Oral Cancer Detection

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Lora Cook RDH

Your Dentist can play vital role in detecting cancerous cells in the mouth at stage 0 to stage 1.

“According to the National Cancer Institute, most mouth cancers start as small flat cells that are in the lining of the mouth.” These area’s include lips, inside lining of the cheeks, roof or floor of the mouth. Also area’s of the tongue, sides of the tongue and under the tongue. The back of the throat is another area in the mouth that cancer can form. When oral cancer is caught early before it grows deeper into the tissue and progresses into the lymph nodes the outcome for the patient is good.

  • Stage 0 – Is the precancerous stage, this is where cells are identified to be abnormal. They have the potential to develop into tumor.
  • Stage 1 – Is when the primary tumor is 2 centimeters or smaller. In this early stage there are no cancer cells present in the nearby oral tissues or lymph nodes.

So what can the dentist do to catch oral cancer in the precancerous and primary stage of development? Its is called the Velscope! This is a tool used by the dentist to help detect precancerous and cancerous cells in small and early stages not easily seen by the naked eye. This type of exam is more thorough. This scope helps the doctor check for abnormalities just under the tissue surface. It can show where abnormal cells are, months and even years before they become easily visible to just the naked eye.

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http://www.leddental.com

 

Frequently asked questions:

What does the doctor look for?

The scope will direct fluorescence light to find abnormal cells. When looking through the scope healthy tissue will fluoresce, any tissue that is abnormal will appear dark. So the doctor is looking for any dark spots or areas. The dentist and your hygienist will also do a manual exam shown below feeling for lumps or bumps, and unilateral abnormalities.

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http://therightsmile.files.wordpress.com/2013/04/oral-cancer-screening.jpg?w=611&h=611

 

Is radiation involved when using the Velscope?

This exam is very safe, and there is no radiation involved. However the doctor will have you where some orange safety glasses to protect your eyes from the blue LED light from the scope.

How long does the exam take?

This exam takes all of one to two minutes to complete. Just long enough for the doctor to look at all the oral tissue in the mouth looking through the scope.

How often should I have this type of exam?

The doctor recommends thorough oral cancer screenings done at least once yearly.

American Cancer society recommends for people age 20 and older yearly screenings and exams for oral cancer.

 

Want to learn more? Visit us at http://www.alamedadentalaz.com

 

Sources:

http://www.livestrong.com/article/22882-early-stages-mouth-cancer/

http://www.webmd.com/oral-health/guide/oral-cancer

http://www.ddsgadget.com/ddsgadgetwp/velscop-early-detection-of-oral-cancer/

http://www.leddental.com

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Oral Cancer Monthly Self Exam

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Amanda Orvis RDH

The prevalence of oral cancer is on the rise; in fact one person dies per hour from oral cancer. In the early stages oral cancer can often times go unnoticed. It can be painless and not obvious to the naked eye. The most common areas for oral cancer are the floor of the mouth & sides of the tongue. That being said, oral cancer can be found in various locations as well as a variety of shapes, colors and sizes. It is important that you perform monthly oral self-exams. If you notice any suspicious areas that do not go away within seven to fourteen days make an appointment with your dentist to have them checked. Remember early detection saves lives.

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How to perform a monthly self-exam:

Supplies: Flash light and a mirror

Steps:

