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How missed dental treatment is hampering early diagnosis of oral cancer

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Dr G Srikanth, Professor and Head, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, MAHE points out that as patients are avoiding dental treatment during the COVID-19 pandemic, many cases of oral cancer, which are generally first detected early by dentists, could be going undiagnosed until too late. Hence, he suggests that the dental fraternity needs to implement new strategies, specific policies and programmes to educate the public about the early diagnosis of oral cancer and the need to seek dental consultation at the earliest

In March 2020, WHO declared COVID-19 as a global pandemic and since then, COVID-19 has severely impacted our lives. Millions have been infected, and many lost their lives due to this deadly virus. This virus has also adversely affected the world economy. The world is still battling this menace, and now this has become more complicated due to new viral strains emerging intermittently. As Charles Darwin stated, “Survival of the fittest.” We must accept that we ought to coexist with this virus and survive it. We should challenge ourselves by taking all necessary precautions to prevent getting infected by this deadly virus.

Healthcare personnel are recognised to be one of the most at-risk section of society. Specifically, dentists have a higher risk as most dental treatments are aerosol-generating procedures (AGP). This can be potentially hazardous to the dental surgeon operating on the patient. Since the pandemic broke out, the dental treatment protocols worldwide have undergone a paradigm shift. From personal protective gears to infection control protocols, all have undergone a drastic transformation in recent times.

In the wake of COVID cases rising suddenly in the country, specific protocols have been laid down by the government, MCI, and DCI. As advised, only emergency and life-saving cases have been allowed. Operating elective cases has been deferred to a later date and addressed when situations are amicable as per protocols.

Apparently, it seems to be practical, but every coin has two sides. This protocol has adversely affected the prognosis and outcomes of elective cases.  The current pandemic is taking a massive toll on the management of patients with oral cancer. It is a well-known fact that oral cancer is treatable with good outcomes if diagnosed early. Dentists play a significant role in the early detection and diagnosis of oral cancer as most of the time, it is the dentist who is the first to examine the patient suspected of having oral cancer.

However, due to lockdown, strict government protocols, and fear of getting infected, patients are avoiding visiting a dentist. This, in turn, has caused failures in diagnosing an oral cancer patient in the initial stages. Patients are often reported to have seen a dentist when the suspected ulcer or growth has become worse or more advanced. At this advanced stage, the management becomes more elaborate and complicated and doesn’t have satisfactory outcomes.

There are circumstances where patients have already been diagnosed with potentially malignant or premalignant oral lesions and conditions and are under follow up. These patients can’t reach out to the dentists at the appropriate time as most clinics, and hospital OPDs are closed or opened for a restricted time.

All these are grievously affecting their treatment and putting them at additional risk. On the other hand, it adds a lot of burden on our already crumbling medical infrastructure because treatment for an advanced cancer case is quite detailed and expensive.

Looking at the present situation, it can be assumed that this cycle of lockdowns and restrictions will continue in the near future. Therefore, it is imperative that proper steps should be taken to deal with this situation. After all, “necessity is the mother of invention”. If inculcated by the dental fraternity, specific policies and programmes can educate the public about the early diagnosis of oral cancer and seek dental consultation at the earliest. New strategies for continuing care for these particular group of people is the need of the hour.

  • In this era of satellite technology reaching every individual, telemedicine is an efficient and viable alternative to correspond to patients efficiently and safely. Patients diagnosed with pre-malignant or potentially malignant conditions can be kept on a follow-up, and proper guidance can be provided to them. Patients who are on follow-up can send the photographs of the oral cavity to the concerned doctor as a follow-up to visualise the progress.
  • Next, social media networks like Facebook and Twitter can spread awareness about oral cancer to the masses. Via such platforms, we can reach out to people and impart virtual knowledge about clinical signs, symptoms, and risk factors through a series of well-documented videos. Such deliberation should preferably be done by dentists or surgeons themselves or backed by a reliable institution. This is critical to stop any false and misleading information from being conveyed to the public and add to its validity.
  • Discussions can be organised with well-renowned dentist/ surgeons to be telecasted on national television to ensure broad impact even on society’s poor and downtrodden section. Most of the time, this section of society has more incidence of oral cancer than privileged ones.
  • Print media, though old- fashioned, can be another feasible option to educate those who still read newspapers, especially the seniors in society.

Finally, I would conclude that it is high time to resurrect the collapsing healthcare due to COVID-19 by formulating new protocols and adapting to new methods. We need to ensure that early detection and diagnosis of oral cancer cases continue unhindered and necessary treatment is given to people at the appropriate time. Times are complex, and we must get challenged and be ingenious to reach out to the cancer patients who need us.

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