Unique to You

Your oral cavity includes your mouth, jaws, and sinuses. When cancer strikes any of these areas, it is considered oral cancer (oropharyngeal cancers or OPCs). Oral cancer is diagnosed in over 50,000 Americans a year. While treatment methods are improving, the 5-year survival rate is only about 60%, far worse than many other forms of cancer.¹ As with all forms of cancer, early diagnosis and treatment are critical. This is yet another important reason to visit the dentist regularly. Dentists are among the few health care professionals that routinely and thoroughly screen patients for signs of this disease.

There are several types of oral cancer, but the most common is squamous cell carcinoma. At your regular visits, your dentist will examine you for symptoms in these areas:

• Your lips, gums, the lining of your cheeks, the front part of your tongue, the floor of your mouth beneath your tongue, salivary glands, and the hard palate that makes up the roof of your mouth.
• Your throat (oropharynx), which starts at the soft part of the roof of your mouth and continues back into your throat, the back section of your tongue, and your tonsils.
• Your jaws and sinuses.

It's not always clear what causes normal cell DNA to mutate and become cancerous, but there are contributing factors that have been shown to increase your risk.²

Oral cancer can affect anyone. Genetics may play a role, but there are behaviors and personal situations that put you at a greater risk of contracting the disease.

• Tobacco: Tobacco use of any kind, including cigarettes, cigars, chew, snuff, and vaping, puts you at a higher risk of developing oral cancer. While less frequent in the US, individuals that frequently use the smokeless tobacco product betel nut (also known as betel quid) are also at higher risk for oral cancer. Betel nut is more common in Asian communities.

The effects are not limited to tobacco users either. "Research shows that exposure to secondhand smoke may increase a person's risk of developing lip, mouth, and throat cancers by more than 50%. Those exposed to secondhand smoke for more than 10 to 15 years may be twice as likely to develop oral cancer as those not exposed to passive smoke."³

• Alcohol: Heavy alcohol use (more than two drinks a day for men and one per day for women per the ADA and CDC) increases your risk of developing oral cancer. According to the American Cancer Society, 7 of 10 oral cancer patients are heavy drinkers.⁴
• Using both tobacco and heavy alcohol use can increase your risk by 5-14 times versus people who do not smoke, chew, or drink alcohol.⁵
• Age: Oral cancer risk increases as you age. Oral cancers are more prevalent in people over the age of 40, with most being diagnosed in people over 55.
• Gender: Men are twice as likely as women to be diagnosed with oral cancer. The prevailing thought is that this is due to a higher level of tobacco and alcohol use.⁴
• HPV: Human papillomavirus (HPV) affects over 79 million people in the U.S. and is the sexually transmitted disease most frequently linked to oral cancer. It most often presents in adolescents but can affect people of any age. It is also 3.5 times more likely to occur in men than women.⁶ A vaccine for HPV is available and is strongly recommended by pediatricians for children as they enter their teens.
• Sun exposure: Cancer of the lip can be caused by sun exposure.
• Radiation therapy: Your risk of developing oral cancer increases if you have undergone radiation of the head or neck for any reason.⁷
• Oral bacteria: There is growing evidence from clinical studies that some of the bacteria found in the mouth (the same bacteria that lead to periodontal disease) may contribute to oral cancer.⁸
• Other cancers: Most often, cancerous tumors of the jaws originate elsewhere in the body and metastasize to the jaws. For example, breast cancer can spread to the lower jaw (mandible) and may first be noticed on a panoramic X-ray image commonly taken by your dentist.

Some oral cancer symptoms are similar to the symptoms of other medical conditions. If your dentist or physician suspects an issue, they will work together to rule out other possible causes.

It is important to check your mouth regularly for issues that seem out of the norm. Many of the changes you may notice are temporary and don't require medical or dental treatment. However, if you notice suspicious changes in your mouth that don't resolve within 10-14 days, it may be an indication of a more serious issue. Contact your dentist or physician immediately. They can determine whether further examination is necessary. Keep in mind that early cancerous oral lesions may not be accompanied by any symptoms at all.

