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The Early Detection of Mouth Cancer; a Job for the Whole Dental Team!

02/11/2012

 

Today I have good news and bad news.

First the good news: Throughout the developed world the number of deaths from cancer is diminishing. This most scary of diseases is being controlled, prevented and increasingly cured as advances in medical science and patient awareness gather pace.

Now the bad news: There is one major exception. Mouth cancer. Over the past 10 years the incidence of this life-threatening condition has increased by between 30-40% and continues to grow year on year. Especially disturbing is the increase of cases among young adults.

Mouth cancer used to be considered a disease of elderly gentlemen too fond of cigars and Scotch whiskey. This has changed. While smoking and drinking spirits are still major risk factors about 25% of victims have no identifiable lifestyle factors. Women are becoming more and more likely to develop the condition and regular screening is now recommended for everyone over the age of 18.

So what is mouth cancer? Well, it covers a range of conditions but the commonest of these is squamous cell carcinoma. This aggressive cancer rapidly spreads causing devastating local tissue destruction. It also invades lymph nodes and other organs such as the liver and lungs causing a potential risk to life. Discovered late the 5 year survival rate is barely 50% and treatment includes major surgery as well as radio or chemo therapy. Survivors can look forward to a diminished quality of life; often disfigured, unable to talk or swallow properly, having the misery of a dry mouth as saliva glands are often damaged during treatment and often unable to chew properly after loss of substantial sections of the jaws.

Discovered early the results can be very different. Survival rates go up to more than 90% and treatments tend to be much more pleasant without the extreme side effects caused by late intervention.

Signs of early mouth cancer include:

  • Red or white patches on the mucosa
  • Ulcers that do not heal within 3 weeks
  • Unexplained numbness
  • Teeth which become loose in the apparent absence of gum disease

The commonest sites include:

  • The floor of the mouth
  • The sides of the tongue
  • The anterior pharynx

although lesions can occur on any part of the soft tissues.

Dental team members are well placed in the fight against mouth cancer because:

  • We see our patients regularly
  • Unlike doctors we routinely look inside their mouths
  • We already have a knowledge of oral pathology
  • We are used to other early detection techniques like x-rays, gum probing, saliva diagnostics and trans illumination

How can a mouth cancer examination be easily carried out? Well, it starts before the patient even sits down! Look at the face and neck as the patient approaches. Is everything symmetrical? Are there lumps and bumps which look suspicious? As the patient sits down look at the back of the neck. Ask the patient to turn the head from side to side. This stretches the skin over the lymph chains and can make enlarged nodes much more apparent. Palpate the submandibular and cervical lymph chains as well as the parotid areas but make sure you have told your patient what you are going to do in advance! Patients may find it peculiar when their dentist runs his or her hands down their necks! Look at the lips and the skin of the face to identify any abnormalities then look inside the mouth. A good light is required and magnification is helpful. Go around the mouth systematically. Use a check-list of the surfaces to be screened to make sure nothing is missed. Ask the patient to say: Aahh in order to see the throat. Record any abnormalities on a mouth map and take photos if possible.

If there are areas of concern ask the patient to return for a review 1-2 weeks later; however, if you discover lesions you are sure are suspicious refer to the local oral surgery unit for an opinion straight away. The best possible response you could have would be: ‘On examination the oral surgeon could find no trace of the lesion you described.’!

Mouth cancer detection is for the whole dental team. Dentists, hygienists, therapists, clinical dental technician and dental nurses can all carry out screening with proper training. This is an evidence-gathering exercise; secondary care will make a diagnosis.

Everybody can use their eyes! Even non-clinical staff should be aware of what’s normal and what’s not and alert the clinical team if they have any misgivings.

With practice a thorough mouth cancer screening can be carried out in less than 2 minutes. Not a lot of time to save a life! With the early detection of mouth cancer joining the GDC’s list of recommended core CPD all dental professionals should find out more about the subject, whatever their special areas of interest. Whether we’re cosmetic dentists, orthodontists or anything else we are first and foremost health care professionals and we owe it to the patients who put their trust in us to put their interests first.

 

Philip Lewis has a general dental practice in Freshwater, Isle of Wight

He can be contacted at: Philip-Lewis@btconnect.com

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