1. ( )

2. 3. 4.

5. 1.

( )

6. 2.

( )

7. 3.

(morbidity)

8. 10 98 9.

( )

PMD (potentially malignant disorders)

10.

(population screening)

(targeting screening)

(opportunistic screening)

11. 1. (population screening)

(cost-effectiveness )

(suspicious lesions) 2-16%

12. 2. (targeting screening)

30

13. 3. (opportunistic screening)

( )

( 3-4 )

downstaging

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.

( )

( test)

17.

( )

18.

19. (Basic necessities )

(adequate visibility) 3 : (1) (adequate access) (2 mirror technique) (2) (adequate light) (3)

:

20. /

( )

( ) (2005 )

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

As a mirror

To reflex light to the site whereclose examination is needed.

As a retractor

For primary palpation

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.

8-9(7-11)

36.

( )

(2 mirror technique 2 )

( )

( )

( )

(special sheet)

37. Two Mouth Mirrors 2 Mirror Technique

retractor :

( 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)

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.

(2)

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.

(3)

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.

(4)

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.

(5)

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.

(6)

20.Anterior tonsillar pillar right (43), left (44)

21.Uvula (45)

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. /

( / ABC ) ( / )

:

/ ( )

/ ( )

/

/ ( )

54. / ( )

7. / ( )

8. / / ( )

9. ( )

10. ( )

11. ( )

12. / ( )

09.6.30.

55. (1)

( )

(tumor mass) (swelling) (marginal induration )

56. (2)

( ) /

/

57. : : ( ) ( ) ( ) ( preca. or ca.) ( ca.preca.) : ( ca. or preca.) )cccccaca (advice+ ) : 58. 59.

0%

1-7%

4-15%

28%(18-47%)

4-11%

20-35%

60.

71% 57%

61.

:

( ) (1-2-5-9-19)

( ) (6-10-20)

( ) (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)

( ) (31-27-28-29-30)

( ) (32 )

( ) (33 )

( ) (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