  • Take a moment to look at the skin on your face and neck in the mirror. Look for any changes in the color of your skin, any changes in moles or beauty marks, any swelling, lumps or sores.
  • Use both hands to gently feel along the outside of your cheeks, your lower jaw bone, your jaw joint, in front of and behind both ears. Checking for any areas that do not feel uniform on both sides, any lumps and/or any areas that are swollen or tender.
  • Gently use both hands to feel down the sides of your neck, follow the path along the neck muscles. Gently place your fingertips around your “Adam’s Apple” and swallow. Try to notice if it moves up and down normally or if there is any deviation.
  • Gently use both hands to feel the tissue above and around your clavicles for any swollen or tender areas, or areas that do not feel uniform on both sides.
  • Remove any removable dentures or appliances from your mouth.
  • Use the flashlight to check the roof of your mouth for changes in color or texture. Use your index finger to lightly sweep the roof of your mouth to feel for any lumps or swellings.
  • Pull out your upper lip and then your lower lip looking for any changes in color, size and/or texture. Gently squeeze each lip and cheek with your thumb and index finger feeling for any lumps or tender areas.
  • Using your fingers gently pull your tongue forward and check the back of your throat. Also check all the surfaces of the tongue and the floor of your mouth looking for any changes in color, size and/or texture in the tissue.
  • Lift your tongue to the roof of your mouth. Using both of your index fingers gently place one index finger on the floor of your mouth and the other index finger under your chin and press your fingers towards each other feeling for any swellings or tenderness along the floor of the mouth.
  • Look at your gums for any change in color and/or texture. Run a finger around all the surfaces of your gums feeling for any swollen or tender areas. \

What to look for specifically:

  • White patches
  • Red patches
  • Sores that fail to heal
  • Lumps, bumps or masses
  • Any areas that are differ from one side to another

 

oral-cancer

 Want to learn more? Visit us at http://www.alamedadentalaz.com

 

Sources:

http://myoms.org/procedures/head-neck-and-oral-cancer

http://fightoralcancer.org/information/images/

http://www.sixstepscreening.org/wp-content/uploads/SixStepScreening.pdf

http://oralcancerfoundation.org/

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=lh3dem7gJGMA5M&tbnid=lSyDf2Zx6tGb8M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.ocfstore.org%2Foral_cancer_wristbands_p%2Focf_wristband.htm&ei=73M9U_K4DuO0yAGh6IDABA&bvm=bv.63934634,d.aWc&psig=AFQjCNE7TOClwAu96v2KHsbn1XlrAdQ49w&ust=1396622626125563

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=osKRQqBu-J5qcM&tbnid=o3zZpWEozQnX-M:&ved=0CAUQjRw&url=https%3A%2F%2Fstjamesdentalgroupcudahy.wordpress.com%2Ftag%2Foral-cancer-self-exam%2F&ei=YXQ9U6uJBaKQyAGt9oHQDw&bvm=bv.63934634,d.aWc&psig=AFQjCNFoFpa18hNHhvzAAzKxqgandu3-2Q&ust=1396622812272438

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=JWvDkHxnv4okFM&tbnid=VRZ3RjtVWC5AKM:&ved=0CAUQjRw&url=http%3A%2F%2Flaneendsdental.wordpress.com%2F2013%2F06%2F15%2Fmouth-oral-cancer-in-the-news%2F&ei=zHU9U_XoB6_lygHGu4HQDA&psig=AFQjCNEyDetzw_20EKBCjYSVXCnqHqZW5A&ust=1396623042961165

 

What is Vaping Anyways? An Examination of Electronic Cigarettes

Kara

Kara Johansen BS RDH

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What are electronic cigarettes?

Electronic cigarettes are also known as ENDS (electronic nicotine delivery system), electronic cigarettes, or E-cigs. “Electronic cigarettes are designed to look like cigarettes, right down to the glowing tip. When the smoker puffs on it, the system delivers a mist of liquid, flavorings, and nicotine that looks something like smoke. The smoker inhales it like cigarette smoke, and the nicotine is absorbed into the lungs. The e-cigarette is usually sold as a way for a smoker to get nicotine in places where smoking is not allowed.” (www.cancer.org) When people use ENDS it is sometimes called vaping

E-cigs have a vaporization system, rechargeable batteries, controls and areas to refill the liquid for vaporization. The ENDS can contain between 6mg to over 100 mg of nicotine.  Nicotine can be lethal in large amounts, 0.5-1.0 mg per kj of weight of the person. Because the products contain nicotine they can cause dependence and addiction. The chemicals used in the liquid for vaporization is not fully known. The products are not labeled or stated on the bottles.

