It’s April again! Which means Oral Cancer Awareness month. I can’t even begin to tell you how critical it is to receive regular oral cancer screenings. Your dentist and/or dental hygienist should perform a basic screening at your six month check-ups. We also recommend having a more in depth oral cancer screening (such as the Velscope, Oral ID, or Identafi) annually. These more in depth screenings use florescent or ultra violet lights that can detect signs of oral cancer much earlier. The earlier cancer is caught, the sooner treatment can begin and the better the prognosis.
Oral cancer is any abnormal growth of cells in the oral cavity (mouth). Abnormal cell growth can be benign (no cause for concern) or malignant (can be life-threatening). The oral cavity consists of the lips, cheek lining, salivary glands, hard and soft palates, uvula, tongue, floor of the mouth (underneath the tongue), gums, and tonsils. The tongue and the floor of the mouth are the most common areas for oral cancer to occur. However, the cancer can spread to other areas of the oral cavity and/or other areas of the body.
Oral cancer can manifest itself in many ways including swellings, lumps or bumps, numbness, abnormal bleeding, white patches, red patches, speckled patch, sores that do not heal, sore throat, pain when chewing/speaking/etc., changes in voice, ear pain, and dramatic weight loss. If you are experiencing any of these symptoms please visit your dentist or primary care physician.
Risk factors for oral cancer include tobacco use, alcohol use, sun exposure, having HPV (Human papillomavirus), and a history of having oral cancer previously. Tobacco use is the reason for most oral cancers, especially in those individuals who have used tobacco for lengthy amounts of time. The risk increases when tobacco users become heavy alcohol drinkers. Three out of every four oral cancers occur in people who use alcohol, tobacco, or both. The Human papillomavirus is mainly linked to oropharyngeal cancers. Limiting sun exposure and the use of sun screen and lip balm can help reduce the risk. Men are twice as likely to develop oral cancer than women. It is also important to note that more than 25% of oral cancers are found in individuals with no risk factors.
Everyone is at risk! Make sure to visit your dentist and dental hygienist for regular oral cancer screenings.
Many people are realizing that there is a direct connection between oral health and total body health. It is finally being generally accepted that oral health and general health are to be interpreted as one entity, not separate as has been the view in the past. Dentists has been saying this for years, and finally science is proving them right! You cannot be healthy without good oral health.
“The mouth can act as a portal of entry for infection, ” says Salomon Amar, DMD, PhD, Professor and Director at the Center for Anti-Inflammatory Therapeutics at Boston University School of Dental Medicine. “Ongoing inflammation in your mouth can allow bacteria to enter the bloodstream, which may lead to more inflammation in other parts of your body, such as the heart.”
What conditions may be linked to oral health?
Your oral health might affect, be affected by, or contribute to various diseases and conditions, including:
Endocarditis. Endocarditis is an infection of the inner lining of your heart (endocardium). Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.
Cardiovascular disease. Some research suggests that heart disease, clogged arteries, and stroke might be linked to the inflammation and infections that oral bacteria can cause.
In 2005, the NIH funded a study on this topic. They randomly selected 1,056 participants with no prior heart attacks or strokes. All were evaluated for levels of periodontal bacteria. After removing the effects of the other risk factors of age, gender, and smoking, Moise Desvarieux, MD, PhD, Associate Professor of Epidemiology at the Mailman School and lead author of the study stated, “It was found that there was an independent relationship between gum disease and heart disease.” One theory about why this may occur is that small amounts of bacteria enter your bloodstream while you’re chewing. “Bad” bacteria from an infected mouth may lodge itself inside blood vessels, ultimately causing dangerous blockages. Strengthening his theory is the fact that when scientists have looked at atherosclerotic blood vessels, they have sometimes found fragments of periodontal bacteria. Meanwhile, a study published in the New England Journal of Medicine in 2007, established that aggressive treatment of gum disease reduces the incidence of atherosclerosis within six months.
It has been found that up to 91% of patients with heart disease have periodontitis. “The theory is that inflammation in the mouth causes inflammation in the blood vessels,” says Sally Cram, DDS, PC, Consumer Adviser for the American Dental Association. “This can increase the risk for heart attack in a number of ways. Inflamed blood vessels allow less blood to travel between the heart and the rest of the body, raising blood pressure. There’s also a greater risk that fatty plaque will break off the wall of a blood vessel and travel to the heart or the brain, causing a heart attack or stroke.”
Pregnancy and birth. Periodontitis has been linked to premature birth and low birth weight.
