European white paper: oropharyngeal dysphagia in head and neck cancer.

PURPOSE: To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS: Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS: Twenty-four sections on HNC-specific OD topics. CONCLUSION: This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

Outcomes from the first mouth cancer awareness and clinical check-up day in the Dublin Dental University Hospital.

PURPOSE OF THE STUDY: To increase public awareness about mouth cancer, the Dublin Dental University Hospital (DDUH) hosted an awareness day and free mouth check-up in September 2010. The messages of information, self-examination and risk management, and the importance of early detection, were available to all attendees. The role of general dental and medical practitioners in examination of the mouth was stressed. MATERIAL AND METHODS: A questionnaire regarding knowledge about the causes of and risk factors for mouth cancer, and a clinical check-up, were completed. RESULTS: A total of 1,661 individuals (675 male, 986 female) were examined. The mean age was 59.6 years. Just over one-third (36.5%) of those examined required no action, and slightly less (30%) were advised to return to their general dental or medical practitioner (GDP/GMP). Some 21% were advised about self-examination of the mouth, and 8% about smoking cessation. Of the remainder, 52 people (3.5%) were sent for a second opinion. Of these, 30 individuals were referred for further investigation, including biopsy in 27 cases. Following biopsy, five individuals were diagnosed with carcinoma in situ or carcinoma. CONCLUSIONS: The diagnosis of five people with mouth cancers, who may not otherwise have been identified for early treatment, highlights the need for regular mouth examination. It is inappropriate that such an exercise would remain the preserve of the dental teaching hospitals, and it is vital that all dentists take on the responsibility for regular mouth checks for all of their patients. More should be done to encourage those identified as high risk to visit their dentist. There is a need for recognition of the additional resources required for the detection and timely management of such cancers.

Oral and neck examination for early detection of oral cancer--a practical guide.

Cancer of the head and neck region presents a challenge since, unlike other areas of the body, the boundaries are not always easy to delineate. The functional morbidity associated with head and neck cancer and its treatment are considerable. Head and neck cancer is described as cancer of the lip, mouth, tongue, tonsil, pharynx (unspecified), salivary gland, hypopharynx, larynx and other. Oral cancer refers to cancers of the lip, tongue, gingivae, floor of the mouth, palate (hard and soft), maxilla, vestibule and retromolar area up to the anterior pillar of the fauces (tonsil). When patients present with oral cancer, over 60% of them have regional (lymph node) and sometimes distant (metastatic) spread. The overall five-year survival rates for oral cancer average at between 50 and 80%, depending on the stage of the disease, varying from 86% for stage I to 12-16% for stage IV. The incidence of 'field cancerisation'/unstable oral epithelium is high (17%), and even after successful treatment our patients need to be monitored for dental care and further disease. Unlike other areas in the body, the oral epithelium is readily accessible for examination and even self-examination. Dentists and dental hygienists are effective clinicians in the examination of the oral cavity for mouth cancer. An oral and neck examination must be part of every dental examination. An examination protocol is suggested here, which is similar to, but more detailed than, the standardised oral examination method recommended by the World Health Organisation, and consistent with those protocols followed by the Centres for Disease Control and Prevention and the National Institutes of Health.

Oral cancer: knowledge, practices and opinions of dentists in Ireland.

