1 population screening 2 targeting screening 3 opportunistic

篩檢之分類 1. ㄧ般民眾型篩檢(population screening) 2. 標靶型篩檢(targeting screening) 3. 隨機型篩檢(opportunistic screening)

Lim, Moles, et al: Opportunistic Screening for Oral Cancer and Precancer in General Dental Practice ¡ Opportunistic screening in a general dental practice setting may be a realistic alternative to population screening. ¡ General dental practice is ideal for the evaluation of such systems prior to extending these studies to other healthcare setting. Br Dent J 2003; 194: 497 -

NOTE : This is a bad example !

NOTE : This is a bad example !

NOTE : This is a bad example !

NOTE : This is a bad example !

A PRACTICAL TECHNIQUE OF SCREENING FOR ORAL CANCER （SUMMARY） —reported at 41 st APACPH(Asia Pacific Academic Consortium for Public Health) Confrerence, 5 th Dec. 2009 L. J. Hahn, DDSc, FICD Oral and Maxillofacial Surgeon, National Taiwan University Hospital

Current and conventional method of screening for oral cancer in Taiwan ¡ The examiner and the examinee sit face to face on 2 chairs. ¡ The examiner use only 1 -2 disposable tongue depressors without using mouth mirrors, to perform the so-called “oral cancer screening”. 28

Disadvantages of such conventional methods ¡ Against human engineering ¡ No mouth mirror → no complete screening (there are dead corners on examination) ¡ Prone to result in FALSE NEGATIVE finding. 29

Correct and practical method of screening for oral cancer ¡ The examinee takes supine position ¡ The examiner sits at 7 -11 o’clock position of the head of an examinee ¡ Use 2 mouth mirrors( 2 -mirror technique ) ¡ Examine 50 sites of the full mouth mucosa, in definite order without missing any site. 30

4 Functions of the mouth mirror ¡ As a mirror ¡ To reflex light to the site where close examination is needed. ¡ As a retractor ¡ For primary “palpation” ¡ So, using mouth mirrors is mandatory to perform correct screening for oral cancer.

“Palpation” with a mouth mirror ¡ Whilst digital palpation of the mucosa would be ideal, for practical reasons MOUTH MIRRORS may be used to gain an idea of the texture of the tissues. ¡ Digital palpation using any necessary precautions, may then be reserved for the examination of particular lesions. ─ WHO : Guide to epidemiology and diagnosis of oral mucosal diseases and conditions, 1980 ¡ As suggested in the WHO guide, 2 mouth mirrors are recommended with digital palpation for particular lesions ─Zain et al : Clinical criteria for diagnosis of oral mucosal lesions, 2002

Advantages of 2 -mirror technique of screening for oral cancer by supine position ¡ Good accessibility to the oral cavity ¡ Fit human engineering － for adequate inspection and palpation ¡ Using 2 mouth mirrors－ much better than just using tongue depressors only ¡ Natural posture, less fatigability ¡ Can detect more precancers and early cancers(may achieve “downstaging”) ■ ■ Less possibility of causing FALSE NEGATIVE result.

A simplified method of screening for oral cancer (Hahn’s method) ¡ Can be used if the dental, or flexible and portable chair for oral cancer screening is unavailable (Please watch DVD demonstration, if available)

Two Mouth Mirrors在篩檢時的功能 －2 Mirror Technique 1. 鏡子功能：照出視線無法直接看到的地方，如小 部位、小角落或牙齒後方視線死角處（舌側、腭 側）黏膜。 2. 反射功能：可藉反射送更多光線到需細看的部位。 3. 當做肌鈎（retractor）: 推開或拉開舌、唇、頰等。 4. 用來觸診：可做經常性或初步的觸診，必要時對 特殊病變(particular lesions)才換用手指觸診即可 （WHO Guide to epidemiology and diagnosis of oral mucosal diseases and conditions/Clinical Criteria for Diagnosis of Oral Mucosal Lesions－ An aid for dental and medical practitioners in the Asia-Pacific Region）

TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA, (HAHN, L. J. modified after WHO monogragh) §口腔黏膜細部區分 (1) 1. Vermilion border ― upper (1), lower (2) 口唇(唇紅部)－上、下 2. Labial commissures ― right (3), left (4) 唇聯合－右、左 3. Labial mucosa ― upper (5), lower (6) 唇黏膜－上、下 4. Cheek (buccal muccsa) ― right (7), left (8) 頰黏膜－右、左 5. Labial sulci ― upper (9), lower (10) 唇溝－上、下 6. Buccal sulcus ― right upper (11) lower (12) 頰溝－右上、右下 7. Buccal sulcus ― left upper (13) lower(14) 頰溝－左上、左下

TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA, (HAHN, L. J. modified after WHO monogragh) §口腔黏膜細部區分 (2) 8. Posterior gingiva and alveolar ridge (process) buccally 後牙頰側牙齦及齒槽堤 Upper gingiva or edentulous alveolar ridge buccally ― right (15), left (16) 上右、上左 Lower gingiva or edentulous alveolar ridge buccally ― right (17), left (18) 下右、下左 9. Anterior gingiva and alveolar ridge (process) labially: 前牙唇側牙齦及齒槽堤－上、下 Upper (19) Lower (20)

TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA, (HAHN, L. J. modified after WHO monogragh) §口腔黏膜細部區分 (3) 10. Posterior gingiva and alveolar ridge (process) palatally and lingually 後牙腭側或舌側牙齦及齒槽堤－上右、上左、下右、下左 Upper ― right (21), left (22) Lower ― right (23), left (24) 11. Anterior gingiva and alveolar ridge (process) palatally and lingually, palatally (25) and lingually (26) 前牙腭側或舌側牙齦及齒槽堤－腭側、舌側 12. Dorsum (dorsal surface)of the tongue ― right (27), left (28) 舌背－右、左

TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA, (HAHN, L. J. modified after WHO monogragh) §口腔黏膜細部區分 (4) 13. Base of the tongue ― right (29), left (30) 舌根－右、左 14. Tip of the tongue (31) 舌尖 15. Margin (lateral border) of the tongue ― right (32), left (33) 舌側緣－右、左 16. Ventral(inferior) surface of the tongue ― right (34), left (35) 舌腹面－右、左

TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA, (HAHN, L. J. modified after WHO monogragh) §口腔黏膜細部區分 (5) 17. Floor of the mouth Frontal (36) 口底－中央 Floor of the mouth Lateral ― right (37), left (38) 口底－右邊、左邊 18. Hard palate ― right (39), left (40) 硬腭－右、左 19. Soft palate ― right (41), left (42) 軟腭－右、左

TOPOGRAPHICAL CLASSIFICATION OF ORAL MUCOSA, (HAHN, L. J. modified after WHO monogragh) §口腔黏膜細部區分 (6) 20. Anterior tonsillar pillar ― right (43), left (44) 扁桃前柱－右、左 21. Uvula (45) 懸雍垂 22. Retromolar region (trigone) － right (46), left (47) 臼齒後(三角)區－右、左 23. Oropharynx and tonsils (48) 口咽 24. Tonsils-right (49), left (50) 扁桃腺－右、左

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