Dental Bun Podcast

Saving Lives Chairside: The Cotten Method for Oral Cancer Screening

• Janiece • Season 1 • Episode 6

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Every dental professional knows they should perform oral cancer screenings, but many struggle with confidence in their technique and communication. In this episode with Susan Cotten, creator of the Cotton Method Screening and owner of Oral Cancer Consulting, we explore how to transform routine dental appointments into potentially life-saving encounters.

Susan walks us through her four science-based pillars for effective oral cancer screening, beginning with implementing dedicated risk assessment forms that not only collect vital patient information but naturally open conversations about oral cancer risk factors. She shares practical language for discussing sensitive topics like HPV—now the leading cause of oropharyngeal cancers—using her signature phrase "what we know now is..." to present information in a non-threatening way that invites patient questions.

The most valuable takeaway might be Susan's guidance on communicating findings confidently without causing alarm. "We're not diagnosing," she reminds us, "but anything that persists for two weeks deserves further investigation by a specialist." This simple, matter-of-fact approach keeps both clinician and patient calm while ensuring proper follow-up care. For practices struggling with time constraints, Susan offers a framework for difficult conversations with practice owners using "I feel, I think, I want" language that addresses concerns about patient care and professional liability.

Ready to enhance your oral cancer screening protocols? Connect with Susan through her

Website: https://oralcancerconsulting.com/

Email: oralcancerconsulting@gmail.com

Facebook: https://www.facebook.com/SusanCottenRDH

Instagram: https://www.instagram.com/scottenrdh/

Thank you to our sponsors:

The DEN List:  www.thedenlist.com

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Janiece:

Welcome to the DentalBun Podcast. My name's Janice and I am your host. Today's guest is Susan Cotten. She is the owner of Oral Cancer Consulting and the developer of the Cotten Method Screening. Thank you so much, Susan, for joining us today.

Susan:

Oh, janiece, thank you for having me. I'm excited to be here and talk about oral cancer and screening and saving lives Well if you've been living under a rock.

Janiece:

Someone at least most people have actually seen you in person, live or on a webinar just educating our dental professionals about how we can save lives chairside by doing our oral cancer screenings effectively. And this episode is really going to dive into how to help the clinician chairside be confident and effective with their patients while they're visiting with them about oral cancer, hpv, other risk factors that we all face when we're visiting with our patients and guiding them towards health.

Susan:

You know, janice, in the cotten method I've got four pillars of four science-based pillars that consist of the cotten method and that's having a solid knowledge of those etiologies HPV, tobacco, alcohol, betel, quid understanding those additional risk factors Not so much causes but additional risk for oral and head and neck cancers and recognizing the signs and symptoms associated with the oral and oropharyngeal cancer, other head and neck conditions, and being confident in that, comprehending visual, tactile, extraoral, interoral evaluation. Where that really starts is from the moment I walk in. So when I work with offices, I recommend that those what we know now about additional risk factors and signs and symptoms and incorporate those either into their health history questionnaire or have a separate oral cancer risk assessment form that they fill out. And the reason why I encourage that separate oral cancer risk assessment form to begin, encourage that separate oral cancer risk assessment form to begin that clinical intake of information and that helps us communicate with our patient, is that they fill that out. We're gaining the information that we want. But it's also piquing curiosity in our patients. They'll be going, but I'm just here to get my teeth cleaned. Why is this important? And they'll come back with questions and it opens up that conversation and why I think this is critical.

Susan:

Many years ago I went in for my mammogram and I sat down. They gave me an iPad to fill out and it had a form, so I filled out all of my information. My name, blah blah blah. But then they had about gosh, about 15 different things. They asked me and the light bulb went on. I'm like they're doing a risk assessment on me.

Susan:

So not only will they be doing the mammogram to get those pictures and do that clinical assessment, but they want to know what else is going on in my life, these other things that they know now. And so, gosh, we can do that same thing in dentistry, because we know that they're not always going to verbalize it. Or when they fill that out, they may mark no, no, no, no. But then when we bring it back, we can say oh gosh, you know, thank you for filling this out. I see that you've marked difficulty swallowing. No, persistent sore throat. These are things that we know now to pay attention to when we're doing our head and neck oral cancer screenings. And it just opens up the conversation, it starts it sick.

