A comment from a patient the other day inspired this month’s topic. I had gone down to the room of one of the hygienists on my team to examine a patient at their 6 month preventive therapy visit. I sat down and began examining the skin of the face and neck when the patient asked me what exactly I was looking for. It made me think. Maybe our patients don’t know what we are looking for as we dentists examine them. The exam is much more than coming in, picking up a mirror and explorer and checking just the teeth. Each dentist has their own method and technique of performing the exam. Rest assured this important step is not missed.
So what is it I am looking for? This particular patient that prompted me to discuss oral cancer asked me the question as I was looking along their hairline and lifting back their bangs so I could examine the scalp and forehead. If you were to look at the Skin Cancer Foundation website (www.skincancer.org) you would find that Basal Cell Carcinoma is found mainly on the face, scalp, ears, neck, shoulders, and back. Let’s see, 4 out of 6 of those are right front and center to me when I go to look at a patient at their recall exam. Sure makes sense for me to check! So for this patient I told them I was looking for any signs of skin cancer and if there was anything that I thought was suspicious I would make a referral to my dermatologist colleagues for further study.
My exam next took me inside the mouth. I was looking for various types of cancer in each area of the mouth. I took a gauze square and grasped the tongue as my patient put their tongue out for me. In the mouth the most common site for a squamous cell carcinoma is along the side and underside of the tongue. The rest of my exam was completed, looking under the tongue, the floor of the mouth, the throat, the roof of the mouth as far back as I could see and the lips both inside and out.
Lets’ talk about oral cancer a bit. 2010 is the fifth year in a row that there has been an increase in the rate of occurrence of oral cancer. That is one scary statistic, especially to us dentists who are the ones who are looking in the oral cavity every day! The other scary statistic is that if oral cancer is detected in the early stages the survival rate is 80-90%. Unfortunately the majority of oral cancers are found in the late stage where the death rate is 45% and the treatment is very disfiguring. When we dentists complete the oral cancer screening there are tools at our disposal to make a decision as to whether a lesion needs to be examined further. Items such as a brush biopsy allow us to make faster decisions to refer for biopsy. Any lesion that is present for 2 weeks without resolution should be considered suspect and worthy of biopsy or referral. We now have further screening devices including lights and rinses which have proven to be screening tools but studies have shown they are no more effective than a thorough visual exam.
Oral cancer is such a disfiguring cancer that it behooves every dentist and hygienist to be part of the process to detect it early. As a patient, you can help to prevent oral cancer by eliminating tobacco use, both smoking and spit tobacco, and limiting alcohol use. Be sure to visit your dentist regularly and tell them if there are any sharp areas on teeth, fillings or dentures as long term exposure to these can precipitate cells to become irregular. Hopefully we can improve the detection of this cancer.