Scientists believe that gum disease or inflammation in the mouth possibly triggers an increase in a chemical compound called prostaglandin, which induces early labor. While this theory has not yet been confirmed, a 2001 study found that pregnant women who develop gum disease between weeks 21 and 24 of their pregnancy are four to seven times more likely to give birth before week 37. There is evidence that poor gum health in the extreme can lead to low birth weight as well.
Babies born too early or at a low birth weight often have significant health problems, including lung conditions, heart conditions, and learning disorders. While many factors can contribute to premature or low birth weight deliveries, infection and inflammation in general seem to interfere with a fetus’ development in the womb.
Though men have periodontitis more often than women do, hormonal changes during pregnancy can increase a woman’s risk. For the best chance of a healthy pregnancy, Pamela McClain, DDS, President of the American Academy of Periodontology, recommends a comprehensive periodontal exam, “If you’re pregnant or before you become pregnant, identify whether or not you’re at risk.”
Diabetes. Diabetes reduces the body’s resistance to infection which puts the gums at risk.
Gum disease appears to be more frequent and severe among people who have diabetes. Research shows that people who have gum disease have a harder time controlling their blood sugar levels. Researchers at Columbia University’s Mailman School of Public Health followed 9,296 non-diabetic participants, measuring their level of periodontic bacteria over the course of 20 years. “We found that people who had higher levels of periodontal disease had a two-fold risk of developing type 2 diabetes over that time period compared to people with low levels or no gum disease,” explains Ryan Demmer, PhD, Associate Researcher at the Department of Epidemiology at the Mailman School and the lead author. There are a few theories about why this might be the case. One proposes that when infections in your mouth get bad enough, it can lead to low-grade inflammation throughout your body, which in turn wreaks havoc on your sugar-processing abilities. “There are all kinds of inflammatory molecules,” says Dr. Demmer, “and it’s believed that maybe some attach to insulin receptors and prevent the body’s cells from using the insulin to get glucose into the cell.”
It has also been noted that inflammation that starts in the mouth seems to weaken the body’s ability to control blood sugar. People with diabetes have trouble processing sugar because of a lack of insulin, the hormone that converts sugar into energy. “Periodontal disease further complicates diabetes because the inflammation impairs the body’s ability to utilize insulin,” says Dr McClain. Diabetes and periodontitis have a two-way relationship. High blood sugar provides ideal conditions for infection to grow, including gum infections. Diabetes can also slow the healing process and lower resistance to infections, including oral infections. Fortunately you can use the gum disease-diabetes relationship to your favor: managing one can help bring the other under control.
HIV/AIDS. Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS. Studies suggest that oral bacteria and the inflammation associated with periodontitis, a severe form of gum disease, might play a role in some diseases. Certain diseases, such HIV/AIDS, can lower the body’s resistance to infection, making oral health problems more severe.
Osteoporosis. Osteoporosis, which causes bones to become weak and brittle, might be linked with periodontal bone loss and tooth loss. Osteoporosis and periodontitis have an important thing in common, bone loss. Researchers are testing the theory that inflammation triggered by periodontitis could weaken bone in other parts of the body.
Alzheimer’s disease. Tooth loss before age 35 might be a risk factor for Alzheimer’s disease.
–Dementia: The bacteria from gingivitis may enter the brain through either nerve channels in the head or through the bloodstream, that might even lead to the development of Alzheimer’s disease.
Pneumonia. A 2008 study of elderly participants found that the number who developed pneumonia was 3.9 times higher in patients with periodontal infection than in those free from it. “The lungs are very close to the mouth,” says Marsha Rubin, DDS, practicing Diplomat of Special-care Dentistry at New York-Presbyterian/Weill Cornell. “Even in a healthy mouth there is lot of bacteria, but bacteria in a not-healthy mouth can get aspirated into the lungs, causing pneumonia or aggravating COPD, chronic obstructive pulmonary disorder.” Several intervention studies cited by the CDC show that an improvement in oral health can lead to a reduction in respiratory infection. Periodontal disease may make pneumonia and chronic obstructive pulmonary disorder worse, possibly by increasing the amount of bacteria in the lungs.
Pancreatic Cancer. A study published in 2007 in the Journal of the National Cancer Institute surveyed 51,529 American men about their health every two years between 1986 and 2002. Of the 216 participants who developed pancreatic cancer, 67 of them also had periodontal disease. Independent of the participants’ smoking status, the study found that having a history of periodontal disease was associated with an increased risk of pancreatic cancer. This, according to the study, could be because of systemic inflammation or increased levels of carcinogenic compounds produced in the infected mouth. Interestingly, another viable theory about why gum disease may cause type 2 diabetes points to damage to the pancreas as well. “With the pancreatic cancer study, we thought it was very interesting that you have this localized infection that has an impact on a systemic organ that is very intimately tied to the pathophysiology of diabetes,” says Dr. Desvarieux.