Some of the things you should look for include:

• Sores, irritation, lumps, or thick patches in your mouth, lip, or throat that don't heal.
• White, red, or mixed white-red patches anywhere in your mouth.
• A sore throat or a feeling that something is caught in your throat.
• A lump or mass in your neck.
• Difficulty chewing, swallowing, or speaking.
• Difficulty moving your jaw or tongue.
• Swelling of your jaw. This may cause dentures to fit poorly or become uncomfortable.
• Numbness in your tongue or other areas of your mouth.
• Weight loss
• Voice changes
• Ear pain

Early detection is the most important element of successfully treating oral cancer and preventing its spread. This is why it's important to maintain strict oral health habits, being aware of suspicious changes in your mouth, and keeping regularly scheduled dental exams and cleanings. Remember, your physician will not typically conduct an oral examination and thorough oral cancer screening, but your dentist should.

At your regular exam, your dentist or hygienist will ask about your health history and current health status, which can help identify any specific risk factors for oral cancer. Then, as part of your exam, your dentist or hygienist should conduct two visual exams. If these exams are not conducted, you should ask the dentist or hygienist to perform them.

• A soft tissue exam: The soft tissues of your mouth include the tongue, inside of the lips and cheeks, the floor and roof of your mouth, and the back of your throat and tonsil area. Your dentist will visually examine these areas for spots, lesions, cuts, growths, or swelling.
• An external oral cancer exam: Your dentist or hygienist will look for signs of oral cancer that may have spread to other areas of your face, head, or neck. They will feel under your jaw and the sides of your neck for bumps or swelling of your lymph nodes.

Your dentist may supplement their visual exam with additional adjunctive pre-diagnostic cancer tests. These tests help to illuminate potentially cancerous lesions that are difficult to detect with the naked eye. These tests do not provide a diagnosis but may be helpful in determining whether additional diagnostic tests are necessary.

If your dentist identifies suspicious lesions, you will require a definitive diagnosis. There are several tests a dentist may prescribe. These tests may be done during your exam, or you may be asked to come for another appointment. It is also common for dentists to refer patients for evaluation of abnormal lesions. If samples (such as soft tissue cells or saliva) need to be collected and sent to a dental laboratory for analysis, it may take several days to get the results.

Below are four common diagnostic tests that dentists perform:

• Brush biopsy
• Exfoliative cytology
• Incisional biopsy
• Excisional biopsy

There's no absolute way to prevent oral cancer. However, there are many steps you can take to reduce your risk, including:

• Not using tobacco products of any kind.
• Limiting your alcohol intake.
• Visiting the dentist regularly. As part of a routine dental exam, ask your dentist to inspect your entire mouth for abnormal areas that may indicate mouth cancer or precancerous changes.
• Wearing lip balm with a high SPF rating.
• Avoiding tanning beds.
• Vaccinating yourself and your children against HPV (when they are of an appropriate age).
• Using protection during oral sex to prevent the transmission of HPV.
• Maintaining proper nutrition.
• Notifying your dentist immediately if you notice anything suspicious in your mouth.

If you are diagnosed with any type of cancer, it is generally a good idea to treat it as soon as possible. For oral cancer, your physician may refer you to one or more specialists. Your general dentist will stay in contact with the specialists to coordinate your care. Depending on the diagnosis, these specialists may include:

• Oral pathologists
• Head and neck surgeons
• Oral and maxillofacial surgeons
• Periodontists)
• Ear, nose, and throat doctors (otolaryngologists)
• Physicians who specifically treat cancer (medical and radiation oncologists)

When oral cancer is diagnosed, the extent of the cancer is categorized into stages ranging from one to four. The stage helps your dentist and doctors determine your treatment options. A lower stage, such as stage I, indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger cancer or cancer that has spread to other areas of the head, neck, or other areas of the body.⁹ Treatment choices will depend on your general health, where the cancer began, the size and type of the tumor, and whether the cancer has spread.

When detected at an early stage, oral cancer is most often treated with surgery or radiation therapy. Oral cancer in advanced stages may use a combination of treatments, such as radiation and chemotherapy at the same time. There are also newer treatment options that use drugs or other substances to identify and attack cancer cells precisely.

Other considerations

Treating oral cancer can lead to other dental issues. If possible, take care of any dental work you need at least a month before starting cancer treatment. This allows time for your mouth to heal before your treatment begins. In addition, talk with your dentist and physician about ways to control pain and relieve any side effects of treatment.