CONTINUING EDUCATION
extensive treatment plan, limited all my side effects, and resulted in a better lifestyle after treatment. I would rather have been told there was a concern 3 or 6 months before by my dentist or hygienist and addressed the concern with my primary doctor immediately. Early detection results in better patient outcomes. I was informed by my oncologist that out of 4 million people, 10 to 15 people get the type of cancer I was diagnosed with: Salivary Duct Carcinoma HER2 Positive. I was also told that I have been beating the odds, and I am one of a kind. I would rather be many of a kind when it comes to living through and after cancer. This is one of my motivations to encourage all hygienists and dentists to perform a cancer screening exam that includes the neck. Most people with my diagnosis are not here to tell their story. I intend to purposefully speak for them and myself as I encourage all dental professionals to perform a head and neck exam on every adult patient, every time they see them!
Figure 1: Salivary gland extraoral exam
The clinical imperative The dental setting provides a unique, often untapped opportunity to detect early signs of head and neck malignancies. The Conventional Visual and Tactile Examination (CVTE) is a simple, low-cost, evidence-based procedure that can uncover abnormalities before they become life-threatening. The American Dental Association (ADA) recommends that clinicians perform a systematic CVTE for all adult dental patients, including inspection and palpation of the face, neck, and regional lymph nodes to detect tissue changes, masses, or asymmetry.1 This recommendation is echoed by the American Academy of Otolaryngology–Head and Neck Surgery, which emphasizes evaluation of the skin, salivary glands, thyroid, and lymph nodes using bimanual palpation techniques.2 Despite this guidance, implementation in general practice remains inconsistent.3
Figure 2: Thyroid exam
Step-by-step: performing the Conventional Visual and Tactile Examination (CVTE) General observation
Observe facial symmetry, skin color/lesions, swelling, and visible masses. Note signs of asymmetry, facial droop, or skin changes.
Lymph node palpation Preauricular and postauricular, submental and submandibular, cervical chain (anterior and posterior), supraclavicular nodes. Use gentle, circular pressure with the pads of your fingers, bilaterally when appropriate.
Figure 3: Intraoral vestibule exam
Salivary glands Palpate parotid, submandibular, and sublingual glands for enlargement, tenderness, or firmness (Figure 1).
Thyroid gland Visually inspect for enlargement while the patient swallows. Palpate the thyroid gently from behind the patient using both hands (Figure 2). endopracticeus.com
Figure 4: Lateral tongue exam
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