Oral Cancer. WHAT???

Oral cancer is a topic that, unfortunately, does not get a lot of press release. As I am educating my patients, I tend to get a variety of responses on this. Anything from: "I have never heard of getting cancer in the mouth" to "I don't smoke though," and the one I least like hearing, "I have never had that done before." Eeks. What??? So, it is in response to these statements that I feel it is best to address this issue.

So why is this an issue, and is it that serious?
Here are some stats I found from the oral cancer foundation.

"More than 34,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 34,000 newly diagnosed individuals, only half will be alive in 5 years. This is a number which has not significantly improved in decades. The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer, Hodgkin's lymphoma, laryngeal cancer, cancer of the testes, endocrine system cancers such as thyroid, or skin cancer (malignant melanoma)"

Pretty scary! WHY don't we here more about this? I don't know, but this is why I stress this exam. I will walk you through what to expect, and what to look for. If you have not have this done, get it done. Just ask. Most offices do not charge for it.

The exam is called an extra oral (outside of the mouth) and intra oral exam (inside of the mouth).Or you can call it an Oral Cancer Exam/Screening. And quite frankly, I find it the best part of the cleaning appointment. (my second would be when the hygienists cleans my lower front teeth and afterward I can run my tongue behind them, it just feels so good and clean. I love it!) I mean it feels like a little mini massage(the cancer exam) and all I could ask for more would be to have someone massage the feet and my dental appointment would be the best part of my week! So let me walk you through the exam. It is actually quite quick and doesn't take a lot of time away from the cleaning; and it is way worth it, esp. since sometimes it can be a challenge to see everything in our own mouth.

extra oral

• examine the head and neck (check for moles, freckles, discoloration, lumps)
  
• Note and measure any abnormalities to observe for any changes
• palpate lymph nodes on/ near cheeks and ears , down the neck, under the chin, and near clavicle, and also back of the neck near the nape of neck or where the head meets the neck.
• note any enlargements and tenderness
  
• at this time I will also have you open and close this is mainly to check the jaw for any Temporal Mandibular Joint Disorders, checking for popping, grinding and alignment/deviations. (tangent: TMJ is the joint of your jaw everyone has a TMJ, but some have a TMJ Disorder :)
  
• discuss any concerns

Intra Oral

• Examine soft tissue for lesions bright red, white, brownish, purplish, or blue in color
  
• note and measure any lesions and/or sores in the mouth
  
• Palpate tissue (cheeks, lips, floor of the mouth,tongue, palate...)
• examine tongue, by having them stick the tongue out and examine the borders(sides of the tongue) and base (back of tongue)
• depress the tongue have patient say "ahhh"(think opera singer) to examine soft palate, tonsils, and uvula.
• Measure and note any lesions, lumps, discolorations.
• check saliva flow, drying each parotid duct (salivary glands) with a cotton 2X2 and then stimulating it, this is found on the inside of each cheek near the molars. may also check sublingual glands located on the floor of the mouth
  
• note any abnormalities and discuss
• Some offices will also use a solution and a light to help diagnose as well
• Also x-rays are used, and compared from previous years to see if there are any lesions or changes in the bone that should not be there.
  

At this point the hygienist/or dentist will decide if they need to refer ,or watch and observe.
If a referral is made they will be referred to an Oral Surgeon or an Ears Nose and Throat doctor(ENT). If This is the case some medical insurances will pay for the ENT , but most will not pay for the Oral Surgeon. But if it is serious, who cares! You will want to get it taken care of. Also if your lucky some dentists will do it(biopsy) right then and there in their own office and send it to the labs. How great , no wait:)

What to expect after the referral.

Well, the specialist will take a look and most likely will do a biopsy. There are a couple different types of biopsies. Depending on the lesion, they might do a brush biopsy. This is where they just take a little bristle brush and brush it over the lesion to get a tissue sample or the might just biopsy the whole thing (which sounds good to me why wait just get rid of it). They then will send it to the lab and the lab will send it back for the results. Then depending on the results it will go one step at a time, or phew I'm glad that's done with. THE ONLY WAY TO KNOW FOR SURE IF IT IS OR ISN'T CANCEROUS IS TO DO A BIOPSY. sorry.

OK, So Don't Panic. If you see some of these things I have described above, don't worry too much. Some peoples gums naturally have brown pigmentation like freckles, and some people will have what we call amalgam tattoos from fillings which cause discoloration but isn't harmful. Also some people may have just bit down on something wrong and have not realized it.Many people also grow extra bone (tori, pronounced" tore-eye") on and around their mandible(lower jaw) and maxilla (upper) and palate (roof of your mouth)this is fine , no need to worry you just have extra bone, lucky you. But if you have any questions don't hesitate to have it looked at. It is always better to be safe than sorry.

