

3. Oral cancer doesn't affect just the mouth.


	Oral cancer affects the whole person. While the primary tumor may reside in the oral or oropharyngeal anatomical structures, so often, the malignant cells will travel to the lymphatic system. Even the most advanced treatment modalities often come with life-changing effects that prevent pre-cancer function in simple daily tasks such as swallowing and speaking. Immunosuppression and thrombocytopenia may place the oral cancer patient going through chemotherapy at great risk for systemic life-threatening infections or bleeding issues, while external beam radiation therapy may cause blistering of the skin and severe burns and loss of facial hair in men. Oral effects often include long-term or permanent xerostomia, oral mucositis and an increased risk for osteoradionecrosis. Non-oral long-term effects such as carotid stenosis, muscular atrophy and esophageal constriction are often experienced by survivors. And these are just the physical changes. Consider the psychological stress of fighting a potentially deadly disease or the emotional distress of not being able to eat dinner with your family at your favorite restaurant because you cannot tolerate the spices in the food or you are afraid you might choke to death if the food is not pureed. Imagine the loss of identity for those who wake up every morning and see someone else looking back at them in the mirror-a person they do not know-a person does not even resemble their reflection prior to reconstructive surgery. Why wouldn’t we, as health care professionals, do all that we can to prevent anyone from having to suffer through this kind of agony?


	Fortunately, as advances in oncology care are realized, more people are surviving oral and head and neck cancers. Yes, it is true and terribly sad that we lose many good people to this ugly disease each and every day, but for those who live beyond oral cancer, we must be ready to meet their needs. Oral and head and neck cancer survivors deserve our attention to their unique needs. They need oral health care providers who understand their journey, know the limitations of care that are applicable to them as individuals based solely upon their treatment. Cancer survivors of all types are realizing that individualized medicine is the new norm. Individualized care is not some “next wave” that we will see 20 years from now-it is here now. Prepare yourself and your staff to know the needs of oral and head and neck cancer survivors. Be able to offer to them the excellence in care that you provide the rest of your patients by understanding their unique needs. Be willing and able to meet them where they are and realize you can improve the quality of life for an oral cancer survivor by providing him or her the oral health care he or she wants and deserves.

1. You will see these patients in your office.


	With the aging of the Baby Boomer generation, we are seeing an increase in the number of cancer cases. It is estimated that by the year 2024, more than 19 million people in the U.S. will be living with cancer, up from approximately 14.5 million in 2014. As more and more patients are seeking oncology care close to home, there is a new need for dentists and hygienists to know how to care for oral cancer patients. These will be your patients of record…people you have known for years, with whom you have an established doctor/patient relationship. They will want you to take care of them when that time comes. Be prepared. Know how cancer treatment affects not only the intraoral structures, but also how you must be prepared to play a role on their cancer care team. Form alliances with medical and radiation oncologists in your community. Know how you can, and should, be there to manage the oral health of your patient during their battle with cancer and beyond.

 April is Oral and Head and Neck Cancer Awareness Month, a time to pause to consider the ravages of this disease and rededicate our efforts as oral health care providers to do our part to find oral and oropharyngeal cancers at an early stage.

The top 5 reasons to really think about oral cancer

Oral health has found a new seat at the wellness table. Sure, we’ve always tried to prevent caries and structural breakdown of teeth, but with more focus recently being placed on the link between oral health and systemic health, new areas of collaboration between the medical community and the dental community are coming to light.

One of the hottest areas of interest lately is understanding the impact of the human papilloma virus (HPV) on the face of oral cancer. HPV has changed the demographics of disease and has affected who and how dental professionals screen for oral cancer. In years past, most patients presenting with oral cancer were males over 60 years old with a history of either moderate to heavy alcohol consumption or tobacco use, or both. Now, we are seeing people as young as their late teens or early 20s presenting with the disease. We are seeing more oral cancer in women, in individuals with no social history that would contribute to the disease, and who are otherwise healthy. So, the “at risk” group for oral cancer has greatly expanded with a clearer understanding of HPV as an etiological factor for the disease. Because the vast majority of HPV-related cancers occur in the tonsils, oropharynx, base of tongue, posterior pharyngeal wall, and the larynx, the dental professional must adapt screening techniques to properly evaluate these areas as well as they are able. These adaptations may include repositioning the patient to better evaluate the tonsils and throat or referring a patient to an otolaryngologist if clinical signs give the clinician reason to suspect oral cancer might be present, but the primary lesion cannot be visualized. Because of the expanded pool of patients at risk for oral cancer, many dental practices are encouraging patients to make an oral cancer screening part of an annual wellness plan. Much like having a Pap smear, PSA test, or mammogram, an oral cancer screening can detect cancer at a much earlier stage, thus improving the prognosis for the patient should cancer be detected.

