Eileen Morrissey, RDH, MS

	June 7, 2010 | modernhygienist.com
	web exclusive

Part 1: The importance of oral cancer screenings

	Of late, there has been attention highlighted on the undisputed necessity that hygienists provide an oral cancer screening for every patient at his/her recare visit. In many offices, this does not happen. Despite that all of us were trained to do so, for whatever the reason, some of us have allowed this important component to fall by the wayside.

	I contribute this perspective, because while I’m associated with two dental offices permanently, I also provide temporary hygiene services in a variety of dental practices. I cannot begin to tell you how many times I perform the screening in new settings, and the response from the patient is something is: “What is this? No one has ever done that for me in the past…”

	Today’s article has a two-fold message. 1. To reiterate the importance that we all take the time to provide the screening; and, 2. To share with you how one doctor has chosen to integrate adjunctive oral cancer screening technology into a practice I am associated with.

	I don’t see the need to go through the grim oral cancer statistics with readers again, mainly because we cannot open any dental hygiene journal or magazine today without seeing the important attention this topic has received. Suffice to say that one person dies every hour in the US as a result of oral cancer. As far as why some RDHs and doctors have gotten away from providing the screening, there may be many reasons. Lack of time, the doctor provides the exam, we simply stopped doing it, or we just forgot how, to name a few. It doesn’t really matter; let us move forward from here. Not only do we need to provide the screening; we need to make certain our patients have the awareness that we are doing so.  An efficient oral cancer screening can be accomplished in two minutes, according to Dr. Howard Glazer of the New Jersey AGD*2. A patient that is preoccupied, exhausted, anxious etc. may “zone out” during the procedure. I recommend that you state to the patient what you are doing and why you are doing it, so that you create awareness that this valuable service is being provided. Be consistent, and provide an oral cancer screening it at every recare visit.

	If you are rusty and would benefit from a coaching tutorial, visit the following website. www.nidcr.nih.gov, or call 301-402-7364. A short powerpoint can be downloaded in said format, or as a PDF handout, with images that you can study for a memory refresher. And remember, it does not matter that you may not remember the names of all anatomy. What matters is that you are consistent, and provide the screening each and every time, so that you are quickly able to recognize anything that deviates from the norm. You can then bring it to your doctor’s attention.

	And…ponder this one. (It was a question that recently came up at my “Ultimate Recare” seminar.) What would you do if you found an area of concern that you brought to your doctor’s attention, and he responded by stating, “Let’s check it at the 6 month recare visit.” What if it was a finding that really, really worried you? I’d love to hear stories from readers. Email me at eemorrissey@aol.com and I’ll provide a follow up article on Modern Hygienist.com. Feel free to be anonymous.

	Lastly, I wanted to share the approach one of my employers is using regarding ancillary oral cancer screening technology. We began using the Velscope in our general dental practice several months ago. Dr. McDermott felt strongly about integrating the technology as an adjunct to the conventional screening that both he and his two hygienists provide routinely. For those of you who are unfamiliar, Velscope is a technology that allows us to see above and beyond what we can see with the naked eye. I have heard some doctors use as an analogy, a pap smear. “The gynocologists don’t just inspect; they have the cells looked at more closely under the scope.” (Regardless of how accurate or not that analogy might be, it seems to be one that patients can relate to and understand.)

	I should share with you first, that I have temped in a number of practices that have also introduced advanced oral cancer screening technology. Some were offering ViziLite Plus; others, the Velscope. In central New Jersey, the majority of practices that were providing these services were charging the patient an additional $60-$65 above and beyond traditional maintenance visit and exam fees. I learned from a doctor just today, that the companies provide a recommendation as to what doctors should charge.

	What I observed, in general, as I frequented practices “out there”, was that many patients were declining the adjunctive technology. Because insurance has not yet caught up with the importance, patients simply did not wish to absorb the additional fee. Many had not had an initial baseline; and those that did, and had received a clean bill of health, were declining subsequent exams, and setting their own frequency as to when they would allow it to be provided. Now, granted, I’m in these practices only a day here and a day there, so I can only comment on what I saw to be a general trend.

