Considerations in the evaluation and management of oral potentially malignant disorders during the COVID‐19 pandemic

Abstract

Aim: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for health care practitioners and facilities serving at the frontlines of this pandemic. With regard to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. Methods: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment vs telehealth assessment during the COVID-19 pandemic. Results: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients. Conclusions:The COVID-19 pandemic has required health care practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high risk for severe illness are also higher risk for the development of OPMDs.

The role of teledentistry in oral cancer patients during the COVID-19 pandemic: an integrative literature review

“…Included studies were conducted in Brazil [ 30 – 32 ], England [ 33 ], Hong Kong [ 34 ], Italy [ 35 , 36 ], India [ 37 ], Saudi Arabia [ 4 ], and USA [ 38 , 39 ], all published in English.…”

“…Seven references were letters to the editor/editorials [ 4 , 30 – 33 , 36 , 37 ], and four were case reports [ 34 , 35 , 38 , 39 ] evaluating the application of remote technologies in the follow-up and monitoring of patients with oral cancer and head and neck cancer during the COVID-19 pandemic. The emphasis was on the mitigation of the evolution, severity, and complexity of the disease in the face of restrictions that the pandemic imposed on health systems.…”

“…Some authors have observed that dentists may carry out virtual visits for follow-up, interviews, and clinical examinations with the guidance of oral habits for their patients [ 4 , 37 ]. Two authors verified that patients could take photographs and copy of biopsy report [ 35 , 39 ] of the mouth and refer them to the dentist to manage the evolution of the lesion. According to the authors, this also allows the control of the virtual education of the patients about the clinical signs and risk factors of oral cancer, through valid and reliable websites, reducing anxiety with information available in the common media [ 4 , 37 ] and a spatial appreciation of in some oral lesions through using the mobile phone light, allowing the humanization of the virtual visit [ 39 ].…”

Impact of the first month of Covid-19 lockdown on oncologic surgical activity in the Ile de France region university hospital otorhinolaryngology departments

“…In China, these findings led to guidelines advocating changing certain practices during the epidemic in digestive and lung cancer patients, with 2 main aims in view: to limit high-risk situations such as surgery, and to limit contact, especially with health-care establishments. At the same time, several societies, groups and associations specializing in head and neck cancer surgery put forward various advices [1,[8][9][10][11][12][13][14][15][16][17][18]. The first idea was a form of triage, adapting the interval to surgery according to the potential danger of the cancer.…”

Penn Medicine Head and Neck Cancer Service Line COVID-19 Management Guidelines

“…• If this is the first patient visit for leukoplakia with no history of prior biopsy and no histologic diagnosis, we recommend the patient send pictures of the suspicious area(s) via our secure patient portal followed by a telehealth video visit 6 To avoid missing cancer, perform either incisional or excisional biopsy within 1 -6 weeks depending on the surgeon's index of suspicion based on the pictures. The biopsy can be done in the outpatient setting or in the operating room depending on the preference of the clinician.…”