The Routine Dental Exam: The First Line of Defense Against Oral Disease

Oral diseases present a global problem, imposing severe health and economic burdens on approximately 3.5 billion people worldwide. The Centers for Disease Control and Prevention (CDC) report that over 40% of adults have experienced mouth pain within the last year and Americans spend more than $124 billion annually on dental care alone.

The most common and consequential oral health conditions include dental caries, periodontal disease and oral cancers. The first two are nearly ubiquitous – more than 90% of adults have experienced tooth decay, and nearly half of adults age 30 and older have some form of gum disease. As for oral and oropharyngeal cancers, though less common than other conditions, the consequences can be much more severe. These diseases have an overall 65% 5-year survival rate and, of the predicted 53,260 new oral cancer cases in the United States in 2020, an estimated 10,750 deaths will occur.

Despite their prevalence and risk, most oral diseases are treatable, if not entirely preventable, with the right approach to care. While quality at-home care and dietary and behavioral habits are undoubtedly essential to maintaining good oral health, professionally administered dental examinations act as the first line of defense against oral disease. Optimal health outcomes are highly dependent on early detection, and research indicates that routine screenings can significantly reduce the morbidity associated with dental caries and periodontal disease and the mortality associated with oral cancer.

Additionally, early detection in the preclinical phase, followed by preventive measures to arrest disease progress, will likely produce secondary benefits including less time spent chairside per patient, more time for personnel to treat other patients, and cost savings for both patients and third-party providers. For these reasons, regular comprehensive dental exams provide patients the best chance at improving their health and quality of life while allowing practitioners to deliver a higher standard of care.

Early detection in the preclinical phase, followed by preventive measures to arrest disease progress, will likely produce secondary benefits including less time spent chairside per patient, more time for personnel to treat other patients, and cost savings for both patients and third-party providers.

Before the exam

Conversing with the patient and reviewing their oral and overall condition before beginning the exam can offer many valuable insights. Exploratory questioning should aim at clarifying any health or personal concerns patients might have, as well as whether they are experiencing discomfort, or pain.

Clinicians also should ask whether patients have noticed any recent changes in their face, mouth, or neck, such as newly discovered growths or difficulty swallowing, hoarseness or earaches. This phase of the exam also allows clinicians to obtain a more complete picture of the patient’s medical history, update medication documentation, and check for contraindications.

During the exam

After this initial review, a variety of diagnostic tools can assist in searching for signs of oral disease and formulating a treatment plan. X-rays, radiographs, intraoral cameras, and other imaging technology can help identify tooth decay and otherwise hard-to-diagnose problems such as jawbone damage, impacted teeth, abscesses, cysts, tumors, and proximal caries. Likewise, intraoral mirrors can be used to check for caries while periodontal probes measure pocket depth, a common indicator of gingivitis and periodontitis.

The necessity and extent of this component of the exam vary from patient to patient, but both the Food and Drug Administration (FDA) and the American Dental Association (ADA) agree that bite-wing X-rays of premolar and molar teeth should be taken annually to detect cavities in these areas.

Oral cancer screening

While most dental professionals are likely well-acquainted with performing X-rays and periodontal probing, data imply that many may be less familiar with administering oral cancer screenings. Despite the prevalence of the disease – oral cancer is the eighth most common type of cancer in men, occurring at a rate twice as high as in women – a recent survey reveals that only 29% of patients received an oral cancer screening during their last dental checkup. And while, historically, oral cancers were considered an exclusive concern for older, “high-risk” adults (primarily tobacco and alcohol users), the Oral Cancer Foundation (OCF) reports that “the fastest-growing segment of the oral cancer population are young, non-smoking individuals” believed to have contracted the disease via the human papillomavirus.

Today, 25% of oral cancer cases occur in people younger than 55. Given this development, and the quick, painless, and inexpensive nature of the exam, experts now suggest that annual opportunistic oral cancer screenings should be part of every patient’s care regimen, regardless of age.

According to the OCF, “a good oral cancer exam is visual and tactile.” The clinician should use a combination of gloved hands and a bright white light to inspect the patient’s face, neck, lips, tongue, gums, and throat for signs of the disease, which include lesions, lumps, and abnormal coloration. Adjunctive tools such as mirrors, special lights, dyes, and tissue brushes also may be used to assist with screening but are not a replacement for the traditional visual and tactile exam. Achieving early detection (stage I and II cancer) via these methods can lead to survival rates of up to 90%.

