The Dentist's Role Spotting Oral Cancer

All of us have to worry about tooth decay, but after the age of 40, the risk for an even more serious condition increases dramatically: oral cancer!

Ten thousand people die from oral cancer each year, with 95% of them over the age of 40.

Cancer can strike any part of the mouth, including the lips and tongue. If the cancer is not detected early, tumors can grow deep into local tissues and spread to lymph glands in the neck. The risk for oral cancer increases with age and alcohol and tobacco use.

Be sure that at regular visits your dentist or hygienist is taking the time to detect oral cancer at a stage when it can be more successfully treated.

You can help, too. When brushing and flossing, check for red or white patches in your mouth. Look for tender or numb areas, sores that don't heal, and lumps or rough spots.

If you detect any of these signs or symptoms, call your dentist at once.

Screening for Oral Cancer

Cancers of the oral cavity and pharynx are a major cause of death from cancer in the U.S. An estimated 30,750 new cases of oral cancer are expected to be diagnosed in the U.S. in 1997 and approximately 8,440 people will die of the disease.[1] This form of cancer accounts for about 3% of cancers in men and 2% in women.[1] It occurs more frequently in blacks than in whites.[2]

More than 90% of oral cancers occur in patients over the age of 45. The incidence increases steadily with age until 65, when the rate levels off. Over the past 11 years, there has been no change in incidence, but there has been a slight decrease in mortality rate.

The primary risk factors for oral cancer in American men and women are tobacco (including smokeless tobacco) and alcohol use; lower socioeconomic status, poor oral hygiene, and decayed teeth have also been implicated.[3]

Oral cancer occurs in a region of the body that is generally accessible to physical examination by the patient, the dentist, and the physician. Screening can be made more efficient by inspecting the high-risk sites where 90% of all squamous cell cancers arise: the floor of the mouth, the ventrolateral aspect of the tongue, and the soft palate complex.[4] It has been pointed out that high-risk individuals visit their medical doctors more frequently than they visit their dentists. An inspection of the oral cavity should be part of every physical examination in a dentist's or physician's office.

Although easily detected and often cured in its early stages, most oral cancers are moderately advanced (regional stage) at the time of diagnosis. Unfortunately, this trend has not changed. An oral examination should also look for leukoplakia and erythroplastic lesions, the earliest and most serious signs of squamous cell carcinoma.[5] The overall survival rate also has not changed over the past few years.

Evidence of  Benefit

The routine examination of asymptomatic and symptomatic patients results in the detection of earlier stage cancers as well as premalignant lesions. In 1982, routine oral examinations were performed on 672,000 initial exam veteran patients with the detection of 814 oral squamous cell cancers. In high-risk heavy smokers and drinkers over 40 years of age, the detection rate can be as high as one cancer in every 200-250 individuals examined.[1] In a regional oral cancer detection program in the Boston area, early stage disease increased from 20% to 33% over a 3-year period by stressing the importance of the routine oral examination.[2] It did not require an intricate time-consuming examination, just an examination. In Sri Lanka, primary health care workers were trained in the oral examination, and they sent to a referral center 660 suspected cancers, of which only 10% had no lesion, and 58% were confirmed as having oral cancer.[3]

When monitored in an entire population, white males have a higher percentage of oral cancer diagnosed and treated for early cancer than black males. White males with localized cancer have a better survival than black males. This indicates either more advanced localized disease in black males or a difference in treatment. Unfortunately, when detected, most oral cancers are advanced in both races.

Oral Pathology

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:  

  • Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth

  • A sore that fails to heal and bleeds easily

  • A lump or thickening on the skin lining the inside of the mouth

  • Chronic sore throat or hoarseness

  • Difficulty in chewing or swallowing

These changes can be detected on the lips, cheeks, palate, gum tissue around the teeth, tongue, face, and/or neck. Pain is not always necessary to define a pathology and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.  

We would recommend performing a oral cancer self examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores, please contact us so we may help you.  

If you feel that you or someone you know have any of the symptoms that have been discussed or if you have any questions and / or concerns, please do not hestitate to contact our office so we may be of some assitance to you.

Facts About Oral Cancer

Oral cancer represents approximately 3% of all cancers. This, however, translates to 30,000 new cases every year in the United States. The single greatest risk factor is tobacco. While cases of oral cancers are seen in patients who do not use tobacco, these constitute a very small percentage of all oral cancers. All forms of tobacco have been implicated as causative agents including cigarette, cigar, and pipe tobacco as well as chewing tobacco. In India and Sri Lanka, where chewing tobacco is used with betel nuts and reverse smoking (placing the lit end in the mouth) is practiced, there is a striking incidence of oral cancer- these cases account for as many as 50% of all cancers! Heavy alcohol usage is an additional causative factor. Lip cancer, while included in statistics for oral cancer, is more similar to skin cancers. Sun exposure is the primary cause of these, while pipe smoking is also a factor.

Cancers of the mouth present in various forms. Any persistent white patch must be regarded as being suspicious. Additionally, velvety red patches- particularly those with white speckles- should be areas of concern. Finally, any non-healing ulcer (erosion) merits evaluation. More often than not, these areas are painless.

The tongue is the most common site of oral cancer. Typically, the side of the tongue (farthest back in the mouth) is involved. The floor of the mouth (that area beneath the tongue) is next in order of frequency followed by the insides of the cheeks with involvement of other areas showing a lesser incidence.

While self-examination is advised, some areas cannot be adequately viewed and, of course, there is no substitute for examination by a professional. The best method for detection is to be sure to have semi-annual check-ups by your dentist. Should an area of concern appear in between these appointments, arrangements should be made for examination. If your dentist has any concern or question, he or she will refer you to an oral and maxillofacial surgeon for evaluation and possible biopsy. Biopsy is a quick office procedure which allows the surgeon to take a sample of the tissue in the area of concern for examination under a microscope.

Certainly, it is best to err on the side of caution. However, one should not be unduly alarmed by every white area in the mouth nor by every ulcer since there can be a multitude of harmless causes.

As with any other cancer, treatment of oral cancer is best undertaken at the earliest stage. This maximizes chances of successful treatment. Smaller areas may be treated by radiation or surgery while larger areas will often necessitate combined therapy. Prevention, of course, is the best approach and can best be achieved by avoiding risk factors- refraining from all tobacco products and consuming alcohol in moderation.

Virtual Glasses

image How about 007 helping you out or maybe the magical land ? It really isn't impossible anymore. They'll be happy to be with you during your next appointment! We have used stereo headphones for years. BUT... now there's something really special available... VIRTUAL TV GLASSES. Maybe there's another special someone that REALLY gets you goin' - no problem there are dozens of movies to choose from !!
  • The eyeglasses are attached to an Video i-pod and give the illusion of an 80 inch TV suspended in space 11 feet in front of you.
  • Earphones over each ear for stereo sound.
  • 30+ movies to choose from.

LOCAL NEWS

The image above is Channel 24 (KVUE) filming a local news segment on our Virtual Glasses.

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Dr. Maury Hafernik
11645 Angus Road, Suite 10
Austin, Texas 78759
P: (512) 345-5552

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