How Does Oral Cancer Happen?

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Andra Mahoney BS RDH

Two weeks ago, Becky gave us some great info raising our Awareness to Oral Cancer.  She touched on the importance of screenings and mentioned the risk factors.

But How Does Oral Cancer Happen?

According to the Oral Cancer Foundation, about 48,000 people are diagnosed each year.  Of those, about 9,500 people will loose their battle with oral cancer.  Of the 48,000 people diagnosed, only 57% of them will be alive 5 years after diagnosis.  Sadly, the number of diagnosis and deaths have not decreased over the last decade.

Let’s review the risk factors in detail…

Age

Probability dictates that the older you get, the more likely you have a chance of getting cancer.  Therefore, age will be a risk factor.  Oral Cancer is more often detected in those over the age of 40.  However, this statistic is changing with the prevalence of HPV.  We will talk more about this in a following section.

Although age does play a part, around 91% of all diagnoses of Oral Cancer are linked to “lifestyle” choices.
These following risk factors will show us why.

Sun Exposure

Excessive and unprotected exposure to the sun is linked with cancer in the lip area. To reduce your risk of lip cancer, decrease your unprotected exposure to sunlight and other sources of ultraviolent (UV) radiation.  (1)

Sun exposure and other sources of UV radiation can damage lip cells.  This damage can cause them to multiple when naturally they should die.  Fast reproduction of abnormal cells is how we classify cancer.

Tobacco Use (use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others)

The report from the Institute of Medicine (2007) says that tobacco kills more Americans annually than AIDS, alcohol, cocaine, heroin, homicides, suicides, car accidents, and fires combined.

Nationally, tobacco contributes to about one-third of U.S. cancer, one-quarter of heart disease and about 490,000 premature deaths each year. Tobacco is a known cause of lung, bladder, mouth, pharyngeal, pancreatic, kidney, stomach, laryngeal, and esophageal cancer. About ten million people in the U.S. have died from causes attributed to smoking and tobacco use (including heart disease, emphysema, and other respiratory diseases) since 1964. Tobacco is the most global cause of cancer, and it is preventable. (2)

There are thousands of chemicals contained in a single cigarette, and their point of entry is the mouth.  Smoking helps to transforms saliva into a deadly cocktail that damages cells in the mouth and can turn them cancerous. (3)

If you would like help on quitting, please check out the resources on this page: http://smokefree.gov

Alcohol Use

People who consume approximately 3.5 or more alcoholic drinks per day, or 21 drinks in a week, have at least a two to three times greater risk of developing cancer than nondrinkers. (4)

Those who both smoke and drink, have a 15 times greater risk of developing oral cancer than others.

Alcohol’s effect on the mouth may be the key to understanding how it works with tobacco to increase the risk of developing cancer. The dehydrating effect of alcohol on cell walls enhances the ability of tobacco carcinogens to permeate mouth tissues; additionally, nutritional deficiencies associated with heavy drinking can lower the body’s natural ability to use antioxidants to prevent the formation of cancers. (5)

HPV Infection

The human papilloma virus (HPV) is a common, sexually transmitted virus, which infects about 40 million Americans today. There are about 200 strains of HPV, the majority of which are thought to be harmless. Most Americans will have some version of HPV in their lifetimes, and most immune systems will be able to fight off the virus.  Those who get specific strains, and lack the ability to fight those strains off, are the ones who develop cancer.

The two strains that are mainly associated with oral cancer are HPV16 and HPV18.  HPV is a double-stranded DNA virus that infects the epithelial cells of skin and mucosa.

It is likely that the changes in sexual behaviors of young adults over the last few decades, and which are continuing today, are increasing the spread of HPV, and the oncogenic versions of it.  You can get HPV by vaginal, anal, or oral sex.  Condoms can limit, but do not prevent HPV.  HPV significantly increases with multiple (especially more than four) sexual partners. (6)

How to Spot it

One of the real dangers of this cancer, is that in its early stages, it can go unnoticed. It can be painless, and little in the way of physical changes may be obvious. The good news is however, that your Physician or Dentist can, in many cases, see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages.

It may appear as a white or red patch of tissue in the mouth, or a small ulcer which looks like a common canker sore. Because there are so many normal tissue changes that happen normally in your mouth, and some things as simple as a bite on the inside of your cheek may mimic the look of a dangerous tissue change. It is important to have any sore or discolored area of your mouth, which does not heal within 14 days, looked at by a professional. Other symptoms include; a lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, any wart like masses, hoarseness which lasts for a long time, or any numbness in the oral/facial region. (7)

But like any cancer, even if you do not do these risk factors, there is still a possibility of getting it. 

