Oral Cancer

Overview

Oral cancer is a common health risk existing in our population; the dental and medical professions have done little to bring it to the attention of the public. The five year survival rate for oral cancer has not improved much in the past 50 years. The best method for addressing and preventing this troubling condition is early detection and treatment. Routine dental visits and regular oral cancer exams are your best protection.

The oral cancer examination

Examination for early detection of oral cancer and tissue changes should be a regular part of your dental care. At the first sign of any abnormality, the dentist must decide whether to schedule the patient for a follow up exam (to check if there have been changes to the suspected tissue), perform a biopsy or refer to an Oral Surgeon for a second opinion and/or biopsy.

The oral cancer examination may include:

  • Inspection of your hairline, the top of your ears, and over your nose; visual inspection of your scalp if your hair is thinning or if you have bald spots. These areas have had the greatest exposure to sun.
  • Palpation (as defined in the American Heritage Dictionary: to examine or explore by touching) of your lymph nodes in the neck and the area around the back of the neck
  • Inspection and palpation of your upper and lower lips
  • Inspection and palpation of your inner cheeks
  • Inspection of all the gum tissue around all of your teeth
  • Inspection of your entire tongue (the top and bottom); your dental health professional should use a piece of gauze to gently pull your tongue out for inspection of the sides (31% of all oral cancers are found on the lateral borders of the tongue). Palpation of the entire tongue (between 1985 and 1996, 30% of all oral cancers were found on the tongue)
  • Inspection of the floor of your mouth and palpation with two fingers: one inside the mouth under the tongue and one on the outside of the mouth, under the lower jaw. This allows the two fingers to press against one another to feel for any irregularities.
  • Inspection of your hard palate; palpation of your hard palate, feeling for either lumps or areas where bone may be absent
  • Inspection of your soft palate by asking you to say “ah” and watching for your soft palate to move. A mouth mirror should be used to inspect the area behind the soft palate.

Statistics on oral cancer

  1. For all stages of oral and pharyngeal cancer, the:
    • one-year survival rate is 82%
    • five-year survival rate is 59%
    • ten-year survival rate is 48%
  2. The Caucasian survival rate is 55%; the African American survival rate is 31%.
  3. Worldwide, oral cancer is the sixth most common cancer.
  4. In the oral and pharyngeal cancers are responsible for 35,000 cases and 7,600 deaths per year.
  5. About half of these cases are found in the oral cavity; cancer of the oral cavity is more common than cervical and ovarian cancer, Hodgkin’s Lymphoma, or leukemia.
  6. The average age of diagnosis is 63, with 96% of oral cancer being diagnosed after age 40 and 60% after age 65.
  7. Male-to-female ratio of oral cancer diagnosis is 2:1 with a ratio of 1:1 with advancing age.

Highest to lowest area of the incidence of oral cancer

  1. Sides of the tongue (lateral border of tongue)
  2. Lips
  3. Glands that produce saliva (salivary glands)
  4. Under the tongue (floor of mouth)
  5. Inside the cheeks and lips (buccal mucosa)
  6. The gums (gingiva)
  7. The roof of the mouth (palatal mucosa)

Risk factors associated with oral cancer

Highest risk factors: (combine any of these and chances increase by 30%)

  1. Tobacco of any kind
  2. Alcohol (ethanol beverages or mouthwash)
  3. Viruses: HPV16, HCV
  4. Age
    • More than 95% of oral cancers occur at or over age 40
    • More than 83% of oral cancers occur over the age of 55
    • Men 63 years old or older
    • Growing concern for young women in their 20’s
  5. Gender – M: F = 2:1
  6. Ethnicity – African American: Caucasian = 2:1

Secondary risk factors:

  1. Chronic inflammation, trauma (such as an ill-fitting denture or partial)
  2. Immunosuppression/solid organ transplant
  3. Nutritional deficiencies
  4. UV light

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Rhodus, Dr. Nelson L. DMD, MPH (2009). Oral cancer: improving outcomes. Compendium of Continuing Education in Dentistry, 30(8), 486-499.

Rhodus, Dr. Nelson L. DMD, MPH. “Dental Management of Medically Compromised Patients.” Minneapolis, Minnesota. 5 Nov. 2010. Continuing Education, University of Minnesota.