Can your dentist save your life?

As a full-time dentist and a recreational blogger, I take a great deal of pride in my ability to effectively explain even the most mundane dental subjects to my patients in a way that is easy to understand.  If you have had the opportunity to read my posts on things like: bad breath, sleep apnea and periodontal disease you can see that I try very hard to provide useful information while also injecting a little humor into these subjects.  But, today, I am going to write about a subject that I take very seriously and, as you will see, very personally: Oral Cancer.

I remember it like it was yesterday.  On a Tuesday afternoon in June of 2006, a long time patient of our practice, Mr. B, came into the office with what he described as, “a sore tongue.”  To say Mr. B is a long time patient of our practice does not tell the whole story.  I have known Mr. B my entire life.  Our families lived across the street from each other in a quiet cul-de-sac in Vienna for 13 years.  The B’s were our favorite neighbors and our families have been intertwined for as long as I can remember. His wife was the neighborhood nurse and a close friend of my mother.  My oldest sister was his daughter’s matron of honor, his son took my other sister to her homecoming, and when my family drove across the country in the summer of 1980, we spent 6 weeks and 7,000 miles in a van Mr. B graciously loaned to us.  In high school, when I decided to take my father’s car out joyriding while my parents vacationed in Alaska, it was Mr. B who sat me down and “forcefully explained” the irresponsibility of my actions (and never told my parents).  Many years later, as a dental professional, we only needed one look to know, without question, what we were seeing when we examined this irritated area on the side of Mr. B’s tongue.   Mr B had cancer.

It’s hard to describe what I thought and felt when I realized that this man who I have known for my entire life had walked into our office to show us a squamous cell carcinoma on the right side of his tongue.  In all honesty, after the shock, denial and introspection had subsided, I can remember going to my computer and looking up the statistics.

According to the Oral Cancer Foundation:

  • Roughly 37,000 people in North America will be diagnosed with oral or pharyngeal cancer this year.
  • It will cause over 9,000 deaths, killing nearly 1 person every hour of every day.
  • The death rate for oral cancer is higher than that of cancers which we hear about routinely such as: cervical cancer, Hodgkin’s lymphoma, testicular cancer, thyroid and skin cancer (malignant melanoma).
  • Of those newly diagnosed individuals, only half will be alive in 5 years.
  • This 5 year survival rate is a number which has not significantly improved in decades.

I can’t help feeling deep sadness when I think of any patient discovering that they have oral cancer, and certainly this sadness only intensifies when, in the case of Mr. B, the diagnosis hits so close to home.  I’m happy to report that Mr. B was in the office this week.  In 2006, his cancer was successfully removed and he recently saw his oncologist for his five year follow-up and he is cancer free!  Clearly, we are elated to know that he beat the odds.  After going thru this with Mr. B., I know that, as dental professionals, we want to do everything we can to spare our patients the experience Mr. B and his family had to endure.

So let’s start with those statistics.  Why are they so staggering?  Well the answer to this question is twofold.  Unfortunately, approximately two-thirds of the newly diagnosed cases of Oral cancer aren’t discovered until they are in the later stages.  This can be attributed to poor screening tools and the reality that oral cancers often do not produce recognizable signs and symptoms until they reach these later stages.  The other piece to this puzzle is that the face of the oral cancer patient is now changing. 

Who’s at risk?

The classic oral cancer patient exhibits the following risk factors:

  • Tobacco use. It should come as no surprise that tobacco, in all its forms, is the largest contributor to the development of oral or mouth cancers.  Not using tobacco is the single most important thing you can do to avoid oral cancers.
  • Excessive alcohol consumption.  More than 15 drinks per week will put a person at greater risk for oral cancer.
  • The combined use of alcohol and tobacco.  This will significantly increase a person’s risk for oral cancer more than either by itself.
  • Age. Older individuals (>40 years of age) tend to develop more diseases in general, including oral cancer, as their immune systems become less efficient.
  • Gender. Males are statistically more likely to develop oral cancer than females.  This tends to be a direct relation to lifestyle issues and not biology.
  • Diet. A low intake of fruits and vegetables will decrease the amount of protective nutrients contained in these foods.
  • Excessive exposure to the sun.  Exposure to the sun will increase the likelihood of lip cancers, and it is recommended that everyone wear SPF 30 sun block on your lips.
  • Use of betel nut and bedis.  This seed of the Areca palm grows in the tropical pacific, Asia and parts of east Africa.  It is chewed much like tobacco and it acts as a mild stimulant.  Excessive use has been linked to an increased likelihood of mouth cancers.
  • Race, ethnicity and economics– Persons of African descent are twice as likely to develop oral cancers than other races.  Whether this is a product of biology or reflection of socioeconomic/access to care factors is still under examination.

This is the classic presentation of an oral cancer patient, and I take great pains to describe this profile to make the point that the “typical” patient is changing.  No longer are the newly diagnosed patients forty- five year old males who drink, smoke, work outside and like to occasionally chew on an east African stimulant. 

The Changing Face of Oral Cancer

Over the past decade there has been a steep increase in patients who do not fit this profile in any way.  The incidence of oral cancers diagnosed in twenty-something patients, who don’t drink, don’t smoke and lead a relatively healthy lifestyle is on the rise.  The medical and dental community has discovered that infection by The Human Papilloma Virus (HPV-16) is the most likely causative factor of this alarming trend.

