Advocate of oral cancer prevention, Shannon Nanne, RDH: “One person dies every hour from oral cancer, so we have an ethical obligation to provide screenings to save lives.”

Shannon Nanne is a dental hygienist, educator and key opinion leader in the dental industry, focused on actively spreading awareness of oral cancer, ways to aid its prevention, and its side effects. In her career, she has experienced many instances of patients telling her – following an oral cancer exam – that they had never had anything like that done to them before.

In this interview she answers the most frequent questions about the practice of oral exams, so that more dental professionals can realise the importance of the screening and add this short, but life-saving, procedure to their regular appointments with patients.

Oral cancer screening should be an essential part of dental appointments. How long does it take and what is specially observed during the screening process?

An oral cancer exam should take less than five minutes. As a dental professional we are looking for any lumps or bumps that have not healed in over seven days. You need good lighting, a good mirror and a 2″ × 2″ (approx. 5 × 5 cm) piece of gauze to grab a hold of the tongue. It is important to tell the patient what you are doing. I provide a hand-held mirror so they can watch. 

Who should usually provide the oral cancer screening – the dentist or dental hygienist/ therapist?

The dental hygienist should complete an oral cancer exam at every dental appointment, and pass their findings to the dentist, who should then have a further look during the dental exam. If the hygienist has not done a prior screening, the dentist should do the full screening.

What questions should be part of dental anamneses, that are important for oral cancer screening and risk assessment?

A thorough health history should be updated at every dental visit, as this opens the door for many discussions about the patient’s health. Asking the patient about their habits is extremely important. i.e. smoking and drinking alcohol. 

What diagnostic aids should every dental office have so as to support early detection of cancerous lesions?

During every continuing education lecture I present, I start by telling the dental professionals that the exam begins as soon as you collect the patient from the waiting room. I look at the patient’s face for symmetry, noting any lumps or bumps that don’t match with the other side.

I listen to their voice for hoarseness and sometimes you can use your nose to detect a scent coming from their mouth. These are adjuncts that can be used along with the tools we all have in an everyday office setting: fluorescence, toluidine blue, brush biopsy, chemiluminescence.

The Six-Step Oral Cancer Screening Method

What areas should be examined and inspected:

1. Tongue

2. Cheeks & lips

3. Floor   

4. Palate

5. Throat  

Source: Eva Grayzel’s six-step screening

6. Neck

How often should the exams be done?

Although the American Cancer Society recommends oral cancer screening exams every three years for people over the age of 20, and annually for those over the age of 40, I personally look at every patient at every dental visit because changes can occur more frequently.

I screen each and every patient regardless of age or risk factor. One person dies every hour of every day, so we have an ethical obligation to provide screenings so as to help save lives.

What advice should dentists and dental hygienists give their patients regarding oral cancer prevention? What should they do at home? What should they avoid?

Oral cancer screenings are extremely important to help save lives. Many people don’t know that cancer can occur in the mouth so they should be informed about oral cancer and its potential horrific effects. The patient should be told about any suspicious lesion during the screening, while they watch what we are doing. Too many times I have provided an oral cancer exam and the patient tells me that they have never had anything like that done to them before. Patients should also know to watch out for ulcers that do not heal within seven days, so they can be rechecked and referred out for a biopsy.

What are the main risk factors of oral cancer, and what do you recommend as the best means of preventing the disease?

The primary risk factors for developing oral cancers in the US include the use of tobacco and alcohol, as well as exposure to the sun for cancer of the lip. Using a lip protectant with an SPF of 30 can help prevent lip cancer. Using tobacco and alcohol products independently can increase risks of oral and pharyngeal cancer, whilst using both puts people at a much higher risk than those who only do one or the other.

Cancer is a very sensitive topic and many dental professionals can struggle with talking to their patients about it. Do you have any tips on how to introduce the screening to the patient, or on how to inform of a potential cancerous lesion?

As a dental hygienist I believe we have an ethical obligation to save lives. When performing an oral cancer exam I tell the patient what I am doing, have them watch with a handheld mirror, and talk to them about any suspicious lesions they may have. Questions unite us, and as their healthcare provider during that visit I am their personal TSA (Transportation Security Administration) Agent, “If I see something, I say something”. 

There is nothing better in life than to save a life. I am not afraid to talk to a patient or even a friend at a party if I see something suspicious. As a matter of fact, a small spot on my friend’s lip looked suspicious to me, I mentioned it to him, and it turned out to be a squamous cell carcinoma. Any dental professional should know that as difficult as it may be to talk to a patient about screening, it is always better to save a life.

Shannon Nanne, RDH graduated from the University of Pittsburgh School of Dental Medicine in 1994. She has spent most of her professional career focused on creating awareness of oral cancer and its side effects. As the executive director of the Global Oral Cancer Forum 2016, Shannon helps promote the changes required for achieving a substantial impact on incidence, morbidity, and mortality of oral cancer worldwide, by educating health professionals globally.

Shannon has held an executive board position in the Cleveland Dental Hygiene Association, and is the author of several scientific articles and publications. For more than 20 years she has been presenting courses globally, including Curaden Academy webinars.