Friday, May 6, 2011

Oral Cancer revisited

Oral cancer (not my patient)

Oral Cancer.
Recently, someone showed up at my office for a dental exam. I had known that there was a history of smoking and alcohol intake which had continued for more than 20 years. Knowing the link between alcohol, tobacco and oral cancer, I was sure to look very carefully at the tissues in the mouth. In addition to a few teeth needing treatment was a red and white lesion under the tongue. He did not noticed that there was anything going on under his tongue. I took pictures and tested it with our Vizilite Plus® oral cancer screening system. Sure enough it looked suspicious. Without trying to scare him, I mentioned that he have it looked at and removed ASAP. The diagnosis came back as oral cancer. Apparently a few lymph nodes were enlarged  and a PET scan was performed. The scan came back normal. I don’t know the follow up treatment that will be instituted at this time, but I am concerned for this person.

Two in one month! 
Interestingly enough I had another spouse of a new patient visit me recently who had just been treated for oral cancer  also. He had a large swelling in his cheek where they had to do a skin graft from his leg to close the surgical site. He was a tobacco chewer. Wow, two oral cancer patients in one month. In my 30 plus years of practicing, I have only seen a handful of oral cancer patients.

Predisposing factors.
The most common predisposing factors for oral cancer are tobacco and alcohol.
There is no safe tobacco. There is also no safe way to use tobacco in the mouth. There are at least 28 carcinogens  in the tobacco. Alcohol tends to dry out the gum tissues and also leads to cancers.

Other problems caused by tobacco.
In addition to oral cancer, other problems associated with tobacco are gum disease  (periodontal disease, and gum recession). Tobacco users have a poorer response to periodontal treatment, and have a reduced micro-vascular circulation condition leading to more bone loss Finally tobacco users seem to have a low pain threshold requiring more anesthetic and post operative pain management medications.  

Precancerous lesions in the mouth.
I see these very commonly, especially in tobacco chewers. they are grey or white patches in the cheek or vestibule.  These must be closely monitored for and changes.

What is the  big deal with Oral Cancer?
Oral cancer has a 50% mortality rate.Two people each hour are diagnosed with oral cancer in the US and one of them will die from it. Early detection and aggressive treatment are required for the best outcome.

Screening is critical.
If your dentist and dental hygienist does not routinely screen for oral cancer at every checkup visit, find a new dentist.








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About Me

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Born in the Midwest. Married with 6 children and 3 grandchildren. Attended Maine West High School, Harper Jr College, Northern Illinois University, the University of Illinois College of Dentistry. Practice in Crystal Lake, Illinois.