PLEASE, Stick Your Tongue Out at Your Dentist

Kim McCrady

Kim McCrady RDH, BA

Dedicated to Phil Swanson and his courageous family

     Come on, you know you have always wanted to stick your tongue out at your dentist and or your hygienist. Honestly, we invite you to be as impolite as possible. During the oral cancer-screening portion of your dental check up we need and want to see as much of your tongue, tissues, lips, and throat as we can.

Oral Cancer Risk Factors

     Unfortunately, according to The Oral Cancer Foundation, cancers of the tongue, lips, cheeks, throat and floor of the mouth are on the rise and have been for the last five years.   In fact, one person passes away every hour from oral cancer.  Those at the highest risk for oral cancer are people with past or current tobacco use habits.  Patients with a family history of oral cancer and men are at a greater risk for oral cancer than women.  The latest consideration as a causative factor for oral cancer is the human papilloma virus (warts) in the oral cavity.  Other listed risk factors include heavy alcohol consumption and over-exposure to the sun.  However, there are many people with oral cancer who will have none of the major known risks factors.

Signs and Symptoms

     There are some signs and symptoms of oral cancer, but most are not detectable until the later stages of development. The National Cancer Institute lists a few of the symptoms of possible oral cancer.  They are patches of tissue that become white or red or a combination of white and red.  Sores on the inside or outside of the lips, mobile teeth, difficulty or pain when swallowing.  If you wear dentures, pain while wearing your dentures can be a warning sign.  Lumps in your neck, along your jawline, behind your ears, pain in your ear that does not subside and lumps in the floor of the mouth are also possible symptoms of oral cancer. 

Oral Caner Screening

     Your dentist and hygienist will check your tissues by having you stick out your tongue.  We catch your tongue with a piece of gauze and will pull it from side to side. We will ask you if you have noticed any sores in your mouth that have been present for more than two weeks.  We will have you touch the roof of your mouth with the tip of your tongue so we can easily view the underside of your tongue.  We also evaluate the inside of your cheeks, lips, floor of the mouth and the back of your throat is also examined. Even the lymph nodes in your neck and along your jawbone need to be checked regularly for abnormalities.  We also check your face, neck and lips for abnormal changes.

     Luckily, new technology is available for oral cancer screenings.  Our office uses a piece of equipment called, the VELscope.  The VeELcope allows the doctor to see changes in the tissue using fluorescence.    This technology allows the doctor to detect changes in the tissue earlier than he can with the naked eye.   Like most technology, we are confident these tools will continue to evolve in accuracy and be used more and more in dental offices.  It is our office philosophy to stay aware of these changes in technology and make them available to you.

Diagnosis and Treatment

     If a suspicious area is detected during your oral cancer screening, your dentist will refer you to an oral surgeon, ear nose and throat specialist or a dermatologist for evaluation and probable biopsy of the area in question.  If you are diagnosed with an oral cancer, treatment will likely vary depending upon the stage of the cancer.  Surgery, radiation, targeted therapy and chemotherapy are often used in combination as treatments.  Early detection and immediate treatment is critical to survival.  Prognosis in a latter stage of development is poor because oral cancers spread (metastasize) quickly to the lymph nodes and other parts of the body as they grow. 

Prevention

     Decrease your risk of oral cancer by reducing your alcohol intake, commit to tobacco cessation.  If you need help quitting, contact your doctor or contact a support program like Ashline.  Be proactive, check your tongue and tissues at home regularly and report to your dentist immediately if you find any concerning areas in your mouth.  The ADA estimates 60% of the US population will see a dentist each year.  This means dental professionals are your partner providers in early detection.  When you see your dentist and your hygienist at your regular visit, insist on an oral cancer screening.  Our office takes oral cancer screening seriously and we invite you to, “PLEASE, stick your tongue out at your dentist!”

 

The Oral Cancer Foundation:  http://oralcancerfoundation.org

National Cancer Institute:  http://www.cancer.gov/cancertopics/wyntk/oral/page1

Ashline: http://www.ashline.org

Oral Surgeons and the VELscope system:  Partners in Early Detection and Diagnosis:  http://www.velscope.com/upload/VELscopeVX_Oral_Surgeons.pdf

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Embracing Fluoride

 

Peggy 

 

 

 

 

 

Peggy Stoor BSRDH

As a hygienist with many years of experience, I’m starting to notice an alarming trend.  I began to be suspicious, when my own children who I fanatically watched the diet and toothbrushing habits of, werefound to have cavities. A small number of cavities, but still! My kids! How could this happen?

According to the Centers for Disease Control, the caries rates (cavities) in children ages 2 thru 5, is onthe rise. This is a trend we have not seen in over 40 years. Many dental professionals are beginning tosuspect that this is, at least in part, due to drinking bottled or filtered water, without fluoride. Fluoride isoften found naturally and may be added to our community water supplies. But, a recent study found thatabout 45 % of parents give their children only or almost exclusively bottled water. The Journal of Pediatric Dentistry reports that figure closer to nearly 70%.  While the correlation between the increase in caries and the decline in fluoridated water consumption hasn’t been sufficiently linked, many are beginning to believe that this is a contributing factor.

