By: Susan Cotten, BSDH, RDH OMT

Writing this article, it is the last day of Oral Cancer Awareness Month. During April, the call to action and focus throughout dentistry is to perform a comprehensive oral cancer screening and head and neck exams for every patient, every visit, regardless of age or perceived risk. This is as it should be. It is our ethical responsibility as dental professionals to provide this life-saving screening for every patient. The CDT exam codes, DO12O, DO150, and DO180, state that an oral cancer evaluation is to be performed when an exam is done, and codes are submitted – it is not optional. Additionally, both the American Dental Association (ADA) and American Dental Hygienists’ Association (ADHA) state in their policies that dentists and dental hygienists are to screen patients for oral and oropharyngeal cancer.

An important focus I have taken on in the past two years is: “Who is screening the screener?” Ask a dentist or dental hygienist when they last had a comprehensive oral cancer screening and a head and neck exam. Have they had one in the last year? The sad reality is that most dental professionals are not being screened.

I am asking you here: When was your last comprehensive oral cancer screening, head and neck exam? Have you had one within the last year? Not just a quick look at the tongue or a rushed exam during a cancellation in the schedule, but an intentional, comprehensive, visual, tactile, extraoral and intraoral evaluation, along with an inquiry about the signs and symptoms associated with oral and oropharyngeal cancer.

We are not immune to oral and oropharyngeal cancer, or any head and neck cancer, simply because we are in dentistry. The Human Papillomavirus (HPV) is responsible for approximately 70% of oropharyngeal cancers and now causes more oropharyngeal cancer than cervical cancer. Oral cancer of the mobile tongue is on the rise in the younger population with no known risk factors. Tobacco and alcohol use are no longer the only risk factors. In fact, some oral cancer patients have no risk factors.

CALL TO ACTION
My call to action for you is: Get Screened! Schedule screenings for each team member, including the screeners. A perfect time for this is during a monthly team meeting. In addition to screening everyone, this is an optimal opportunity to calibrate screeners on a comprehensive extraoral and intraoral evaluation, including assessment of the thyroid gland and the oropharynx, so you won’t hear patients say, “I’ve never had that done before by the other hygienist or dentist in this office.”

This is also an optimal time to educate all team members on HPV. Evaluate your office and each provider’s risk of liability. Review systems and protocols for thorough documentation, referrals to specialists, and follow-up appointments. If you decide to “watch” something, what is the specific plan for that “watch” to ensure optimal patient outcomes and attention to reducing liability?

I reached out to the Rocky Mountain Dental Convention (RMDC) and shared the uncomfortable truth: the majority of people working in dentistry are not receiving an annual comprehensive screening. I asked if they would be open to free screenings on the exhibit floor for convention attendees. They said yes. 2025 was the first year we offered screening in the Expo Hall at RMDC, and we returned this year. Each day during lunch, dental professionals were lined up waiting to be screened, with some from 2025 returning for their annual check. I recruited an incredible team of dental hygienists who screen their patients using The Cotten Method™ of Screening in daily practice. A common comment we heard from attendees was, “No one has ever done this for me before.”

In 2026, we screened 123 dental professionals. Of those screened, 23 follow-up referrals were made based on identifying concerns that warranted further evaluation by the appropriate specialist.

Early detection starts with us, but it must also include us. Raise the standard and start within.

Ms. Susan Cotten, BSDH, RDH, OMT, is CEO of Oral Cancer Free and Oral Cancer Consulting. She is the creator of The Cotten Method™ – a science-based approach to screening. She serves as Dental Lead for the Alliance for HPV Free Colorado and RDH Advisory Board member for RDH Magazine and the Oral Cancer Foundation.