Janiece:

When I speak with clinicians, I always find it interesting that they have a little bit of difficulty kind of moving forward with talking about things with their patient, and I have to remind them that most of the time we've seen these patients more than once, so the comfort level is there. A lot of times they see us more than their MD and they do tend to be a little bit more open, even just socially, about what they've been doing on the weekend. I do feel we have an advantage as dental professionals because we do see our patients a little bit more often, that they do lower the guard and allow us to ask a little bit more often, that they do lower the guard and allow us to ask a little bit more, and they are a lot more relaxed in the chair and are willing to tell us certain things that maybe they wouldn't offer up to their physician. Yep, exactly, exactly.

Susan:

And one. You know, one phrase I use in my courses to open up a new conversation, whether it be about HPV or more information about tobacco or beetle quid, or the signs and symptoms. Is you know when we're doing that visual, tactile, extraoral, interoral evaluation? Is you know, be sure to tell them we're doing an oral cancer screening. You know, janice, today I'm going to do an oral cancer screening on you, and what we know now is that blah, blah, blah. What is it that you want to share? What we know now is it's not just tobacco and alcohol that contribute to oral cancers.

Susan:

Now, the main cause of throat cancer is the human papillomavirus, hpv, the most common sexually transmitted infection in the United States. Leave it there, you know, if you haven't shared about HPV with your patients yet, and just leave it there. That's how I started and they'll either ask you some more questions or, you know, sometimes they'll say, yeah, I've heard about that. Or really, hpv, I've heard about cervical cancer, but I haven't heard about throat cancer and HPV. Or yeah, is that the thing that Michael Douglas had, you know, and it just all we have to do is say it and stop and let the patient take the lead from there on what they want to know on what they want to know.

Janiece:

When you speak with clinicians, either chair side or when you're doing your speaking events, being confident in discussing what you have found, what are tips that you can give the clinicians when we're working chair side with our patients, to help us be confident in doing that?

Susan:

Yeah, so if somebody marks, you know, difficulty swallowing, persistent sore throat, change in voice, you know any persistent signs or symptoms, or if we see a lesion, persistent lesion or anything, the first thing to remember is that we're not diagnosing. Remember is that we're not diagnosing right. So these are things to watch for Now, while we may see a lesion that is just blatantly blaming probably oral cancer, right, and we know it we're still not diagnosing. Janice, what we know now is that anything that persists for two weeks deserves further investigation by the appropriate specialist. So we're going to refer you to Dr So-and-so and have them investigate this further.

Susan:

We don't need to mention cancer, we don't need, you know, and the calmer we are, the calmer your patient will be. You know, and just be very matter of fact. Oh gosh, well, you know, I see this and well, we don't know. And but we need to know just what we know now. Is this just and and related to medical? You know, just like your medical provider, when your blood pressure is persistently high or your blood sugar, or if you've been to the dermatologist, further investigation, and they'll probably ask well, what do you think it is?

Susan:

Well, you know what we don't know, and that's why the referral to the specialist, just like we refer to a periodontist or an endodontist. Just like we refer to a periodontist or an endodontist. We've done our job as a clinician by screening thoroughly, identifying something, whether it be a lesion, maybe a mass or persistent swollen lymph node or a persistent symptom. You know the difficulty, swallowing sensation of something caught in the throat. That's our job. We're not diagnosing. And then to make that appropriate referral to the appropriate specialist and confidence in doing that, it just comes with doing it, it just comes with doing it Right.

Susan:

I relate it back to hygiene school, because when I started deep into oral cancer and doing this, I wasn't confident, you know, and I messed it up a lot of times. But it just takes doing it over and over and finding your verbiage and if you can use what we know now and refer to the appropriate specialist, all of those different things. I got that verbiage from my dad, who was a veterinarian that I worked with for so long. But it's just doing it, and what I was going to say is I relate it back to hygiene school. I always wondered will I ever be able to do a comprehensive periodontal charting in less than a half an hour and get it right? Right, yeah, and get it right and yeah, we get there. Because why we do it over and over and over? It's like with anything new that we're trying developing verbiage skills.

Janiece:

Yeah, once we complete our oral cancer screening and oral pharyngeal screening. Once we complete our oral cancer screening and oral pharyngeal screening, our time is shorter and shorter. In the clinical space that we work in, some people have an hour, some people have 45 minutes and, sadly, some people have 30 minutes. And when we look at those timeframes we all as clinicians know that sometimes those initial steps, unfortunately sometimes the oral cancer screening, does not get done Right. So how do we combat that in making sure that those discussions are had with our dentists and doctors and maybe office managers, to allow us to be able to get that done for our patient.