The Human Papilloma Virus and Development of a Vaccine

Strangely enough, the Human Papilloma Virus is something with which I am very familiar.  As an undergraduate at Georgetown University, I had the opportunity to work for Dr Richard Schlegel, the chairman of the MD/PhD program and director of a pathology laboratory that researched HPV-16 and 18.  By mere coincidence, I spent 4 years of my life researching the papilloma virus and it was the subject of my senior thesis.  At the time, I knew it as a sexually transmitted virus that is the cause of over 95% of all cervical cancers.  And since there are no outward symptoms, individuals that carry the disease are unlikely to know that they have it.  It is now estimated that 60-80% of people will be infected by HPV in their lifetime.  I am very proud to have worked for Dr. Schlegel.  His lab contributed significantly to the new papilloma virus vaccine that is now commercially available and saving lives.  At the time that I decided to pursue a career in dentistry, I never thought that HPV-16 would reenter my life. 

Routine Screenings

So, besides the development of the HPV vaccine, is there any other good news?  Of course there is.  When we find oral cancers in their early stages, the 5 year survival rate goes from about 50% to over 80%.   All of the statistics that I have presented here have echoed one consistent reality; we are finding these patients too late in the disease progression.  Mr. B. was very lucky.  Fortunately, he came to our office when he first suspected something might be wrong with his tongue.  This allowed us to quickly get him to an oral surgeon, who immediately obtained a diagnosis and the carcinoma was removed before it traveled into his lymph nodes. 

If we can learn one thing from Mr. B’s experience, it is that early detection is the key!   This is why we and the rest of the dental community routinely screen our patients for oral cancer at every visit.  There are two ways that we now screen my patients for any tissue changes that may indicate oral cancer.  The first is a visual and tactile examination.  We have diligently performed this examination for as long as I have been in our office; it was taught to me by my father during my first week in his practice.  After asking our patients if they have noticed any lumps, bumps or swellings in or around their mouth, we carefully examine all the soft tissues of the oral cavity.  Many of you will remember the times when we ask you to stick your tongue out, then grab it with a gauze pad and inspect the sides.  This is when we are checking you for cancer.

There is now a second way that we check our patients for oral cancer using an adjunctive screening tool called the VELscope®.  We are very excited about this technology because using blue light and proprietary filters, the VELscope® allows us to use fluorescence to better visualize any changes in the tissue that are otherwise invisible to the naked eye.  Using tissue fluorescence as a screening tool is nothing new; this technology has been available for decades to examine the lungs, cervix, colon and skin, and now it has been proven to be an effective tool for examining the tissues of the oral cavity.  The test is completely safe, painless, and only takes 2-3 minutes.  This adjunctive screening tool allows us to evaluate the mouth in a way we never could before, at every hygiene visit.

Be Aware, Be Proactive!

Patients are also responsible for their own oral health.  Just as we ask you to brush and floss, we now want you to be aware of the signs and symptoms of oral cancer.  Regular screening by a qualified medical or dental professional is the single best step that you can take to ensure that any changes in your oral tissues are identified at the earliest possible stage.   It bears repeating that Mr. B’s quick action to come see us when he was first concerned about his tongue is probably the reason his treatment was so successful. 

Please give our office a call if you experience any of the following:

  1. Red and/or white discolorations of the soft tissues of the mouth.
  2. Any sore that does not heal in 14 days
  3. Hoarseness which lasts for a prolonged period of time.

In the middle to late stages, indicators can include:

  1. A sensation that something is stuck in your throat
  2. Numbness in the oral region
  3. Difficulty in moving the jaw or the tongue
  4. Difficulty swallowing
  5. Ear pain which occurs on only one side
  6. A sore under a denture, which does not heal, even after an adjustment.
  7. A lump or thickening which develops on the mouth or neck.

It’s important to become aware of the signs and symptoms of oral cancer, but don’t forget that the mouth is normally under constant trauma.  Anytime you eat, the tissue can be traumatized or ulcerated (remember the pizza burns on the roof of your mouth).  Keep in mind that, 99% of the time, a suspicious area in the mouth is NOTHING, but that doesn’t mean that you should take it lightly.  In our office, every suspicious area is first evaluated both visually and under the VELscope®, pictures are taken and the patient is asked to return in 14 days to allow the area to heal.  If after 14 days we remain suspicious, we can then perform an almost painless brush biopsy that removes the top layer of cells and we send those cells to a lab for evaluation.  If we are still unsure after these two steps have been completed, only then do we send the patient to an oral surgeon for further evaluation.   A referral to a surgeon should not alarm a person; we do this in an effort to conclusively determine what any abnormality may be and if early treatment should be administered.  Always remember, early detection is the key to success!

I hope you have found this blog informative, educational and reassuring.  I promise to lighten up the next post and write it in such a way as to inspire the response that I have dedicated my life to: your smile.  As always, we love answering any questions you may have.  Please feel free to write, call or drop by our office if we can be of any assistance to you or to someone you know.  Our website is loaded with useful information and we encourage you to check it out at your leisure.

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