Wellness in dentistry extends even beyond just the oral cancer screening. CAMBRA is a method of assessing caries risk and making restorative recommendations based on a patient’s caries risk. The methodology employed by CAMBRA is analogous to a physician using risk information to assess for heart disease. Caries detection technology allows for early intervention of dental decay which may permit the dentist to place a more conservative restoration that preserves natural tooth structure and function while still ridding the tooth (an thus the body) of destructive bacteria. Salivary diagnostics can screen for the presence of periodontal pathogens and even HPV so patients can be aware of susceptibility to periodontal disease or the risk of oral cancer. Through utilization of such technologies, patients can monitor and improve oral health, knowing that in so doing they are supporting good systemic health.

I believe that with a better understanding of the link that ties oral health to systemic health, we are beginning to see a more concerted effort between physicians and dentists. One of the areas where this collaboration is most apparent is the field of dental oncology. Dental oncology is an intersection of dentistry and oral medicine that focuses on the unique and sometimes complicated care of patients undergoing treatment for cancer. The scope of care in dental oncology extends far beyond those patients with oral or head and neck cancer since essentially all types of cancer therapies can wreak havoc on oral hemostasis and present a wide variety of oral complications. As such, communication between the dentist and the medical oncologist, radiation oncologist, and oncological surgeon is imperative. Ideally, the dentist sees the patient soon after the diagnosis of cancer is made and before any surgery or treatment has begun. The dentist must have a clear understanding of the diagnosis and recognize potential oral complications that might be realized before, during, and after treatment. The patient’s hematological status must be closely monitored to ensure that the patient is never at risk for infection or a bleeding episode. Close communication must be maintained throughout the patient’s treatment by all parties of the cancer care team. 

While the need for specialized dental and oral health care may diminish for the cancer survivor whose life returns to normal, many patients require specialized care for the remainders of their lives. This is particularly important for survivors who have received head and neck radiation, those who have received IV-administered bisphosphonate therapies, and bone marrow or stem cell transplant patients. These populations of survivors have special oral health care needs that last a lifetime and have the potential to grow more complicated as the patient grows older. Again, collaboration between the medical practitioner and the dentist is essential to maintain not only oral health, but systemic health as well. Many complications subsequent these treatments can very quickly affect the patient’s overall health and quality of life and, if left untreated or not treated adequately, can jeopardize the patient’s life.

Another population beyond the cancer patient that needs a collaborative effort between medical and dental health care professionals is that of the organ transplant patient. Like the oncology patient undergoing chemotherapy, these patients experience severe immunosuppression. However, unlike the patient with cancer, these patients remain immunosuppressed for the remainder of their lives. Dental clearance is required in most circumstances before a transplant surgery is offered. Again, lab results and clinical findings must be freely exchanged between physician and dentist to ensure that the patient’s oral health status is satisfactory before the commencement of immunosuppressive therapy, and constant follow-up is required as dental complications after transplant services can be problematic. With more and more hospitals across the country offering organ transplants, dentists will be seeing more of these patients in their practices. 

The true value this collaborative effort obviously lies in the level of care provided to the patient, but for the dental office that incorporates level of service into its practice, the benefits are unending. Once a relationship is established between the physician and dentist, patients can be mutually referred between the two practices. This has a bottom-line business benefit for both establishments. The level of treatment acceptance is considerably higher in patients who have been referred by their physician to a dental practice. The dental practice is seen as going above-and-beyond something I refer to a “pedestal factor” when it is willing to care for needs beyond the norm. Physicians appreciate having a practice to refer patients to who can effectively meet the oral health care needs of their patients. It begins and ends with communication! Let the physicians know what you are doing (or can do) for their patients, and that you are willing to work with them, then be the doctor you are! Realize you know more about the mouth and teeth than the physicians who are referring to you that’s why they are referring to you. Provide written reports of your findings, recommendations, and necessary treatments. Realize you are an integral part of the patient’s health care team. And finally, enjoy the reward of knowing you can make a positive difference in the overall health of your patient.

Editor's Note: You can read more thoughts about the collaboration between the medical and dental communities in the January issue of Dental Products Report.