Cancer. Your dentist and hygienist should screen for oral cancer and other cancers of the head and neck, including skin cancer, cancer of the jaw bone, and thyroid cancer, during routine checkups. He or she feels for lumps or irregular tissue changes in your neck, head, cheeks and oral cavity, and thoroughly examines the soft tissues in your mouth, specifically looking for any sores or discolored tissues. Survival rates greatly increase the earlier oral cancer is discovered and treated. During your next dental visit, ask your dentist to do an oral cancer screening. See your dentist immediately if you observe:
Any sore that persists longer than two weeks
A swelling, growth, or lump anywhere in around the mouth or neck
White or red patches in the mouth or on the lips
Repeated bleeding from the mouth or throat
Difficulty swallowing or persistent hoarseness
Scientists aren’t sure of the exact cause of oral cancer. However, the carcinogens in tobacco products, alcohol and certain foods, HPV infections, as well as excessive exposure to the sun, have been found to increase the risk of developing oral cancer. Risk factors for oral cancer may also be genetically inherited. You can help prevent oral cancer by:
Not smoking or using spit tobacco
Limiting your alcohol intake
Eating plenty of fruits and vegetables
Also, periodic self-examinations can increase your chances of detecting oral cancer, so be sure to examine your face, cheeks, jaw and neck regularly for any changes or lumps.
Other conditions. Other conditions that might be linked to oral health include Sjogren’s syndrome, an immune system disorder that causes dry mouth, and eating disorders.
Because of these potential links, be sure to tell your dentist if you’re taking any medications or have had any changes in your overall health, especially if you’ve had any recent illnesses or you have a chronic condition, such as diabetes.
How can I protect my oral health?
To protect your oral health, practice good oral hygiene every day. For example:
Brush your teeth at least twice a day.
Eat a healthy diet and limit between-meal snacks.
Replace your toothbrush every three to four months or sooner if bristles are frayed.
Schedule regular dental checkups.
Also, contact your dentist as soon as an oral health problem arises. It is important to let your dentist know your full family medical history. If you have periodontal disease, make sure you see your dentist frequently and get it treated promptly, before it progresses to the point where you begin losing teeth or it starts to affect your overall health. Remember, taking care of your oral health is an investment in your overall health.
One thing is clear: the body and mouth are not separate. Your body can affect your mouth and likewise, your mouth can affect your body. Taking good care of your teeth and gums can really help you live well longer.
Statistics from the World Health Organization show that up to 93% of diabetes, 81% of heart disease, 50% of strokes, and 36% of all cancers could be prevented by a healthy diet and lifestyle. We have all heard of fad diets and medications that claim to slim you down in weeks, but have you looked at the asterisk on the bottom of your television screen during their commercials? You will see that the testimonials you are seeing are from “results not typical” and have occurred in less and 5% of the people who took that particular diet plan or pill. The best weight loss experts will tell you that there is no shortcut to being healthy. Diet and exercise are essential in establishing and maintaining health.
Obesity is increasing in prevalence and is a major contributor to worldwide morbidity. As obesity in this country rises, are we surprised that the prevalence of heart disease, diabetes, cancer, and other diseases rises too? One of the dangers in obesity is due to a prolonged state of inflammation in the body. Inflammation is the first response of the body to injury, cell damage, infection, or irritants. Inflammation that is chronic and unresolved can lead to:
Fat cells produce hormones and proteins that cause inflammation and insulin resistance, which promote cell growth. Overweight people have high levels of substances circulating in their blood that stimulate cell division. The more often cells divide, the more opportunity there is for cancer to develop. To help lower your risk for cancer, it is important to know how much inflammation is present inside your body.
At your next visit to your doctor, ask for a blood workup with a screening of your C-reactive protein, a protein made by the liver when there is inflammation in the body.
Inflammation also often manifests in the mouth. If you have one or more of the above diseases, inflammation may be the underlying factor. At your next dental visit, ask your dental hygienist if there is inflammation in your mouth. Your dental hygienist can provide great information about the inflammation process and its effects on the body.
Brand-Miller J, et al. Cur Opin Lipidol 2012, 23(1): 62-7
Low Dog, MD. (February 2014). Cancer and Nutrition in the 21st Century. Western Regional Dental
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.
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!”