Like most other jobs, dentistry can be hectic and demanding. One moment I may be in the middle of a root canal, and the next I may be demonstrating the proper way to floss. In planetary terms, root canals and flossing are galaxies apart, yet they both inhabit the same universe of dentistry. Switching gears is taxing, and at times stressful. Over time, many dentists find it easier to skip the patient education and either delegate that to other team members, or stop doing it entirely. Unfortunately, this is also true of more mundane and repetitive tasks like the head and neck exam.
Most dentists operate on a fee-for-service model. This means that your dentist gets paid for qualified services. This incentivizes dentists to maximize services that pay, and minimize those that don’t. When your dentist does an exam, they will be paid whether they do a head and neck exam or not. In fact, many dentists will notate that they did one, even when they didn’t, for billing and C.Y.A. purposes. It shouldn’t be this way, but unfortunately it is. Because mosts dentists are paid per qualifying service, we have a tendency to focus on performing those services. We optimize the time we spend doing financially productive things, then delegate the rest to our staff. Often though, the unproductive services slip through the cracks entirely.
Head and Neck Exams Save Lives
Every year, over 50,000 Americans are diagnosed with oral or oropharyngeal cancer. It kills nearly 10,000 Americans per year, and the combined five-year survival rate is around 60%. As with most cancers, early diagnosis is key to a better outcome. It’s difficult to say how many of these cancers would be detected early with routine head and neck exams, but it’s probably a lot. Many of the early signs of oral cancer may not be noticed by the patient, but may be seen by a dentist.
A thorough head and neck exam takes only a minute or two. In my own practice, I start with the head and neck exam, because it allows me to also evaluate the gums, teeth, joints, and bite. In fact, by doing a head and neck exam, get a big-picture view of my patient’s mouth which expedites the rest of the examination. The head and neck exam is also a great way to ease patients into their exam and build trust with me. Furthermore, it allows me to demonstrate my commitment to the patient’s well-being beyond the fillings and crowns they typically associate with going to the dentist.
Dentists Won’t See What They Don’t Look For
It takes many years to become a dentist. But, all of this is for nought if a dentist can’t detect or diagnose the disease they were trained to. When patients refuse x-rays, I inform them that I will be unable to see potential problems that are only visible on an x-ray. The same is true for head and neck exams. I simply can’t diagnose what I can’t see. Not doing a head and neck exam is like not taking x-rays.
Below is a non-exhaustive list of the problems that can be detected with a routine head and neck exam:
- TMJ problems
- Acid reflux disorders
- Bulimia
- Cancer of the mouth, throat, thyroid, lymph nodes, skin, and breast
- Sleep apnea
- Tooth grinding / clenching
- Orthodontic problems
- Skeletal alignment discrepancies
- Geographic tongue
- Autoimmune disorders such as Lichen Planus, Pemphigus Vulgaris, and Sjögren’s Syndrome.
- Airway / breathing problems
- Fungal, bacterial, and viral infections
- Salivary gland dysfunction and associated dry mouth
In just a minute or two, a skilled clinician can identify hundreds of potential problems. So, why don’t more dentists do this simple exam? The simple answer is time. A more nuanced answer may involve a lack of competence, confidence, time, reimbursement, or desire. It is important that you advocate for yourself and request that your dentist perform a thorough head and neck exam.
Anatomy of a Head and Neck Exam
Every clinician performs a head and neck exam differently. Although there is more than one way to perform a thorough head and neck exam, these are a few of the things your clinician should evaluate:
- Lymph nodes along the sides of the neck, below the lower jaw, behind the ears, and at the base of the skull
- Skin of the head and neck
- Thyroid health
- Jaw joints during opening / closing
- Tissues of the the tongue, floor and roof of the mouth, cheeks, gums, lips, and throat
- How the teeth come together when biting
- Airway and ability to breathe freely
- Evidence of acid exposure (reflux), or mechanical stresses (clenching and grinding) on the teeth
- Tonsil health
- Salivary gland function
As you can see, a simple head and neck exam reveals a lot of information about your health. Your dentist or hygienist can detect anything from a simple tonsil stone to breast cancer in a matter of minutes.
The Gateway to the Body
The medical community is waking up to the realities of the mouth-body connection. Many medical and dental practitioners have even suggested that the mouth is the gateway to the rest of your body. And of course, in a literal sense, this is true. Your mouth is the place where food, air, and water first enter the body. But, the mouth is also a great place to diagnose a patient’s overall health status. In fact, all-cause mortality rates are significantly associated with a patient’s oral health status.
In the horse trade, buyers check a horse’s mouth and teeth to assess their overall health. The phrase “don’t look a gift horse in the mouth” literally means that you shouldn’t question the health of a horse that was gifted to you. Slavers of antiquity were also known to check the mouths of slaves before trading them. The practice of evaluating the health status of people and animals is an ancient practice, and one that should still be practiced today.
As dentists, we have begun to recognize our role in the early detection of conditions like hypertension. It’s time we also recognized our role in the early detection of a far wider range of maladies that may first be observed in the head and neck. If your dentist or hygienist aren’t regularly performing a head and neck exam on you, then you should request it.