	I want to commend Dr. Patrick McDermott of Freehold, NJ, on his unique approach. He is charging $25 only for the adjunct Velscope exam. Because it’s only $25, patient acceptance rate is significantly higher. Of 8 patients offered the technology on Thursday of last week, I noted a 100% acceptance rate. Since he is charging such a nominal fee, the patients are less concerned about whether or not insurance will reimburse. Dr. McDermott is achieving his goal of getting the technology accepted by patients in the practice. It’s too early to tell if they will continue to accept it, but I have to believe they will.

	Kudos to him, and there is a message here for other practices. This technology is expensive to purchase, and the author recognizes general anxiety from doctors about getting it paid for. I look at Dr. McDermott’s approach and believe it will happen sooner with a reduced fee. If you truly want your patients to participate in the technology, which is what this is really about, consider doing as Dr. McDermott is.

Eileen Morrissey, RDH, MS, is a contributing editor for Modern Hygienist. 

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 June 7, 2010 | modernhygienist.com web exclusive  Part 1: The importance of oral cancer screenings    Photo: Trimira Clinical Image Library

Importance of oral cancer screening: Consider this perspective

	Years ago I became bored with my workout routine, so I decided it was time to make a change. I grabbed my tennis shoes, took the second mile of my three-mile run, turned around, and walked it backward. My inspiration came from hearing about the work of the great coach Vince Lombardi, who ran his players backward as part of their training.
	
	Apparently, a significant percentage of folks out there are into this fad known as retro exercising. It’s every personal trainer’s horror show, and many experts say there are ample reasons why people should not participate.
	
	However, I looked at what I perceived as the benefits and found myself addicted to what has become a frequent segment in my workout. Walking that one-mile backward is gratifying physically, emotionally and mentally, and I have learned how to do it safely. Why am I so hooked? Maybe it’s because I’m using muscles I don’t ordinarily use, or maybe it’s because I frequently see a passer-by smile. Maybe I was drawn to it because I know I always have walked to the beat of a different drum.
	
	The surprise benefit (and the one I stumbled on accidentally) is in the mental arena. It turns out my newfound pastime inspires my creative genius. When I’m “stuck” on something, or in pursuit of a new idea, I am more motivated than ever to engage in this activity.

	When I walk backward, I am putting myself in a different perspective, and the actual physical inversion inspires me to look at my challenge from a different angle. More than once, I have brainstormed ideas that, at first consideration, appeared totally backward. I found, however, that these ideas led me to my solutions. It’s happened too many times to call it coincidence.

	
	How might we apply this perspective to a recare visit? The concept of polishing first, before scaling, is one example. For many, this might be a totally backward sequence. Out of box, and off the wall. Consider this: A doctor I once worked with is convinced hygienists can potentially convert an incipient carious Class V lesion into an area that requires a restoration by unknowingly using the ultrasonic on it for deplaquing biofilm. His contention supports the rationale for polishing first to make sure we are fully aware of what and where we are about to scale. Another benefit? Polishing first, with a therapeutic agent such as GC America’s MI Paste, can help make a sensitive patient comfortable during an ultimate recare visit.    

	I’m not suggesting walking backward will become your forte. And I must admit, I typically (unless my patient is sensitive) continue to scale first, followed by my own version of selective polishing. I do recommend, however, that if you are “stuck” to consider an out of box approach. Walk either yourself, or your routine, backward and you may be pleasantly surprised at the outcome.

 Years ago I became bored with my workout routine, so I decided it was time to make a change. I grabbed my tennis shoes, took the second mile of my three-mile run, turned around, and walked it backward. My inspiration came from hearing about the work of the great coach Vince Lombardi, who ran his players backward as part of their training.