PURPOSE OF THE STUDY: Early detection of oral cancer improves prognosis, but the malignancy is often detected at advanced stages, when more aggressive therapies, often with poor and devastating outcomes for the patient, are needed. Oral cancer can be detected by opportunistic screening of oral mucosa without need of sophisticated equipment. Dentists are important in primary and secondary prevention of oral cancer; therefore, assessing their knowledge, opinions and practices is crucial. MATERIALS AND METHODS: A questionnaire survey of dentists was conducted regarding knowledge of risk factors and diagnostic concepts of oral cancer, practices of primary and secondary prevention, and opinions of the effectiveness of formal undergraduate training for early detection and prevention of this disease. The survey explored dentists' potential training needs. RESULTS: Dentists appear to be generally knowledgeable regarding diagnostic concepts and risk factors. A total of 89% reported providing screening of intra- and extra-oral soft tissue to adult patients (18+) to exclude oral cancer. A total of 27% always provide tobacco use cessation counselling, and 12% provide alcohol moderation/cessation assistance. A total of 54% felt adequately trained to palpate the lymphatic nodes associated with oral cancer. Over half of dentists reported that their knowledge of and training on oral cancer was current; however, 74% reported lack of patient education materials regarding prevention and early detection of oral cancer. CONCLUSIONS: The survey findings suggest that dentists are underutilised in the prevention and early detection of oral cancer, and one of the barriers is lack of training. Dentists' knowledge and skills must be reinforced and systematically updated by continuing professional education. Greater emphasis should be placed on the fact that dentists have a larger role to play in the prevention and detection of this malignancy at its early, curable stages.

Oral health needs of the head and neck radiotherapy patient: 1. Epidemiology, effects of radiotherapy and role of the GDP in diagnosis.

UNLABELLED: Head and neck cancer represents a heterogeneous group of neoplasms affecting a number of sites in the aerodigestive tract, histologically primarily epithelial in type. Most are sensitive to a treatment regime of ablative surgery followed by radiotherapy. The incidence in Ireland of head and neck cancers is approximately 11.8 per 100,000 population and is the 8th commonest cancer in males and the 16th in females. Many of these cancers will manifest with oral signs and symptoms thus placing the GDP in the unique position of being able to detect and positively influence outcomes: the GDP also has a vital, proactive role to play in supportive care before, during and following surgery and radiotherapy. CLINICAL RELEVANCE: The aim of this paper is to review the rationale for the different treatment modalities and the oral/dental side-effects of each.

Oral health needs of the head and neck radiotherapy patient: 2. Oral and dental care before, during and after radiotherapy.

UNLABELLED: Head and neck cancer represents a heterogeneous group of neoplasms affecting a number of sites in the aerodigestive tract, histologically primarily epithelial in type. Most are sensitive to a treatment regime of ablative surgery followed by radiotherapy. The incidence of head and neck cancers is approximately 11.8 per 100,000 population and is the 8th commonest cancer in males and the 16th in females. Treatment comprises ablative surgery with, in 60% of cases, radiotherapy. The oral and dental sequelae of such treatment, and their management, is described. CLINICAL RELEVANCE: Many of these cancers will manifest with oral signs and symptoms, thus placing the GDP in the unique position of being able to detect and positively influence outcomes. As well, the GDP has a vital, proactive role to play in supportive care before, during and following surgery and radiotherapy.

5.2 Ethics, equity and global responsibilities in oral health and disease.

The charge of this Section is ethics and global responsibilities in oral health and disease. Oral health is determined by the same factors as those for general health. To a limited extent, the level of oral health care and dental education. The philosophy and organization of the health care system and dental education, therefore, are key determinants of oral health. Dental education has expanded in many countries where there has been an increase in wealth. Unfortunately, there has been no concomitant increase in the number of dental educators. This is a problem throughout the world. This present situation raises certain ethical issues with regard to professional responsibilities. It also raises some important questions for dental education. This Section has chosen to focus its efforts on examining two issues: * What can be done within dental schools? * What can be done external to dental schools - either individually or collectively? The best practices identified are more akin to goals, as it is recognized that, in a world in which there are enormous variations in economic, environmental, social, and cultural features, a single uniform set of practices is impracticable. The central core value identified is the realization by students, and faculty/teaching staff of the quest of life-long learning against a background of the social and ethical responsibilities of health professionals. The conclusion of the group is that biology is not the sole determinant of health. Understanding the role of social, economic, environmental and other factors in determining health status is critical if greater equity in dental education and care are to be achieved.