Obviously, the eating habits of American children also play a huge role and every time a child has a sweet snack, their mouth becomes acidic.  The number and frequency of these acidic attacks is important in causing tooth decay.  Sweetened juices, high sugar, and high carbohydrate snacks coupled with parents’ reluctance to brush their children’s teeth with fluoride toothpaste also play a large role.

Interestingly, a study by The National Center for Health Statistics found that boys in higher income families had the greatest prevalence of decay.  Is it because parents in higher income families can afford to provide more beverages such as juice, sports drinks, and bottled water believing that they are doing better for their children? Parents trying to promote health may potentially help to harm as these drinks don’t protect from cavities and are often high in sugars.  Just as we need to be aware of the amount of sugar in our fruit and sports drinks, we should also be informed of the amount of fluoride in our bottled and filtered water.

baby toothbrushing.jpg

It has been nearly 70 years since the discovery of the decay preventing effects of fluoride. The CDC has recognized water fluoridation as one of the 10 great public health achievements of the 20th century. “The health and economic benefits of water fluoridation accrue to individuals of all ages and socioeconomic groups, especially to poor children”  (Review of Fluoride: Benefits and Risks, 1991, US Public Health Service)

Despite numerous studies from experts in many fields, including the medical establishment, which have proven the safety and efficacy of fluoride, controversy and fears continue among many.  The debate has a very lengthy history and is far too much to detail in these few paragraphs.  Communism, socialism, cancer, mental retardation, and bone fractures are some of the concerns expressed by anti-fluoridationists.  However, in a report on the benefits and risks of fluoride, the U.S. Public Health Service Department states that optimal fluoridation of water does not pose a cancer risk to humans. This is evidenced by extensive human epidemiological data from studies over the past 75 years. While its true that fluoride is found in sources other than water (foods, toothpastes, mouthwashes, and fluoride supplements), the conclusions were that no trends in cancer risk were seen between populations of fluoridated and non-fluoridated communities. These findings were duplicated by the National Cancer Institute in a review of studies and an additional 16 years of research.

Concerned parents have often asked me about the pros and cons of fluoride.  While excessive fluoride consumption is obviously something to guard against, spotty consumption of fluoride poses a great risk for decay.  As in all things, finding a balance is the key. I now advise my patients to find out about their water. Reverse osmosis filtration removes the fluoride as well as the contaminants. While some bottled water contains fluoride, the majority does not. Contact your city’s water supplier and/or research your bottled or filtered water online. This information is readily available and as wise consumers and parents we should be knowledgeable about what our children and we are ingesting.

For young children, ages 2 to 6, please skip the sugar sticky snacks and that bottle of milk or juice at bedtime, drink a little tap water daily, and brush your child’s teeth with a pea size amount of fluoridated toothpaste twice a day. If the child cries or complains, think about how much more difficult and potentially traumatizing decay, pain, and possible tooth loss might be.

 

 

 

Aleccia, J. (2012, March 21). Bottled water may boost kids’ tooth decay, dentists say. NBC News Health. Retrieved July 04, 2013, from http://www.nbcnews.com/health/bottledwater.

Ellwood, R. P., & Cury, J. A. (n.d.). How much toothpaste should a child under the age of 6 years use? 168-74. Abstract obtained from Eur Archives Paediatric Dentistry, 2009 168-74. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed.

Garrison, G. M., MD, & Loven, B., MLIS. (2007). Can Infants/Toddlers Get Enough Fluoride Through Brushing.Journal of Family Practice, 56`(9). Retrieved from http://link.springer.com/article/10.

Hobson, W. L., Knochel, M. L., Byington, C. L., Young, P. C., Hoff, C. J., & Buchi, K. F. (2007). Bottled, Filtered,and Tap Water Use in Latino and Non-Latino Children. Archives of Pediatrics and Adolescent Medicine, 161(5), 457-461.

Kliff, S. (2013, May 21). The Ongoing Fluoride Wars- Once Again Portland Votes Against Fluoridation of … The Washington Post. Retrieved July 4, 2013.

McNeil, D. R. (1985). America’s Longest War: The Fight Over Fluoridation. The Wilson Quarterly, Summer, 140-153.

Sriraman, N. K., Patrick, P. A., Hutton, K., & Edwards, K. S. (2009). Children’s drinking water: Parental preferencesand implications for fluoride exposure. Pediatric Dentistry, 310-5. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed.

United States Public Health Service, Department of Health and Human Services (February 1991), Report of The AdHoc Subcommittee on Fluoride. (n.d.). Review of Fluoride: Benefits and Risks.