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ENDS are usually shaped to look like “conventional” tobacco products like cigarettes, cigars, cigarillos, pipes, hookahs or shishas. Some companies make them to look like ordinary pens, or USB memory sticks to make them more discrete. (The World Health Organization http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/)

Why do people use electronic cigarettes?

Electronic cigarettes are on the rise throughout the world and in the United States. Here are some “commonly reported reasons for use: to quit smoking, to avoid relapse, to reduce urge to smoke, or as a perceived lower-risk alternative to smoking. Few studies, however, have explored whether electronic cigarettes (e-cigarettes) deliver measurable levels of nicotine to the blood. ” (Carcoran O., Dawkins L, 2013) This means that without measurable levels of nicotine in the blood it may not be an effective tool to quit smoking.

According to the US Centers for Disease Control and Prevention (CDC) the percentage of highschool and middle school students who have used electronic cigarettes has doubled from 2011 to 2012. Highschool increased from 4.7% in 2011 to 10% in 2012 and middle school increased from  1.4% to 2.7%. The National Youth Tobacco Study found that by 2012 more than 1.78 million middle and high school students in the US had tried e-cigarettes. (CDC, 2013)

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“ENDS use is expanding rapidly despite experts’ concerns about safety, dual use and possible ‘gateway’ effects. More research is needed on effective public health messages, perceived health risks, validity of self-reports of smoking cessation and the use of different kinds of ENDS.” (Pepper JK, Brewer NT http://www.ncbi.nlm.nih.gov/pubmed/24259045) This statement is from a study completed in 2013. It is saying that even though experts are worried that it ENDS may not be safe and can lead to drug abuse of other substances the sales of E-cigs are increasing.

“The primary concern is whether e-cigarettes have the capability of introducing nonsmoking youth to cigarette smoking,” said Thomas J. Glynn, PhD, American Cancer Society’s director of cancer science and trends and international cancer control. “Will we have new cigarette smokers out of this? A very clear message is that we are very much in need of FDA (US Food and Drug Administration) regulations that will limit access to e-cigarettes to youth.”(Simon, 2013)

Acting through the Family Prevention and Tobacco Control Act of 2009 the FDA is working on creating regulations for the ENDS products. The FDA will require that electronic cigarettes label what is in the product, and how they can market and sell the ENDS. A few states have set regulations on selling and promoting e-cigarettes to ages 18 and younger, however, it is not illegal to sell ENDS to youth in most states. (Simon 2013) The producers of e-cigs are marketing to children, creating products that are meant to taste like candy.

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Are Electronic Cigarettes Safe?

“The safety of ENDS has not been scientifically demonstrated.

The potential risks they pose for the health of users remain undetermined. Furthermore, scientific testing indicates that the products vary widely in the amount of nicotine and other chemicals they deliver and there is no way for consumers to find out what is actually delivered by the product they have purchased.

Most ENDS contain large concentrations of propylene glycol, which is a known irritant when inhaled. The testing of some of these products also suggests the presence of other toxic chemicals, aside from nicotine. In addition, use of these products -when they contain nicotine can pose a risk for nicotine poisoning (i.e. if a child of 30 Kilos of weight swallows the contents of a nicotine cartridge of 24 mg this could cause acute nicotine poisoning that most likely would cause its death) and a risk for addiction to nonsmokers of tobacco products. Nicotine, either inhaled, ingested or in direct contact with the skin, can be particularly hazardous to the health and safety of certain segments of the population, such as children, young people, pregnant women, nursing mothers, people with heart conditions and the elderly. ENDS and their nicotine cartridges and refill accessories must be kept out of the reach of young children at all times in view of the risk of choking or nicotine poisoning.

