Mouth cancer diagnosis – be safe not sorry

DDU urges dentists to be safe not sorry with mouth cancer diagnosisIn support of Mouth Cancer Action Month, Sue N’Jie highlights the dentolegal risks of missing a mouth cancer diagnosis.

Mouth cancer can be a devastating disease for those affected. Dentists are in an ideal position to spot suspicious lesions or ulcers.

November is Mouth Cancer Action Month. It is an important opportunity to raise the profile of the illness and to know what signs and symptoms to look out for.

According to the Mouth Cancer Foundation, around 60,000 people will receive a mouth cancer diagnosis over the next decade. Survival chances greatly increase when detected and treated early.

If there is a delay in mouth cancer diagnosis, it can be devastating for patients and their families. In the Dental Defence Union’s (DDU’s) experience, it can also result in a negligence claim, complaint or General Dental Council (GDC) investigation for the dental professional concerned.

It’s important to know how to spot the possible signs and respond appropriately.

Common risk factors for mouth cancer include smoking and heavy drinking. The use of smokeless tobacco, chewing betal quid, HPV infection and poor diet also increases the risk.

Age is also a factor, with people over 40 more likely to receive a mouth cancer diagnoses. Though it affects more young than previously.

The DDU opens a handful of files each year to help dentists with allegations of failing to diagnose oral cancer. Over a recent five-year period, we opened 63 such cases. Of which the majority (53) involved allegations that the dental professional failed to check the patient for oral cancer during their routine dental examination, did not make a prompt diagnosis or delayed referring the patient to a specialist in good time. Sadly, in at least four of these cases, the patient died.

Low threshold of suspicion for mouth cancer diagnosis

Even if you inspect patients for suspicious lesions as part of routine examinations, it’s important to keep up to date. Indeed, the GDC recommends all registrants complete continuing professional development in the early detection of oral cancer.

It’s also advisable to have a low threshold of suspicion when it comes to any lesion or swelling. Particularly when the patient is in a high-risk group. If patients themselves complain of soreness, but there is no obvious problem, be prepared to seek a second opinion and investigate further. Record any suspicious lesions or swellings in the clinical notes. Along with your treatment plan and advice to patients.

Prepare to refer

Dental professionals who suspect an abnormality might be cancerous should make an immediate referral to an appropriate specialist for further investigation, in line with the referral guidelines produced by the National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network.

Your practice should have a protocol in place to ensure referrals are made efficiently and consistently.

The DDU strongly recommends all practices consult their local hospital about referral procedures. Then make the whole dental team aware of what to do.

When explaining to the patient what you have found and what happens next, it’s a good idea to tell them how long they can expect to wait before receiving an appointment with the specialist. And advise them to contact you if there is any delay.

However, the DDU also recommends chasing up mouth cancer diagnosis referrals. This is to ensure they have been received and the patient has been sent an urgent consultation appointment (and to make a record of having done so).

Brush up your knowledge

Other useful resources include Cancer Research UK’s Oral Cancer Recognition toolkit. This illustrates the red flags that should lead to prompt referral to secondary care.

In addition, the Department of Health’s Delivering Better Oral Health is an evidence-based toolkit. It includes useful advice, particularly the sections on smoking and tobacco use, alcohol misuses and helping patients to change their behaviour.

Clearly record your findings

Records are scrutinised when a claim or complaint arisis. As with any clinical examination, it’s important that the records show details of your examination, findings – negative and positive – mouth cancer diagnosis, recognition and referral, and any follow-up required.

It’s also important you record whether you’ve identified and discussed particular risk factors with a patient. Such as alcohol, smoking (or a combination of the two) or betel quid use.

Full and detailed contemporaneous notes are essential with a detected suspicious lesion. These include a detailed record of your telephone (or other) correspondence with patients, relatives and specialists.

Better safe than sorry

The incidence of oral cancer is on the rise and increasingly observed in young adults. Some without a history of predisposing factors. Therefore, we would strongly advise dental professionals not to assume that mouth cancer will not arise in individuals who do not use alcohol or tobacco or have lifestyles not out of the ordinary.

Perhaps the most important rule when it comes to mouth cancer diagnosis is that it is always better to be safe than sorry.

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Published first in Dentistry magazine. If interested in signing up to receive Dentistry magazine, visit

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