Has your dentist ever performed an exam to detect oral cancer? Your answer is likely to be no. In one survey, only 15% of respondents said they were aware that their dentist had performed such an exam. Informal polling of dental professionals shows that the percentage probably is accurate, with only about one in five saying that they consistently conduct the exam.
That’s a mouthful of bad news…
Every year, more than 34,000 Americans are diagnosed with oral cancer, and more than 8,000 people die every year from the disease — a death rate higher than that of other cancers routinely featured in the news, such as cervical cancer and melanoma.
Oral cancer affects the oral cavity — the inside of the mouth, the tongue and the back of the mouth (oropharynx), where the tongue is attached to the throat. When oral cancer is detected in its earliest stages, the survival rate after five years is 80% to 90%. But when it advances undetected — even for a few months — the five-year survival rate drops to 55%. Unfortunately, the majority of cases of oral cancer are diagnosed when they are advanced.
How to protect yourself…
Three out of four people diagnosed with oral cancer are regular users of tobacco products. Cigarettes, cigars, pipes and chewing tobacco damage the DNA of cells in the oral cavity — which is why tobacco use is the leading cause of oral cancer. However, there are other risk factors as well. These include…
Alcohol. Heavy alcohol use (five or more weekly drinks for men and three or more for women) is associated with oral cancer. Also, years of tobacco and alcohol use increase your risk for oral cancer more than tobacco use alone. That’s because aldehyde, a compound in alcohol, boosts the absorption of cancer-causing substances in tobacco.
Mouthwash update: Although a few studies have pointed to a possible link between the alcohol in mouthwash and oral cancer, it is not a proven risk factor. Nevertheless, I advise my patients to use a nonalcohol mouthwash with the ADA seal of approval.
Oral infection with HPV (human papilloma virus). HPV consists of more than 100 strains and is the cause of warts of all types, including genital warts. A longtime (five- to 10-year) infection in the oral cavity with the strain HPV-16 or HPV-18 has been linked to oral cancer at the base of the tongue and on the oropharynx.
The most common source of transmission for this infection is probably oral sex, and HPV-16 can infect the oral cavity without a history of multiple oral sex partners. Recent research suggests that it even is transmissible via open-mouth kissing.
Age. About 95% of oral cancers are in people over 40 years old. The average age of diagnosis is 60.
Male. Men are twice as likely to develop oral cancer. However, women now are smoking and drinking more than they used to — the rate of male-to-female oral cancer patients was six to one in 1950, and it is now two to one.
Family history. If a parent or sibling developed oral cancer, you are more likely to develop it, too.
Oral cancer starts as precancer — an area of abnormal cell maturation called dysplasia. It appears as a small white or red plaque or patch that is slightly elevated.
A thorough exam for oral cancer by a dentist or hygienist checks for signs of precancer on all the soft tissues inside the mouth — the roof… the floor… inside the lips… inside the cheeks… on the top, sides and bottom of the tongue… and at the back of the mouth, using a tongue depressor.
You should receive the exam at least twice a year, at your regular cleaning.
If you don’t think the dentist or hygienist conducted the exam — ask. You might say, “You’ve probably already done it and I didn’t realize it, but did you look today to make sure that I don’t have anything that looks like a precancer in my mouth?”
Smart idea: If you have one or more of the risk factors for oral cancer, conduct a self-exam once a month. Using a hand mirror and flashlight, examine the inside of your mouth. If you see a slightly raised red or white patch, check for it again in two weeks. If it still is present, see your dentist immediately.
If there is an area inside your mouth that the dentist cannot identify as normal and that looks like precancer, a biopsy (tissue sample) should be taken by your dentist from the area and examined under a microscope.
If the biopsy reveals abnormal cells — either a dysplasia or cancer — the area should be surgically excised.
Treatment for advanced oral cancer often is disfiguring and disabling, affecting food intake and speech. In many cases, significant areas of the oral cavity (such as the tongue) and surrounding areas (such as the jaw) are cut out. Your surgeon may recommend reconstructive surgery to restore the appearance of your face or help you regain the ability to talk and eat. The surgeon may transplant grafts of skin, muscle or bone from other parts of your body to reconstruct your face.
Radiation is used to help prevent the spread and recurrence of the disease. Chemotherapy is not a standard treatment for oral cancer, but it may be used when conventional treatment has failed to control the cancer.
