Mouth Cancer is the 6^th commonest cancer worldwide and mortality and morbidity form the disease is high and incidence is increasing.  More than 80%  of these cancers will be oral or oropharyngeal squamous cell carcinomas. Risk factors include, increasing age, tobacco use, excessive alcohol use, immunosuppression, poor diet, a history of potentially malignant disorders (PMDs) or malignant disorders. Survival rates are dependent on stage of presentation and with around 70% being diagnosed a late stage prevention and early detection is important.

The aim of this guidance is to provide clinicians with updated evidence-based recommendations and suggest a clinical pathway regarding whether and when to use these adjuncts as triage tools for the evaluation of adult patients with no clinically evident lesions and clinically evident lesions, including PMDs, in the oral cavity.

Methods  

The guideline development panel followed the methodological approaches as laid out in AGREE (Appraisal of Guidelines Research & Evaluation reporting checklist II) and the GIN-McMaster Guideline Development Checklist.

The guideline scope included patients with no lesions, innocuous or non-suspicious lesions, lesions suspected to be potentially malignant (that is, PMDs), and malignant lesions (that is, OSCC) in the oral cavity but not sarcomas or carcinomas of the lips, oropharynx, and salivary glands.  The key target audience were general and specialty dentists, physicians and physician’s assistants, dental therapists, dental hygienists, nurses, and nurse practitioners

A systematic search was undertaken and pre-existing systematic review updated and evidence on patients’ values and preferences evaluated. The GRADE evidence-to-decision framework was used  to formulate the recommendations and consultation with internet and external stakeholders was undertaken on two occasions.

Recommendations

The panel made one good practice statement and 5 recommendations. The quality of the evidence supporting the recommendations was low to very low means that the strength of the recommendations was conditional.  The panel also provide a clinical practice flow chart. The detailed recommendations and flow chart are available in the form of a chairside guide at the ADE-EBD website.

Comments

This well-developed clinical practice guideline updates a 2010 guideline on “Evidence-based Clinical Recommendations Regarding Screening for Oral Squamous Cell Carcinomas,”  using the internationally recognised AGREE and GRADE approaches. Three key recommendations highlighted on the main page of the ADA-EBD webpage are important for all members of the primary care dental teams.

• Clinicians should obtain an updated medical, social, and dental history and perform an intraoral and extraoral conventional visual and tactile examination in all adult patients.
• For patients with suspicious lesions, clinicians should immediately perform a biopsy of the lesion or refer the patient to a specialist.
• Salivary and light-based adjuncts are not recommended for evaluating lesions for malignancy.

Links

Primary paper

Lingen MW, Abt E, Agrawal N, Chaturvedi AK, Cohen E, D’Souza G, Gurenlian J,Kalmar JR, Kerr AR, Lambert PM, Patton LL, Sollecito TP, Truelove E, Tampi MP, Urquhart O, Banfield L, Carrasco-Labra A. Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity: A report of the American Dental Association. J Am Dent Assoc. 2017Oct;148(10):712-727.e10. doi: 10.1016/j.adaj.2017.07.032. PubMed PMID: 28958308.

Other references

Dental Elf – 25^th Nov 2013

 

Oral examination to detect potentially malignant disorders and mouth cancer

Picture Credits

By Aitor III (Own work) [Public domain], via Wikimedia Commons