Any lesions in the mouth caused by a biting down wrong or burns... should heal with in two weeks or less. The mouth is quite resilient. So if it isn't healing get it checked. I want to add one more thing EXCESSIVE BLEEDING IS NOT NORMAL. I know I have discussed bleeding gums as a sign of gum disease and gingivitis , which it is. BUT if you are able to fill a dixie cup with in a matter of minutes with blood this is NOT related to gum disease. I relate this because sadly, about three years ago a young college student came in to our office because of this exact situation. She thought it might be gum disease so she tried her home care for a while and it didn't get better. It got to the point where she carried a cup with her through out the day and lots of kleenix. When she came in, we did take an x-ray and a perio exam and tried our best to get the bleeding to stop but this was clearly an underlying health condition, which happen to be cancer. (By the way, I was later informed that she had a type of leukemia that first manifested itself in the mouth. Much like the eyes are the window to the soul, so too, is the mouth to the body. Often first signs of a disease,sydrome,or cancer, may manifest in the the mouth like this.) Do NOT HESITATE. It is better to be safe than sorry. I have referred many patients in my couple of years of practicing hygiene, most have come back clear (yay!) But some have not.

Also, I might inform you that everything I just did, you can do. I recommend this to my patients. I want them to go home and give themselves an exam. This way they know what normal looks like and what normal feels like.( kind of like a self breast exam ). This is important because you will have variations of color and small lumps and bumps that are normal. So, after your hygienist says "everything is within normal limits"(yay!), then go ahead and feel what normal looks and feels like. I also recommend, if their is something your hygienist/dentist is watching ask them to point it out to you; feel it and see what they are seeing. Ask what it should look like and why it doesn't look or feel normal; so you too, can watch it at home. I perform this exam every time I see the patient whether they see me four times a year or once a year (not preferred, by the way). It only takes about five minutes or less and it may save a life.

Now you might ask, Why am I just hearing about this now and why haven't I had my dentist or hygienist do one on me? Well, the answer is they did not stress it years ago. So dentists and hygienists that have been in practice along time, might not be doing it. :(
Now we are! As more and more research is being done the AMA(American Medical Association) is more willing and wanting us to work with them. Same goes for the American Cancer Association. I think it helps that we see you probably more often than you see you medical doctor. But as health professionals, we have to keep current to keep our license(it's the law). So, they may have taken some continuing education courses on it and just not have implemented it yet; or they maybe doing it and your not aware of it.
Everyone is a bit different in their technique some perform the exam a little different and some will not even make their patient aware that they have done one. But it may be noted in the chart.

I like to inform my patients of what I am doing, this helps them to take responsibility for their health. I only get to see you, at the most, 4 times a year and that's only, if you have gum problems. So I really stress home care and patient responsibility. I cannot play catch up every time. Plus I would rather catch it early than later...

If you are not sure, if you are getting a routine oral cancer screening, just ask. You can ask your hygienist to perform an oral cancer screening and explain what he/she is looking for. They may then reply that they usually do one but would be happy to explain what to look for.

Who Gets Oral Cancer?

The answer is anyone. Of course, we know that smoking, and chewing tobacco increases the risk for cancer. But did you know so does drinking alcohol. And other "extra curricular activities " (drugs). And might I also add to the list STD's! Yep, you read that right. STD's increase the risk for oral cancer too. Maybe, think about it twice before you do , you know what, because you may be able to take an antiviral now, but when it comes to cancer it is much different...
Even if you are clean as a whistle, you still can get oral cancer. We just need to be informed.

Last little tid bit of info I will share and I promise I will end this blog. Those of you who are on medication for osteoporosis listen up. Some doctors have prescribed to you a type of amino bisphosphonate (fosamax), this is great and works rather effectively. They have your best interest in mind and are thinking about strengthening bones... but one side effect of these bisphosphonates, that they sometimes forget to inform you about, is necrosis of the jaw. Yikes! One reason they forget is because for years the drug companies of these bisphosphonates didn't report it but now (thanks to lawsuits) it is reported and can be found on that paper that is folded up 20 times and has font the size of a spec of dust. Ok, so I am exaggerating a little, but it is on there, I promise. It can be hard to find because the writing is quite small and lets face it, it's quite a lot of info to take in at once. So, as a warning, we stress that if you are taking a bisphosphonate, have a good home care routine and keep your gums in tip top shape. If you do this, you should be fine. It is when the gum disease gets out of control and you lose a tooth, that we get concerned. Why? Because that is where the necrosis can start and spread. Another place is at the joint of the the jaw. Be aware if you start to feel some discomfort, pain or something out of the norm in the joint. If this is the case get it checked. By the way, even if you are taken off of your medication it can still affect you years after so keep up with your hygiene. Ok that is all.

listed below are some more great links that are informative and easy to understand

http://www.adha.org/downloads/oralcancer.pdf -this is a printable self exam check list

For more information and dental statistics, facts, and questions follow this link http://www.oralcancerfoundation.org/facts/