Incorporating More Oral Pathology in Your Dental Practice

Episode #418 with Dr. Ashley Clark

Survival rates for oral cancers are not great. So, the best thing to do is to actively prevent them.  And today, Kirk Behrendt brings in Dr. Ashley Clark, Division Chief of Oral Pathology at the University of Kentucky College of Dentistry, to share the importance of early detection, the steps to take when you come across a case, and how to communicate your findings without terrifying your patients. Screening every patient, every time, can help save a life! To learn more, listen to Episode 418 of The Best Practices Show!

Main Takeaways:

Early detection is critical to preventing oral cancers.

Screen every patient, every time, for oral cancer.

Adequately train team members to look for signs.

Never ignore leukoplakia. It can become cancerous.

Communicate clearly without scaring your patients.

Quotes:

“Oral cancer is probably the biggest thing we deal with — the most important thing that we deal with, specifically squamous cell carcinoma — and survival rates aren't getting any better. They really haven't significantly improved. So, my passion is to get the information out there, catch it before it turns into cancer. That's my main goal, is to educate as many general dentists, specifically, as possible on how to find leukoplakia, what it looks like, what it can mimic, and what to do about it so we can hopefully prevent these oral squamous cell carcinomas from happening.” (2:25—3:02)

“The five-year survival rate for oral cancer that is HPV-negative is 45% to 50%, overall. And that doesn't include the fact that they're going to have a pretty disfiguring surgery to try to get the cancer out, plus or minus radiation where they might lose saliva and have to deal with those quality-of-life issues. So, if we can catch leukoplakia as it’s in its dysplastic phase, surgically removing it lowers that risk of that patient having oral cancer by 50%. So, that's where we are. I will say that the rates of HPV-negative oral cancer have declined, and that correlates with the decline in smoking. But the survival rates still aren't great.” (3:14—4:04)

“[The decline in HPV-negative oral cancer risk] directly correlates with the decline in smoking. About 80% of patients with HPV-negative oral cancer are pretty heavy smokers — or people who smoke pretty heavily, I'd rather say. But one interesting thing that’s happening is between the ages of 18 and 44, there's been this cohort of young women who have been getting tongue cancers without any risk factors — no HPV, no tobacco, no alcohol. So, that's another thing I like to get out. Don't ignore your 30-year-old female patient who has a white tongue lesion, because incidents have grown 0.06% every year for like 20 years. So, that's another group that might be getting overlooked.” (4:09—4:56)

“I think other healthcare professionals who are focusing on the teeth might forget to look at the soft tissue. That's not a value judgment — I did it myself several times when I was in charge of looking at teeth. I forgot, or I was focused in on that pathology. So, I think it could be really easy to focus in on the crown you're doing and forget about doing an oral cancer screening. So, I think doing them every patient, every time, is one thing upon which we could improve.” (5:34—5:57)

“Another [important] thing is to not ignore leukoplakia, especially if it’s on the gingiva. Sometimes, leukoplakia doesn't really look that scary — especially proliferative verrucous leukoplakia. Initially, it doesn't look that scary. But if it’s left untreated, nearly 100% will eventually turn into cancer. So, don't ignore things that could come down the road.” (6:04—6:26)

“I train a lot of dental hygienists. And they actually find a ton of lesions, in my experience. They...