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Why Dental Hygienists Should Perform Extraoral Head and Neck Examinations

Caries. Gingivitis. Ulcerations. Bruxism. These are among the common ailments dental hygienists watch for in every routine dental examination. But there are some areas of inspection many hygienists overlook: namely, the oral structures of the head and neck.

 

Dental professionals, including hygienists, omit conducting an extraoral head and neck examination on patients on a routine basis. However, head and neck examinations can save lives, as they are key to identifying signs of oral cancer.

 

Importance of Extraoral Head and Neck Examinations

When oral cancer is detected and treated in its early stages, the 5-year survival rate is as high as 90%. However, because it often develops without pain or symptoms, patients rarely notice the disease until it has progressed into Stage 2 or beyond.

 

For this reason, dental hygienists and other professionals can greatly improve patient outcomes, or even save lives, by incorporating head and neck examinations as part of routine dental examinations.

 

Dental professionals conduct extraoral head and neck examinations by palpating important structures of the patient’s head and neck to assess and identify abnormal conditions. A thorough examination involves palpation of the jaw joints, parotid salivary glands, thyroid gland, masseter muscles, and various lymph nodes (submental, submandibular, cervical, supraclavicular, occipital, postauricular, and preauricular lymph nodes).

 

It is not necessary to perform these checks in any exact sequence, but the clinician should choose a sequence and apply it consistently to maintain awareness of abnormal versus normal conditions.

A well-practised clinician can complete this examination within four to five minutes.

 

How Dental Hygienists Can Perform Head and Neck Examinations to Improve Patient Outcomes

Unfortunately, many dental hygienists do not conduct thorough  head and neck examinations on patients.

 

The Canadian Dental Hygienists Association (CDHA) identifies various barriers that stand in the way: lack of time, insufficient training or knowledge, concern about client compliance, and lack of guidelines and tools.

 

But the capacity of these exams to improve outcomes for patients is too great to ignore. Dental professionals can potentially detect up to 84% of new oral cancer cases in the critical early stages. And, as demonstrated by an anecdote told by TGNA Clinical Coach and guest columnist Karina Bapoo-Mohamed, these 5-minute examinations can save lives.

 

Bapoo-Mohamed advised her patient to see a doctor ‘sooner than later’ after discovering an abnormality. Within days, the patient was referred for treatment for stage 1 oral cancer.

 

“Everyone that asks how/why I had it checked,” writes the patient, “and all I say is thanks to my Dental Hygienist.”

 

The CDHA sets out the following steps dental hygienists can take to improve their practice when it comes to extraoral head and neck examinations:

  1. Know the facts on oral cancer. Dental hygienists should be confident in their knowledge and ability to locate, review, and update baseline data.
  2. Know the early signs to look for. Perform extraoral head and neck examinations in addition to other routine dental exams. Use this fact sheet from Canadian Dental Association as a starting point for educating yourself on the signs of oral cancer.
  3. Effectively communicate findings to patients. Ensure that patients understand the urgency of identifying and treating a potential case of oral cancer in the early stages.
  4. Refer patients appropriately. Dentists and dental hygienists should establish a process for referring patients who could have oral cancer to a doctor who can conduct a biopsy.
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