2. 3. 4.
5. 1.
6. 2.
7. 3.
8. 10 98 9.
- PMD (potentially malignant disorders)
10.
- (opportunistic screening)
11. 1. (population screening)
- (suspicious lesions) 2-16%
12. 2. (targeting screening)
13. 3. (opportunistic screening)
14. Lim, Moles, et al: Opportunistic Screening for Oral Cancer
and Precancer in General Dental Practice
- Opportunistic screening in a general dental practice setting
may be a realistic alternative to population screening.
- General dental practice is ideal for the evaluation of such
systems prior to extending these studies to other healthcare
setting.
Br Dent J2003;194:497-502 . 15. 16.
17.
18.
19. (Basic necessities )
- (adequate visibility) 3 : (1) (adequate access) (2 mirror
technique) (2) (adequate light) (3)
20. /
21. NOTE : This is a bad example! 22. NOTE : This is a bad
example! 23. NOTE : This is a bad example! 24. NOTE : This is a bad
example! 25. A PRACTICAL TECHNIQUE OF SCREENING FOR ORAL CANCER
SUMMARY
-
- reported at 41 stAPACPH(Asia Pacific Academic Consortium for
Public Health) Conference, 5 thDec. 2009
- L.J. Hahn, DDS, DDSc, FICD
- Oral and Maxillofacial Surgeon,
- National Taiwan University Hospital
26. Current and conventional method of screening for oral cancer
in Taiwan
- The examiner and the examinee sit face to face on 2
chairs.
- The examiner use only 1-2 disposable tongue depressors without
using mouth mirrors, to perform the so-called oral cancer
screening.
27. Disadvantages of such conventional methods
- Against human engineering
- No mouth mirror -> no complete screening (there are dead
corners on examination)
- Prone to result in FALSE NEGATIVE finding.
28. Correct and practical method of screening for oral
cancer
- The examinee takes supine position
- The examiner sits at 7-11 oclock position of the head of an
examinee
- Use 2 mouth mirrors( 2-mirror technique )
- Examine 50 sites of the full mouth mucosa, in definite order
without missing any site.
29. 4 Functions of the mouth mirror
- To reflex light to the site whereclose examination is
needed.
- So, using mouth mirrors is mandatory to perform correct
screening for oral cancer.
30. Palpation with a mouth mirror
- Whilst digital palpation of the mucosa would be ideal, for
practical reasons MOUTH MIRRORS may be used to gain an idea of the
texture of the tissues.
- Digital palpation using any necessary precautions, may then be
reserved for the examination of particular lesions.
- WHO : Guide to epidemiology and diagnosis of oralmucosal
diseases and conditions, 1980
- As suggested in the WHO guide, 2 mouth mirrors are recommended
with digital palpation for particular lesions Zain et al : Clinical
criteria for diagnosis of oral mucosal lesions, 2002
31. Advantages of2-mirror techniqueof screening for oral cancer
by supine position
- Good accessibility to the oral cavity
- Fit human engineeringfor adequate inspection and palpation
- Using 2 mouth mirrors much better than just using tongue
depressors only
- Natural posture, less fatigability
- Can detect more precancers and early cancers(may achieve
downstaging)
- Less possibility of causing FALSE NEGATIVE result.
32. A simplified method of screening for oral cancer (Hahns
method)
- Can be used if the dental, or flexible and portable chair for
oral cancer screening is unavailable (Please watch DVD
demonstration, if available)
33. 34. 35.
36.
37. Two Mouth Mirrors 2 Mirror Technique
- ( particular lesions ) WHO Guide to epidemiology and diagnosis
of oral mucosal diseases and conditions/Clinical Criteria for
Diagnosis of Oral Mucosal Lesions An aid for dental and medical
practitioners in the Asia-Pacific Region
38. 39. 40. 41. 42. /
43. 44. 45.
- 1.Vermilion border upper (1), lower (2)
- 2.Labial commissures right (3), left (4)
- 3.Labial mucosa upper (5), lower (6)
4 . Cheek (buccal muccsa) right (7), left (8)5. Labial sulci
upper (9), lower (10)6. Buccal sulcus right upper (11) lower (12)7.
Buccal sulcus left upper (13) lower(14) TOPOGRAPHICAL
CLASSIFICATION OF ORAL MUCOSA,(HAHN,L.J. modified after WHO
monogragh) 46.
- 8. Posterior gingiva and alveolar ridge (process) buccally
- Upper gingiva or edentulous alveolar ridge buccally right (15),
left (16)
- Lower gingiva or edentulous alveolar ridge buccally right (17),
left (18)
- 9. Anterior gingiva and alveolar ridge (process) labially:
Upper (19) Lower (20)
TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA,(HAHN,L.J. modified
after WHO monogragh) 47.
- 10.Posterior gingiva and alveolar ridge (process) palatally and
lingually Upper right (21), left (22) Lower right (23), left
(24)
- 11.Anterior gingiva and alveolar ridge (process) palatally and
lingually, palatally (25) and lingually (26)
- 12.Dorsum (dorsal surface)of the tongue right (27), left
(28)
TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA,(HAHN,L.J. modified
after WHO monogragh) 48.
- 13.Base of the tongue right (29), left (30)
- 14.Tip of the tongue (31)
- 15.Margin (lateral border) of the tongue right (32), left
(33)
- 16.Ventral(inferior) surface of the tongue right (34), left
(35)
TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA,(HAHN,L.J. modified
after WHO monogragh) 49.
- 17.Floor of the mouth Frontal (36) Floor of the mouth Lateral
right (37), left (38)
- 18.Hard palate right (39), left (40)
- 19.Soft palate right (41), left (42)
TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA,(HAHN,L.J. modified
after WHO monogragh) 50.
- 20.Anterior tonsillar pillar right (43), left (44)
- 22.Retromolar region (trigone)right (46), left (47) ( )
- 23.Oropharynx and tonsils (48)
- 24. Tonsils-right (49), left (50)
TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA,(HAHN,L.J. modified
after WHO monogragh) 51. : A. ( ) B. C. D. E. F. G. H. I. J. K. L.
52.
53. /
54. / ( )
55. (1)
- (tumor mass) (swelling) (marginal induration )
56. (2)
57. : : ( ) ( ) ( ) ( preca. or ca.) ( ca.preca.) : ( ca. or
preca.) )cccccaca (advice+ ) : 58. 59.
60.
61.
- ( ) (3-7-11-15-12-17-43-46)
- ( ) (4-8-13-16-14-18-44-47)
- ( ) (21-25-22-39-40-41-42-45-48-49-50)
- ( ) (31-34-35-23-26-24-36-37-38)
TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA,(HAHN,L.J. modified
after WHO monogragh) 62.
63.
64. Thank you for yourattention