The dentist as a referral source of first episode head and neck cancer patients.

This analysis was conducted to shed more light on the role of the dentist in the detection and referral of patients with head and neck cancer. No other study of the referral practices of dentists has examined the characteristics of these patients in contrast to those referred by physicians to understand the selection of pathways to care. The findings reported here indicate that: "anatomical provinces" exist for both types of practitioners that are well recognized by the lay community and perhaps reinforced by the health field; advanced stage referrals on the parts of physicians may occur because patients delayed seeking care until symptoms required medical attention; and dentists as a group may b better prepared to detect oral cavity lesions, but not lesions at other head and neck sites. The findings of this study, as well as those of Adams and others and Pogrel, suggest the need for improved educational programs about head and neck cancer directed to the public as well as physicians and dentists. The public should be aware not only of the etiology of head and neck cancers and the associated signs and symptoms, but also of the availability of the dentist, as well as the physician, as a diagnostic resource. Furthermore, educational programs should be developed in dental and medical schools to teach and reinforce detection and diagnostic skill including soft-tissue examination procedures; the use of the indirect mirror for examination of the base of the tongue, larynx, and the lower posterior pharyngeal wall; and biopsy techniques.