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As ENDS do not generate the smoke that is associated with the combustion of tobacco, their use is commonly believed by consumers to be safer than smoking tobacco. This illusive ‘safety’ of ENDS can be enticing to consumers; however, the chemicals used in electronic cigarettes have not been fully disclosed, and there are no adequate data on their emissions.”

http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/

A study done by the FDA found cancer-causing substances in half the e-cigarette samples tested. Other impurities were also found, including one sample with diethylene glycol, a toxic ingredient found in antifreeze.

Studies have shown that e-cigarettes can cause short-term lung changes that are much like those caused by regular cigarettes. But long-term health effects are still unclear. This is an active area of research, and the safety of these products is currently unknown. (http://www.cancer.org/cancer/cancercauses/tobaccocancer/questionsaboutsmokingtobaccoandhealth/questions-about-smoking-tobacco-and-health-e-cigarettes)

 

Conflicting View Points

Dr. Thomas J. Glynn MA, MS, PhD, who is the director of Cancer Science and Trends and director of International Cancer Control for the American Cancer Society from the American Cancer Society created list of reasons why people favor e-cigarettes and why they oppose to their use.

Those who favor e-cigarettes list as benefits:

  • Their ability to deliver nicotine to the user without many of the other 7,000+ chemicals in a regular, burned cigarette;
  • Their absence of secondhand cigarette smoke;
  • Their resemblance to regular cigarettes, which provide the tactile and visual sensations – holding them in a certain way, a glowing tip, blowing smoke, etc. – that many cigarette smokers have become used to, or even psychologically dependent upon; and
  • Their potential for aiding cigarette smokers to who wish to quit to do so.

 Choice between cigarette and e-cigarette

Those with concerns about e-cigarettes warn of:

  • Lack of scientific data about their safety. Simply put, e-cigarette users cannot be sure of what they are inhaling, since e-cigarettes have not been subjected to thorough, independent testing and, due to their manufacture by many different companies, there are no quality assurances in their production processes;
  • Lack of scientific data about their effectiveness as quit-smoking aides;
  • Lack of scientific data regarding their ability to deliver enough nicotine to satisfy withdrawal effects;
  • Lack of scientific data about the effect of secondhand vapor from e-cigarettes;
  • Lack of scientific data about whether the use of e-cigarettes encourages smokers who might have otherwise quit to continue smoking and only use e-cigarettes when they are in no-smoking environments; and
  • Lack of scientific data about whether youth may use e-cigarettes as an introduction to smoking regular cigarettes.

In the end one can clearly see the controversy over wether or not ENDS are good or bad.

Can I use ENDS to help me quit smoking?

“The efficacy of ENDS for helping people to quit smoking has not been scientifically demonstrated.

ENDS are often touted as tobacco replacements, smoking alternatives or smoking cessation aids. But we know that for smoking cessation products to be most effectively and safely used, they need to be used according to instructions developed for each product through scientific testing. There are no scientifically proven instructions for using ENDS as replacements or to quit smoking. The implied health benefits associated with these claims are unsubstantiated or may be based on inaccurate or misleading information. When ENDS are used as cessation aids, they are intended to deliver nicotine directly to the lungs. None of the approved, regulated cessation aids, such as nicotine patches and chewing-gum, delivers nicotine to the lungs. Therefore, the biological mechanism by which smoking cessation might be achieved by delivery of nicotine to the lungs and its effects are unknown. Delivery to the lung might be dangerous. Therefore, independently of the effects of nicotine, it is of global importance to study lung delivery scientifically.

The dose of delivered nicotine is also unknown. It is suspected that the delivered dose varies notably by product, which contain nicotine in various quantities and concentrations.”

http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/

 

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In Conclusion-

An article found on the US National Library of MedicineNational Institutes of Health looked at how ENDS awareness increased from 16% to 58% from 2009 to 2011, and use increased from 1% to 6%. The article included data gathered from 49 other studies. The majority of users were current or former smokers. Many users found ENDS satisfying, and some engaged in dual use of ENDS and other tobacco.

