Oncological alertness of dentists when diagnosing diseases of the oral mucous membrane: clinical cases

The work focuses the attention of primary care physicians and dentists on the timely detection and adequate treatment of chronic diseases and precancers of the oral mucosa in order to prevent their transition to malignant neoplasms.The prevalence of oral mucosal diseases ranges from 5 % to 20 %, among which there are many obligatory and optional precancers susceptible to malignancy. The occurrence of precancerous diseases of the oral cavity and the red border of the lips and their malignancy are influenced by various factors, including chronic trauma from sharp edges of decayed teeth, poorly manufactured parts of orthodontic and orthopedic structures, irritating hot and spicy food, and bad habits (alcohol, smoking, chewing tobacco, etc.), occupational hazards, meteorological, climatic conditions and others. In addition, the growth of advanced cases of oral mucosal diseases is facilitated by late patient referral, the lack of a comprehensive approach to the treatment of precancerous diseases, insufficient oncological alertness of doctors, failure to comply with the terms of conservative treatment, etc., which in the future can lead to malignancy of precancerous pathological processes. At a dental outpatient and inpatient appointment, it is necessary to pay special attention to the lack of proper effect from treatment, changes in the color of the mucous membrane, the appearance of papillomatous growths in the area of   erosions and ulcers, compaction of the edges of the lesions, which should alert the doctor and require urgent referral of the patient for consultation with an oncologist. In this regard, a visit to the dentist should begin with an examination of the oral cavity to exclude pathology of the mucous membrane, early detection, timely conservative or surgical treatment, elimination of local unfavorable factors, and further dispensary observation. To support these positions, the authors presented a number of clinical observations of patients with precancerous lesions of the oral mucosa. In general, the doctor must remember that “from a precancerous condition to malignancy there is only one-step!” and explain to the patient the need to observe all precautions in the prevention and treatment of precancerous diseases.

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