Susan:

Oh, that's a great question, janice. You know I learned this phrase how to have a difficult conversation from an emotional intelligence workshop that I took, an emotional intelligence workshop that I took. And the framework of this to have that conversation with your dentist, with the team, with the office manager is, I feel, I think I want Doctor, so-and-so I feel concerned because I don't have the time to do all of these different procedures in my allotted time. I feel concerned for my liability as a dental hygienist, your liability as the dentist and owner of this practice, but mostly I'm concerned about our patients that they're not receiving a comprehensive head and neck exam, oral oropharyngeal cancer screening. What I'd like, so I feel, I think, I want, so I think how we could best address these concerns. Think how we could best address these concerns and, if you're open to that, is, how can we tackle this as a team? Is it more time? Is it me doing the comprehensive screening? Here's what I recommend as far as asking these questions that we give them this oral cancer risk assessment and then you know whatever other concerns you have, or that you or that the hygienist sees could fit and work in their situation, because it'll be different for everybody. So we've got, I feel, I feel concerned for the patient and for us as dental professionals in our liability, because liability is huge. There was just an $11 million suit against a dentist in an oral cancer case. So it happens and these will be big because oral cancer has many facets to it. So I feel, I think, I think what I'd like is for us to have a discussion further as a team. If there's, you know, are there other hygienists to bring in on this conversation? Bring the team in. So I feel, I think I want and then have that conversation. If they're not open to that conversation or making change, then the hygienist needs to decide. Is that something that you want to continue with? Do you want to continue working there? We have to look at our liability when time is shortened. What's our liability in what we're doing and not doing, because that's huge and then our patients, our patients aren't receiving optimal care.

Susan:

It's the pillow test when you lay your head down at night. Are you happy with what you did as a dental hygienist, as an oral health care professional, dental hygienist, as an oral health care professional? Now, if you've got the time, you know, say you have an hour but you're not doing a comprehensive screening and you want to just start somewhere. And then is it the intraoral that you want to tackle first. Start with the intraoral, start that one week, then add the extraoral, but start somewhere. And are you going to be confident, just like that, 100% right away? No, but like we talked about with the probings, right with the periodontal evaluation, just keep doing it. Periodontal evaluation, just keep doing it.

Susan:

And one tip here is when I do my comprehensive screening, that's when I, if it's a patient, I know I'm asking about the kids, I'm asking about the wedding or how you know the family stuff. We don't have time to do that knee-to-knee. But then I'm also discussing HPV, giving them more information about that, asking again about the signs and symptoms, even if you've asked on that oral cancer risk assessment. But then when I mentor oral, while we call it an oral cancer screening, yeah, I've got my oral cancer screening eyes on, but we're looking at the same structures to evaluate airway. We're looking at the same structures. If we're looking for any myofunctional disorders, I'm doing that at the same time when I've got my mirror in there and I'm looking at everything. Yes, I'm looking for lesions, any abnormalities, but I'm also looking at the heart structures, the teeth, are there any restorations? I want to grab that intraoral camera and take a photo or discuss anything with the patient and the dentist. You know I'm looking at inflammation, so I'm doing a lot when I'm in there and for efficiency.

Janiece:

And it's our job. It's in the dental code of 0120.

Susan:

Yep, exactly, exactly, yeah, yeah. It says in the periodic evaluation, the comprehensive evaluation and that periodontal evaluation.

Janiece:

It says in there now, thanks to a group of dental hygienists, dental Codology Consortium, that is something that Susan is a part of, and they do have a Facebook page, so I can put that in the notes, in the show notes, if you're interested in that. Yeah, but in those codes now.

Susan:

they all used to read oral cancer evaluation, where indicated. But now those three codes read oral cancer evaluation period. So when a hygienist or dentist is submitting those codes we are saying we have done that oral cancer evaluation. It's not period, it's not an option.

Janiece:

Yeah, so when clinicians are kind of once they've finished listening to our podcast and they know that maybe it is something that they need to work on a little bit more whether it's finding a better risk assessment form, maybe buttoning up their medical history, gaining confidence in their screenings when can they find you to get help with either individual help or maybe with their office?

Susan:

Yeah, thanks, Janice. They can reach me through my website, oralcancerconsultingcom, email, oralcancerconsulting at gmailcom. I'm on social media Facebook, LinkedIn, Instagram. Reach out and we can have a short coffee talk and see what your needs are and where you want to go.

Janiece:

Well, thank you so much, Susan. A ton of nuggets for dental professionals to be able to complete their oral cancer screenings with their patients a lot more confidently. So thank you so much, Susan, for joining us on DentalBund Podcast.

Susan:

Thank you for having me, janice, it's been fun.