No longitudinal studies examined whether ENDS serve as ‘gateways’ to future tobacco use. Meaning no studies have been completed that extend long periods of time. Some longitudinal studies are decades of gathered data. ENDS are a new product. There is no way to tell the long term effects of electronic cigarettes on the human body until one of these studies is completed. Self-reported survey data has been completed. Meaning people using the product filled out a questionnaire which includes their feelings and beliefs. These studies have validity problems. Prospective trials  and self-reported surveys suggest that ENDS might help cigarette smokers quit, but no randomized controlled trials with probability samples compared ENDS with other cessation(quitting smoking) tools. Randomized controlled trials are the only reliable research worthy of trusting.  (Pepper JK, Brewer NT http://www.ncbi.nlm.nih.gov/pubmed/24259045)

The World Health Organization states “Until such time as a given ENDS is deemed safe and effective and of acceptable quality by a competent national regulatory body, consumers should be strongly advised not to use any of these products, including electronic cigarettes.”

In conclusion reliable, independent, randomized controlled research needs to be conducted to solidify the pros and cons of electronic cigarettes. There is simply not enough information as to whether vaping is safe to use or a good tool to decrease or end smoking. Our public health choices and policies need to be decided upon fact. As for my health and the health of our patients I will wait or advise a patient to wait to use an electronic cigarette.

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Want more info?

Want to learn more? Visit us at http://www.northstapleydentalcare.com/

Sources:

Carcoran O., Dawkins L, Acute electronic cigarette use: nicotine delivery and subjective effects in regular users. Psychopharmacology (Berl). 2014 Jan;231(2):401-7. doi: 10.1007/s00213-013-3249-8. Epub 2013 Aug 27. http://www.ncbi.nlm.nih.gov/pubmed/23978909

Centers for Disease Control and Prevention. Electronic Cigarette Use Among Middle and High School Students—United States, 2011-2012. Morbidity and Mortality Weekly Report. September 6, 2013
*(Etter, JF, Bullen, C, Flouris, AD, Laugesen, M, and Eissenberg, T “Electronic Nicotine Delivery Systems: A Research Agenda, Tobacco Control Online First, March 17, 2011 as 10/1136/tc.2010.042168).
http://www.cancer.org/cancer/news/expertvoices/post/2011/05/03/electronic-cigarettes-e28093-boon-bane-blessing-or-boondoggle.aspx

Glynn T. MA, MS, PhD, Electronic Cigarettes – Boon, Bane, Blessing, or Boondoggle?, (May 6, 2011), http://www.cancer.org/cancer/news/expertvoices/post/2011/05/03/electronic-cigarettes-e28093-boon-bane-blessing-or-boondoggle.aspx

Pepper JK, Brewer NT, Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review. (2013 Nov 20). Gillings School of Global Public Health, University of North Carolina, , Chapel Hill, , North Carolina, USA. doi: 10.1136/tobaccocontrol-2013-051122.  http://www.ncbi.nlm.nih.gov/pubmed/24259045

Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS) (9 July 2013) http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/

Simon S. Electronic Cigarette Use Doubles Among Teenagers. (9-9-2013) http://www.cancer.org/cancer/news/news/electronic-cigarette-use-doubles-among-teenagers

Image Sources:
#2  https://student.societyforscience.org/article/dangerous-rise-electronic-cigarettes

#3 http://www.drugfree.org/join-together/tobacco/use-of-e-cigarettes-among-middle-and-high-school-students-doubles

#4  https://student.societyforscience.org/article/dangerous-rise-electronic-cigarettes

#5 http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm

#6 https://student.societyforscience.org/article/dangerous-rise-electronic-cigarettes

#7 http://ehealthmd.com/content/want-learn-how-quit-smoking-webquit-study-offers-free-online-smoking-cessation-help#axzz2xHfAcGUy

#8 http://www.nih.gov/health/clinicaltrials/basics.htm

 

Want to learn more? Visit us at http://www.northstapleydentalcare.com/