ISSN: 2763-5724 / Vol. 04 - n 04 - ano 2024

DIFFICULTIES FOR DENTAL SURGEONS REGARDING THE EARLY

DIAGNOSIS OF MOUTH CANCER IN PRIMARY HEALTH CARE:

LITERATURE REVIEW

Cesario Rui Callou Filho1

Antônia Valrilania de Oliveira Rodrigues2

Carlos César Teixeira Da Silva Araújo3

Emilly Vitória De Assis Paula4

Samuel Miranda De Souza Abreu5

Abstract: Introduction: In Brazil, oral cancer disease is considered a malignant neoplasm of the lip,

tongue, gums, oor of the mouth, hard palate and other parts of the mouth. It represents a serious

public health problem due to the high rates of late diagnoses and, consequently, the signicant rates

of morbidity and mortality. General objective: This is a research developed through an opinion article

focusing on the dental surgeon’s approach to diagnosis in Primary Health Care (PHC). Methods: This

is an opinion article survey, developed from February to June 2024, through the reection of the texts

published in the area as well as through the guidelines of the dental surgeon in PHC. Results: In the

end, it can be seen that associated factors evidence this diculty, such as the lack of materials for

biopsy performance. Another important point is the non-implementation of family health strategies as

an approach to the prevention of oral cancer. Final considerations: It can be stated that the training of

1 Teacher of the Dentistry Course at the Ateneu University Center (UniAteneu) https://orcid.

org/0000-0002-0390-2830

2 Students from the Dentistry Course at the Ateneu University Center (UniAteneu). https://

orcid.org/0009-0000-0600-1061

3 Students from the Dentistry Course at the Ateneu University Center (UniAteneu). https://

orcid.org/0009-0006-8197-4799

4 Students from the Dentistry Course at the Ateneu University Center (UniAteneu). https://

orcid.org/0009-0003-7249-955X

5 Students from the Dentistry Course at the Ateneu University Center (UniAteneu). https://

orcid.org/0009-0000-2759-0619

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professionals is an important factor for early diagnosis, as well as the expansion of resources.

Keywords: Dentists; Primary Health Care;Dentist’s Role; Tumeurs de la bouche

In its denition, oral cancer can be a group of malignant neoplasms that aect dierent

anatomical sites in the head and neck region. For the Ministry of Health in Brazil, this condition is

considered a malignant neoplasm of the lip, tongue, gums, oor of the mouth, hard palate and other

parts of the mouth ( INCA, 2019 ).

This disease condition represents a serious public health problem due to the high rates of late

diagnoses and, consequently, the signicant morbidity and mortality rates. According to the incidence

forecast from the National Cancer Institute (INCA, 2019), with the exception of non-melanoma skin

tumors, this tumor is the fth most common site in the male population and the twelfth most common

in the female population .

In developed countries, other numbers represent the majority of patients treated at an early

stage, while in emerging countries, advanced tumors are the most commonly found in public outpatient

clinics ( Veronezzi et al. , 2022).

According to Neville et al . (2004) , white men over the age of 65 are more likely to develop

the disease, with the proportion between aected men and women being 3:1. According to the author,

squamous cell carcinoma is the most commonly found in the oral cavity, corresponding to 94% of all

tumors and its origin is multifactorial.

Among the causative agents are the consumption of various forms of tobacco, especially

when associated with the use of alcohol, in addition to phenols, radiation, a diet lacking vitamins and

nutrients, candida infections and oncogenic viruses such as HPV. Currently, the inuence of poor

hygiene and the use of illicit drugs has been reported (Neville et al ., 2004).

Then, upon the appearance of signs and symptoms, patients directly seek out the dentist for

consultation, however only when they have complaints related to the oral cavity, and for this it is of

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utmost importance that the professional must know the risk factors for this neoplasia and is qualied

to perform complete clinical examinations of the oral cavity, identifying its signs and symptoms

around a malignant lesion and biopsy of suspicious lesions (Neville et al ., 2004).

Therefore, the authors of this article emphasize that, in particular, those professionals who

work in Primary Health Care (PHC) have greater access to the population, as it is the main gateway

to the public Unied Health System (SUS). In Brazil, they can examine their patients on a regular and

periodic basis.

It is observed that patients with oral cancer are often welcomed as a spontaneous demand,

and in many cases, a phenomenon of successive delays begins in primary care , from diagnosis to

referral, which end up postponing the possibilities of early approach. and consequently limit patients’

chances of survival (INCA, 2022).

