Oral cancer awareness

ORAL CANCER SCREENING
I remember on qualification, or at least I seem to remember that I would see two Oral Cancers in my practising lifetime. I distinctly remember the first one, which was a classic in an alcoholic with a loose tooth, in my second year as an associate around the time I made my trip to the GDC. The PA showed a large radiolucency beyond the film's perimeter, so I referred him to the Dental Hospital. He returned after an OPT, and was about to lose half his mandible. He was really annoyed with me.

animation oral cancer check from tony smith on Vimeo.

Many years later, a regular patient missed her appointment and came in overdue by a few months, it transpired she was undergoing radiotherapy for her SCC. A dentist from the new practice inside Sainsburies, where she worked, had asked for volunteers to try out the new surgery. When I apologised and said I must have missed it, she refused my apology and stated I always checked her tongue. I never diagnosed it. One of my friends and a family member have since developed oral cancers, and we arranged for a Peer review session by the local oral surgeon who's team had treated my friend. During the discussion, I came to appreciate how rapidly an SCC can develop. While we need to check patients ourselves, they need to be made aware and check themselves monthly for this deadly disease which is increasing in prevalence, especially in younger patients, due mainly to the HPV virus. I was never any good at feeling lumps and bumps. I asked my patients if they had noticed any swellings recently. My relative noticed their swelling a few months before I could feel it. Fortunately, it was a benign salivary tumour.
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Oral Cancer Awareness 3 from tony smith on Vimeo.

I made a few videos for my App, and I'll add them to this as one is about 20 minutes long and explains how we can fast-track diagnosis using these innovations for the iPhone. I'll include the spreadsheet I made, which is the "scoring" behind the early tooth loss and oral cancer risk. There is no consensus on the scoring, as some say a heavy drinker and smoker is 30 times more likely to get oral cancer, and some say 36. The scoring is not a diagnostic tool, it's a traffic light system as an indication for the user.

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Oral cancer screening from tony smith on Vimeo.

In the conversations I have had with a different NHS innovation company on secure encrypted images being sent to a triage centre, I had a typical setback. Their concern was the public may think the App is a medical device, and therefore there was a potential of getting sued. They wouldn't be interested because of the potential risk, and the 100s of people who could quickly be reassured would lose out. As stated elsewhere and in Jonathon Sumptions Reith's lecture, lawyers have encroached on medicine. In 1911 there was 1 lawyer for every 3000 people. Now it's 1 to every 400. They need to do something, and our litigation rates are twice as high as the USA's when I qualified. The unfortunate outcome is we become risk averse, deskill or specialise and charge more, but general dentistry is beyond the reach of the public, and they don't attend regularly. I did a survey and asked if people would prefer to check themselves once a month or get checked yearly by a dentist. 
Once a year was the overwhelming response.
If the system is wrong, we need to fix it. It would seem we need to pay a better lawyer than the ones lurking at DLP.

If we extend our recall periods, we can signpost the public to take ownership of their health. It will cost us nothing if it's on their mobile phone with a reminder for signs of all cancers.

Disruptive innovation applied to dental health from tony smith on Vimeo.

Poster link
https://www.dropbox.com/s/9vywphajsfg889n/Oral%20Cancer%20Poster.pdf?dl=0
Scoring Link
​https://www.dropbox.com/t/yAtMNhJxba7QYZp0