Sally McCarl Moore and Chris Phillips, dental hygienists at McCarl Dental Group attended a continuing education course to learn more about oral cancer and the latest advances in oral cancer screening. Here is a summary from Sally McCarl Moore about the changing trends and current statistics regarding oral cancer.
Every hour of every day, someone in the United States dies from oral cancer. The five year mortality rate has remained unchanged over the past 30 years at approximately 50 percent. Traditionally, the majority of oral cancers occurred in men over 40 who were heavy smokers and drinkers. This is no longer the case. There is an alarming increase in oropharyngeal (base of the tongue and pharynx) cancer cases seen in the 18-40 age group. This is due to certain types of the human papillomavirus (HPV #16 and #18). Twenty two percent of current oral cancers are related to HPV and the number is growing. Whereas the male to female ratio used to be 5:1 fifty years ago, it has now changed to 2:1. The mode of transmission for HPV is oral sexual activity. What may have once been thought of as a safe sex act is no longer the case.
There are two HPV vaccines, Gardasil and Cervarix, available to protect against the types of HPV that cause most cervical cancers. The Centers for Disease Control and Prevention (CDC), pediatricians and general practitioners recommend the HPV vaccine for all females ages 11 or 12 years old and males 9 through 26 years old. Previously it was only administered to females to prevent cervical cancer caused by HPV. They now realize that they will never stop the widely spread virus without inoculating the males as well. Gardasil is used for both females and males. Cervarix is used only in females. Both vaccines are administered as three shot series. As with any medical procedure, consult your physician to see if it is right for you and your family.
Other than HPV, one of the major contributors to oral cancer has always been tobacco products. With the strict laws against smoking in public, you would think this was less of a problem. Not so. There is a new product called SNUS. This is a small pouch of tobacco placed in the vestibule of the mouth similar to snuff, but typically people swallow snus rather than spit it out. Several of the tobacco companies have their own brand with varying flavors. Some snus cans warn that “it can cause periodontal disease and tooth loss” while other flavors state “it can cause cancer.” This is horrifying to the dental field. Tobacco products placed directly on the mucus membrane have a higher level of tissue damage and potential oral cancer. There is no simple treatment for oral cancer. Patients have radical surgeries consisting of removing parts of their tongues, jaw and face. This is nothing to be taken lightly.
What are the signs and symptoms of oral cancer? The first sign of oral cancer is often a red or white patch or an ulceration that does not disappear in a week or two. Be aware of any changes in your mouth. Visit your dentist immediately if you have any type of sore, ulceration, lesion, lump or thickening of the tissue in your mouth, tongue, cheek or throat. Early detection of oral cancer improves success of treatment.
How do we detect oral cancer? The only definitive diagnosis is through a tissue biopsy, but your dentist and dental hygienist should be performing routine oral cancer screenings. Oral Cancer Screenings are included with every routine dental hygiene visit and dental exam at McCarl Dental Group. This is done by a visual examination of your tonsil area, the base of your tongue, the tissue around your tongue and lips and the roof of your mouth. We also check for lumps or bumps around your neck and ask if you’re having any trouble swallowing. If any ulcers are found, we will try to determine if they are due to trauma or something more severe. Normal, routine mouth sores will go away in 7 – 10 days, cancer will not. If you and your dentist think a sore or lesion is due to trauma, you should return in two weeks for a re-evaluation of the area. If the sore has not disappeared or if we have any concerns at all, we will refer you to an oral surgeon for a small tissue biopsy. As in all health matters, better safe than sorry.
There are several products on the market that a general dentist can use to try to determine if the area is cancerous or not. Again, these products can be helpful, but only a tissue biopsy is definitive. ViziLite Plus, Microlux DL, Orascoptic DK, and VELscope VX use florescence technology to identify areas of cell trauma. Oral CDX uses a small scraping from the site and is sent out for a lab to analyze. If the lab report indicates damaged cells, the patient will be sent for a biopsy. For additional information please visit oralcancerfoundation.com.