/

()

1. ()

2.()

3.(morbidity)

1098

()PMD (potentially malignant disorders)

(population screening)(targeting screening)(opportunistic screening)

1.(population screening)(cost-effectiveness)(suspicious lesions)2-16%

2.(targeting screening)30

3.(opportunistic screening)()(3-4)downstaging

Lim, Moles, et al:Opportunistic Screening for Oral Cancer andPrecancer in General Dental PracticeOpportunistic 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 J 2003;194:497-502.

()(test)

()

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

/ () ()(2005)

NOTE : This is a bad example !

NOTE : This is a bad example !

NOTE : This is a bad example !

NOTE : This is a bad example !

A PRACTICAL TECHNIQUE OF SCREENING FOR ORAL CANCERSUMMARY

reported at 41st APACPH(Asia Pacific Academic Consortium for Public Health) Confrerence, 5th Dec. 2009L.J. Hahn, DDS, DDSc, FICDOral and Maxillofacial Surgeon,National Taiwan University Hospital

Current and conventional method of screening for oral cancer in TaiwanThe 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.*

Disadvantages of such conventional methodsAgainst human engineeringNo mouth mirror no complete screening (there are dead corners on examination)Prone to result in FALSE NEGATIVE finding.*

Correct and practical method of screening for oral cancerThe examinee takes supine positionThe examiner sits at 7-11 oclock position of the head of an examineeUse 2 mouth mirrors( 2-mirror technique )Examine 50 sites of the full mouth mucosa, in definite order without missing any site.*

4 Functions of the mouth mirrorAs a mirrorTo reflex light to the site where close examination is needed.As a retractorFor primary palpationSo, using mouth mirrors is mandatory to perform correct screening for oral cancer.

Palpation with a mouth mirrorWhilst 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 oral mucosal diseases and conditions, 1980As 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

Advantages of 2-mirror technique of screening for oral cancer by supine positionGood accessibility to the oral cavityFit human engineering for adequate inspection and palpationUsing 2 mouth mirrors much better than just using tongue depressors onlyNatural posture, less fatigabilityCan detect more precancers and early cancers(may achieve downstaging) Less possibility of causing FALSE NEGATIVE result.

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)

8-9(7-11)

()(2 mirror technique2)()()()(special sheet)

Two Mouth Mirrors2 Mirror Techniqueretractor:(particular lesions) WHO Guide to epidemiology and diagnosis of oral mucosal diseases and conditions/Clinical Criteria for Diagnosis of Oral Mucosal LesionsAn aid for dental and medical practitioners in the Asia-Pacific Region

/

(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)

(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)

(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)

(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)

(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)

(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)

A. ()B. C. D. E. F. G. H. I. J. K. L. :

/(/ABC)(/):/()/()//()

/()7. / () 8. //()9. ()10.()11.()12./() 09.6.30.

(1)()(tumor mass)(swelling)(marginal induration)

(2)()//

::

0%1-7%4-15%28%(18-47%)4-11%20-35%

71% 57%

: () (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)

//

ABC

Thank you for your attention