Therefore, early detection of oral cancer must cover the epidemiological aspects, dierential

diagnosis, early signs and symptoms, potentially malignant oral lesions, clinical presentation of the

lesions, means of diagnosis such as cytology, use of toluidine blue and techniques of incisional biopsy

(considered the gold standard) for diagnosis, this set as a whole provides security for professionals and

benets for patients ( Wade et al ., 2019) .

However, within this level of care, diculties arise regarding the identication of early

diagnosis, mainly due to the lack of knowledge of dental surgeons in identifying and dierentiating

the diagnosis of the lesion in PHC. There are other associated factors that highlight this diculty,

such as the lack of materials to perform a biopsy. Another important point is the failure to implement

family health strategies as an approach to preventing oral cancer ( INCA, 2019; Foletto ; Aratani ,

2022 ).

Furthermore, it is worth highlighting that due to the limited knowledge about mouth and

oropharyngeal cancer among patients and health professionals, especially on the part of dentists, fear

of diagnosis and diculties in accessing the health system are factors that inuence the diagnosis.

Although some healthcare professionals blame patients for the disease, it is crucial that they recognize

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their responsibilities when it comes to diagnosing cancer. Furthermore, do not blame patients for

the delay in diagnosis. It is essential that professionals develop positive attitudes, personal values,

relationship skills, psychological mastery and self-condence ( Foletto ; Aratani , 2022).

It is extremely important to highlight that a large part of the population ends up not

recognizing the dentist as the professional qualied to detect soft tissue injuries due to a lack of

knowledge about this function. The diculty is also observed in the healthcare team itself, which

does not fully recognize the role of the dentist in diagnosing oral cancer. The problem is aggravated

by the low integration between the members of the multidisciplinary team and the lack of denition

of the roles and responsibilities of each member and level of attention in establishing the line of care

( Cazal et al ., 2022).

In view of this, the need for qualication through training and qualication of these dental

surgeons is evident, aiming at the early detection of disorders with the potential for malignant

transformation and initial lesions of oral cancer ( ref ).

To this end, we authors here reect that improving capabilities/skills and updating knowledge

and practices is essential to achieving the goal of reducing the advanced stage of the disease at

diagnosis, providing patients with more eective treatment at a lower cost. and less hassle.

Therefore, it is necessary to emphasize the importance of early diagnosis associated with

the role of dental surgeons in terms of the rst contact with the patient who seeks primary care.

Of course, it is up to these professionals to know the risk factors and early detection strategies for

oral cancer. However, delays in diagnosis can occur due to the professional’s delay in establishing

the denitive diagnosis or, even, due to the health system itself, which may present diculties in

scheduling appointments, forwarding histopathological samples, among other points (Fernandes et al

., 2023)

Therefore, the need for complete and eective training of professionals is evident, as well

as the implementation of eective public policies and awareness among the population so that there

is comprehensive prevention and early diagnosis of mouth cancer, which is fundamental to reducing

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mortality from this disease. disease and improve patients’ quality of life ( INCA, 2019 ).

Promoting oral health on a regular basis is one of the impacts that will help reduce diagnoses,

aiming to detect risk factors and patients susceptible to this pathology. Providing adequate materials

to perform procedures is essential for early diagnosis ( Fuso et al ., 2023 ).

Therefore, it is interesting to invest in continuing education that can reduce the barriers

associated with early diagnosis, as well as the time spent between self-perception of signs and symptoms

and treatment. What continuing education, frequency and target audience should be worked on? In

order to have an impact on oral cancer morbidity and mortality indicators, training must be rethought

in the form and objectives it proposes ( ref ).

As well as the healthcare team as a whole in the continuing education process, and not

just the dentist. Furthermore, all opportunities and teaching formats are valid as long as they break

with the traditional model of exclusively highlighting clinical aspects of injuries. In addition to the

presentation of lesions, training should also be aimed at controlling factors directly or indirectly

involved in the genesis of cancer, such as smoking cessation, guidance is available at undergraduate

or postgraduate level ( ref ) ( ref ) .

In this paradigm shift proposal, educators would use, instead of the traditional method,

techniques and strategies that involve and motivate the patient, based on behavioral health. Attention

also focused on prevention, excluding and clarifying risk factors, addressing tobacco use, ways to

encourage cessation and early detection of mouth cancer, medication assistance and guidance on

existing smoking cessation groups, care with unprotected sun exposure that targets shermen and

farmers in greater numbers ( Wade et al., 2019) .

So, in the end, it can be considered that the training of professionals regarding the

management of patients with changes in the oral cavity, with probable oral cancer, the initial step will

be training PHC professionals, especially the dental surgeon, and subsequently expanding resources

and equipment.

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