Dentists advised by the DDU to be mindful of signs and symptoms of oral cancer

The Dental Defence Union (DDU) is advising dentists to be aware of the signs of oral cancer in an article featured in the latest edition of the DDU journal which is published today.

The DDU opened 104 files between January 2013 and August 2020 relating to oral cancer, including 69 claims. In the majority of these cases, the dental professional allegedly failed to check the patient for oral cancer during their check-up, did not diagnose a suspicious lesion, or there was a delay in referring the patient to a specialist.

Typically, dental professionals are in an ideal position to spot suspicious lesions or ulcers but the aggressive nature of the disease means that missing an opportunity to make an early diagnosis or prompt referral can have serious consequences for a patient's prognosis.

Making an early diagnosis has become more challenging due to the restrictions placed on dental practices in response to COVID-19. Patient interactions have been significantly reduced over this period, particularly during alert level 4.

Eric Easson, DDU dento-legal adviser said:

"The lack of in-person consultations, due to COVID-19, has meant that while it was still possible to refer patients for suspected oral cancer, it was not possible to examine patients who may be unaware of lesions. As a result, only patients concerned about lesions who contacted their practice are likely to have been referred.

"This is obviously concerning, especially as the Oral Health Foundation's The State of Mouth Cancer UK Report 2019/2020 states that oral cancer cases have increased by 64 per cent in the last decade with 2,701 people dying from the disease last year. 

"Consequently, it is 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 symptoms but there is no obvious problem, be prepared to seek a second opinion and investigate further if necessary."

To reduce the likelihood of a delayed diagnosis, the DDU advises members to: 

  • Consider if a patient is at risk. Make sure you have taken and documented a complete social history. Explain why your questions are relevant if it appears a patient doesn't want to divulge potentially important information.
  • Record your examination findings, even negative ones, in the clinical notes. Make a careful note of suspicious lesions or swellings along with your treatment plan and advice. Using mouth maps and photographs may be helpful.
  • If you suspect an abnormality might be cancerous, you should make an immediate referral to an appropriate specialist for further investigation, in line with the referral guidelines produced by NICE or SIGN. Your practice should have a protocol in place to ensure referrals are made efficiently and followed up appropriately.
  • If a suspicious lesion is found, explain to the patient what you have found and what happens next. It is advisable to explain how long they can expect to wait before receiving an appointment and to make sure they keep you updated if there is any delay.
  • Follow up oral cancer referrals to make sure they have been received and that the patient has been sent a consultation appointment.

Read the full DDU journal.

This page was correct at publication on 09/09/2020. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.