Products for dental exam and prophylaxis

When it comes to battling oral disease, without regular dental visits, patients are left to fend for themselves. As a result, patients must schedule routine appointments – including comprehensive oral exams and prophylaxis – based on their needs. The ADA states that patients at high risk for periodontal disease, such as smokers and those with diabetes, would benefit from more frequent visits (several times per year), while low-risk patients may achieve similar results from as little as one annual appointment. To help you better care for your patients, regardless of their needs, below we’ve detailed several of the best dental exam and prophylaxis products available:

Scalers & curettes

Patterson Curettes (Patterson Dental) are made from surgical stainless steel and aid in scaling, root planing, and periodontal debridement of supragingival and subgingival surfaces during prophylaxis. These lightweight curettes are available in a range of ergonomic designs and universal and Gracey configurations, including a large size that can reduce hand fatigue and increase tactile sensitivity.

XP Scalers and Curettes (American Eagle Instruments) are designed with the hygienist in mind. According to the manufacturer, instruments made with American Eagle’s patented sharpen-free XP Technology stay sharper longer than any other stainless or carbon steel instruments. Additionally, this technology permits a thinner blade design that supports calculus and stain removal in all anterior and interproximal areas, easier access throughout the posterior region, and enhanced patient comfort. With XP’s super-sharp blade, you also can experience superior tactile sensitivity, allowing for a much lighter grasp, easier operation, and reduced hand fatigue.

Mouth mirrors

Patterson Mouth Mirrors (Patterson Dental) make it easy for clinicians to detect signs of disease anywhere in the oral cavity. Mirrors are available in multiple sizes and designs including single use, individually wrapped disposables to minimize cross-contamination and autoclavable, corrosion-resistant versions with either fiberglass or stainless-steel handles. All Patterson mouth mirrors are lightweight for enhanced ease of use and operator comfort.

Sterilizable Mouth Mirrors – Front Surface, Single End (Kerr TotalCare) combine a high-quality front surface, rhodium-plated mirror with a lightweight glass-filled resin handle to eliminate double image when inspecting the oral cavity. These autoclavable/chemiclavable mirrors also feature a non-slip grip and reduce patient discomfort associated with cold, metal alternatives. Kerr Sterilizable Mouth Mirrors are available in a range of colors and sizes.

Crystal HD Mouth Mirrors (Zirc) are one-piece instruments designed for viewing inside the oral cavity and retracting lips, cheeks, and tongue during dental exams. With a soft-grip handle and surface 40% brighter than rhodium, these mirrors can reduce eyestrain and fatigue. Additionally, the instruments feature a lens flush with the mirror frame to eliminate corrosion buildup and a 99% reflection factor for enhanced visibility and color accuracy. Crystal HD Mouth Mirrors are autoclavable up to 136°C/275°F and contain antimicrobial protection.

Oral cancer screening systems

ViziLite Plus Oral with TBlue (Zila tolonium chloride) (DenMat) is an oral cancer screening system developed to help oral healthcare professionals identify, evaluate, monitor, and mark abnormal oral lesions. These include lesions suspicious for pathology such as precancerous cells and cancer that may be difficult to see during a regular visual exam. Quick and easy to use, ViziLite can be seamlessly incorporated into your existing oral cancer screening examination. The small device allows for full visibility throughout the oral cavity while disposable technology eliminates the risk of cross-contamination. Each ViziLite system contains 10 ViziLite lightsticks, 10 retractors, one (10 fl oz) bottle of 1% acetic acid solution, one acetic acid dose cup, one marker, one (1.3 mL) 0.5% Zila tolonium chloride solution swab, and one (1.3 mL) 1% acetic acid post-rinse solution swab.

ORABLU Oral Lesion Marking System (AdDent) is a threecomponent swab system intended for use as an adjunct to a traditional oral cancer examination. After a visual exam with incandescent light, ORABLU can confirm the need to biopsy a suspicious lesion at an early stage. The ORABLU system consists of one 3.0-mL bottle of 0.5% tolonium chloride solution, one 6.0-mL bottle of 1% acetic acid solution, and 30 individually packaged applicator swabs. The ORABLU kit contains enough materials for approximately 10 applications.

Selected references

American Dental Association and Food and Drug Administration. Dental radiographic examinations: Recommendations for patient selection and limiting radiation exposure. 2012.

Centers for Disease Control and Prevention. Oral health conditions. May 1, 2020.

Deep P. Screening for common oral diseases. J Can Dent Assoc. 2000;66:298-299.

Vigilant Biosciences. Oral cancer awareness survey reveals 81 percent of U.S. adults want to be screened for oral cancer during routine dental check-ups; only 25 percent actually are. March 30, 2017.

World Health Organization. Oral health. March 25, 2020.

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This originally appeared in OnTarget.