Download To: Dr. Kelvin Mah, Dentist and Chief Executive Officer at Smile City

To:
Dr. Kelvin Mah, Dentist and Chief Executive Officer at Smile City Square
From:
Jessica Morris
Date:
January 28, 2015
Subject: Proposal for Improving Oral Cancer Screening Protocol at Smile City Square,
Vancouver
Introduction
According to the Canadian Cancer Society 4,300 Canadians were diagnosed with oral cancer in
2014. These rates have risen over the past two decades and are expected to continue to do
so. Traditional risk factors include tobacco and alcohol use; however a universal trend has revealed
an increase in oral cancer among young adults without apparent risk factors. Early detection is
associated with a vast improvement in survival rate; however oral cancer is often identified at an
advanced stage. It is estimated that nearly half of those diagnosed with oral cancer die within five
years of diagnosis.
In 2006 the World Health Organization issued a call to action, asking dentists to play a major role in
early detection by incorporating regular oral cancer screenings into their routine dental examinations.
The BC Oral Cancer Prevention Program partnered with the College of Dental Surgeons of BC to
develop the following Guidelines for Early Detection of Oral Cancer:

Complete a head, neck and oral soft tissue exam at all general dental care visits using a
standardized step-by-step approach to assess for oral cancer

Adjunctive screening tools (i.e. toluidine blue staining and/or direct fluorescence
visualization) may assist with early detection when implemented in conjunction with a head,
neck and soft tissue oral cancer screening
Statement of Problem
Smile City Square currently lacks an explicit standardized step-by-step approach to assess for oral
cancer. It has not be established who will perform a head, neck and oral soft tissue exam, how it will
be done and how often. Furthermore, existing documentation protocol does not require the clinician
to note that an oral cancer screening was completed unless an abnormal finding is discovered. As a
client’s chart serves as legal documentation of services provided, failure to note the completion of an
oral cancer screening via a head, neck and oral soft tissue exam, could leave the clinician and
practice vulnerable to speculation of negligence.
Smile City Square does not currently implement the use of adjunctive aids during oral cancer
screenings. Although use of these adjunctive aids is optional, their inclusion may assist with early
detection when they are used in conjunction with a thorough head, neck and oral soft tissue exam.
Proposed Solution
A proposed solution is to develop a detailed, step-by-step protocol regarding how to perform an oral
cancer screening using a thorough head, neck and oral soft tissue exam. This approach should be
taught to all Smile City Square dental hygienists and the dentist (Dr. Kelvin Mah). This includes
improving documentation practices to ensure a notation is made in each client’s chart indicating the
date the oral cancer screening was completed, by whom, and the findings. The inclusion of an
adjunctive aid (i.e. toluidine blue staining and/or direct fluorescence visualization) should be
investigated to assess the benefits and risks of its use.
Scope
To assess the feasibility of the proposed solution aimed at improving oral cancer screening protocol
at Smile City Square, I plan to pursue the seven areas of inquiry:
1. What are the step-by-step guidelines other dental offices in BC are using to complete a
head, neck and oral soft tissue exam to assess for oral cancer and how effective are they?
2. What are the documentation practices regarding oral cancer screenings in other dental
offices in BC?
3. What training is required to competently perform a head, neck and oral soft tissue exam to
assess for oral cancer?
4. Which adjunctive aids are currently being used to assess for oral cancer in other dental
offices in BC and how effective are they?
5. What is the cost associated with purchasing an adjunctive aid?
6. What training is required to competently use an adjunctive aid to assess for oral cancer?
7. How long will it take to screen each patient for oral cancer using the proposed protocol?
Methods
My primary data source with include interviews with other dentists and dental hygienists in BC to
assess their current oral cancer screening and documentation protocol. These interviews will be
conducted in person or over the telephone. Additionally, I will contact the BC Cancer agency via
email to explore their current recommendations and experiences they have had regarding what
works well in other dental offices.
Secondary sources will include publications from the Canadian Dental Hygienists Association,
Canadian Dental Association and College of Dental Hygienists of British Columbia regarding their
current recommendations for oral cancer screening and documentation.
Qualifications
I have been practicing as a Registered Dental Hygienist for the past nine years. I am extremely
familiar with preforming head, neck and oral soft tissue exams and can use this experience to help
develop a step-by-step approach to assess for oral cancer at Smile City Square. Next April I will
complete my Bachelor of Dental Science in Dental Hygiene at the University of British
Columbia. Part of my degree level training involved multiple literature reviews as a means to assess
current knowledge on various dental hygiene subjects. Being able to evaluate current literature
regarding oral cancer and screening techniques, including adjunctive aids, will assist with making
evidenced based decisions regarding patient care at Smile City Square.
Conclusion
Smile City Square would benefit from a more streamlined process of how and when to perform oral
cancer screenings to ensure their patients are receiving consistent and quality care. As oral cancer
rates continue to rise, such protocol would assist with early detection and increase the likelihood of
successful treatment. Ensuring proper documentation of all oral cancer screening exams is a legal
necessity and will protect Smile City Square from possible accusations of failure to provide such
services. The use of adjective aids could assist clinicians with early detection and as such, it is
worthwhile to explore their uses and limitations.