1. Developing a Curriculum Emphasizing Oral medical examination for improvement of patient care in a diverse population
Ezinne Ogbureke, BDS,DMD ; Ana Neumann DDS, PhD ; Dennis Garcia RDH.BS, MBA; Kalu Ogbureke BDS, PhD ; Ruth Conn RDH, BSDH
Cleverick Johnson DDS MS . .
Background
Comprehensive care by a dentist or dental hygienist must emphasize the complete assessment of a patient and not the limited view of the patient as a set of teeth. Medical history and recording of vital signs must therefore be a starting point as well as a thorough head and neck examination. Oral cancers make up 3% of all cancers in the United States. Nearly thirty-three percent of oral and pharyngeal cancers were diagnosed at the localized stage (stage 1) in 2005–06 and Healthy People 2020 initiative on Oral Health objective 14.2 seeks to increase the proportion of adults receiving annual oral and pharyngeal cancer screening.
Five year survival rate on early detection is 78% tongue,75% floor of mouth,66% oropharynx and floor of mouth.
Evaluation criteria
Site
Recorded finding by Student
Recorded finding by Faculty
Lymph nodes
Thyroid
Temporomandibular Joint
Salivary Glands
lips
Buccal Mucosa
Gingiva
Palate (hard and soft)
Tongue
Floor of mouth
Oropharynx
Other
White plaque, right tuberosity
Right tonsillar mass on routine examination
Description
An IRB approval (HSC-DB ) was obtained from the Committee for the Protection of Human Subjects (CPHS) of the University of Texas Health Science Center at Houston . 51 dental and dental hygiene students were recruited in a five-month study, to perform head and neck and intra oral examinations on new dental patients. The students recorded any abnormal findings and the site of these findings. The faculty investigator performed the same examination on the patient at this same visit termed visit 1. This was followed by clinical and written instructions when findings were missed by the subjects. At a later date, visit 2, the same student would repeat the examination on another new patient and the differences were analyzed.
Conclusions
The study led to a proposal for a clinical elective in the curriculum to bridge the gap between the didactics on oral diseases and clinical practice and early cancer detection.
The elective begins Spring and will be comprised of
1. Lectures
2. Open discussions
3. Patient examinations
4. A debriefing period
All participants will be required to complete two sessions of full head and neck and oral medical examination on new patients. The sessions will be held in the urgent care or assessment clinics under supervision by the faculty instructors on the elective, using the attached rubric above. Students should be able to describe any lesions found, give differentials and suggest subsequent course of action
White lesion on cheek
Evaluation and Results
During the initial five months of the study, several incidental findings were noted: three patients were referred for biopsies and one was diagnosed to be a squamous cell carcinoma in situ, thus highlighting the advantage of early detection. When comparing the study results between visits 1 and 2, no significant differences were observed (p=0.168), however we noted a trend for dental and dental hygiene students to “miss” a greater number of items on the examination checklist – three or more – in the first examination when compared to the second exam. This emphasizes the importance for a clinical course in oral evaluation in the dental curriculum as an adjunct to the classroom didactics..
Red and white asymptomatic lesion
Multiple painful ulcers
References 1.
2. cancer-survival-rates
3.Neville B,Damm D, Allen C ,Bouquot J.Oral and Maxillofacial Path.Saunders 4th Ed pg
4.Marx RE,Stern D.Oral and Maxillofacial Pathology:A Rationale for Diagnosis and Treatment.Pg Quintessence Publishing co,Inc.,2012
Moderately severe oral pigmentation