The best way to detect oral cancer is to do self exams and to see your Dentist regularly.  The Dental Team is the forefront in prevention and detection as their main focus is your mouth!  Your Dentist and/or Hygienist will perform a visual and tactile screening at each appointment.  If they do not, please ask for one.  There are also additional screenings available, and they can tell you more about them during your appointment.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

(1) http://www.cancer.net/cancer-types/oral-and-oropharyngeal-cancer/risk-factors-and-prevention

(2) http://www.oralcancerfoundation.org/tobacco/

(3) http://www.mouthcancer.org/risk-factors/

(4) http://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet

(5) http://www.oralcancerfoundation.org/understanding/alcohol-connection.php

(6) http://www.pureeducation.org/index.asp?N=Pure-Education-Lake-Stevens-WA-HPV-Coaching&C=577&P=7764

(7) http://oralcancerfoundation.org/facts/

http://www.mayoclinic.org/diseases-conditions/mouth-cancer/symptoms-causes/dxc-20157232

http://www.oralcancerfoundation.org/hpv/

Electronic Cigarettes

Sharma RDH

Sharma Mulqueen, RDH

Electronic Cigarettes

E-cigarettes are electronic nicotine-delivery systems (ENDS) that consist of a cartridge containing nicotine and propylene glycol, an atomizer, and a battery (Figure 1). When a user inhales, a pressure-sensitive circuit is activated, which heats the atomizer and vaporizes the liquid as it is brought through the mouthpiece. The vapor consists of a fine mist that does not contain smoke or carbon monoxide and disperses more quickly than traditional cigarette smoke. The act of using ENDS is often called “vaping” and users are termed “vapers.”

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The nicotine cartridges used in ENDS come in a variety of flavors, including vanilla, cherry, java, piña colada, and menthol.  As the demand rises there are some ENDS stores opening with over 1000 flavors.  They are also offered in a myriad of nicotine strengths. When e-cigarettes are inhaled, light-emitting diodes are illuminated. Originally, these lights were red, but now they are often blue or another color to differentiate them from traditional cigarettes.

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There is a lot of stir about the introduction of e-cigarettes and unknown health issues that they may cause. For the mouth, e-cigarettes seem to have some positives and negatives. It is a better option than regular tobacco cigarettes, but worse than not smoking altogether. Here are a few of the effects of e-cigarettes on the mouth.

Unfortunately, research on e-cigarettes is still very minimal. Because they are a new product, research that can space several decades is still unavailable. However, there are several chemicals and clues that help determine what e-cigarettes can do to the teeth.

Just like any cigarette, the main purpose of an e-cigarette is to inhale nicotine. Studies have shown that nicotine can slow down the production of saliva in the mouth. The more nicotine you intake, the less saliva the body is able to produce. Saliva is a main deterrent to harmful bacteria and food particles in the mouth. Low saliva levels can cause quicker tooth decay, sore gums, and eventually a loosening of the teeth. One positive of smoking e-cigarettes verses normal cigarettes is that you can control the amount of nicotine the e-cigarette will release into the body. This will slow down the eventual effect of lowered saliva levels, at least.

Another effect of nicotine in an e-cigarette or a tobacco cigarette is it acts as a vasoconstrictor, which prohibits blood flow to the mouth. This results in a fewer number of white blood cells capable of fending off infections and bacteria that harm your gums. Fewer red blood cells are also sent to your mouth tissues, which lead to faster deterioration of the tissue and your teeth.

Another concern for e-cigarettes is that they contain diethylene glycol, a highly toxic substance. However, at the current point in research, scientists have not determined how much of the substance is needed to be considered harmful to the body, especially seeing e-cigarettes use a very low amount.

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Dental hygienists should continue to support tobacco cessation through evidence-based methods, such as counseling and medications. The American Dental Hygienists’ Association’s (ADHA) “Ask, Advise, Refer” program is a national tobacco intervention initiative designed to promote cessation by dental hygienists. Available at askadviserefer.org, this program follows the most successful steps to aid patients in quitting smoking, including: an in-depth presentation on the effects of tobacco and nicotine; step-by-step guide on questioning smokers; tips on advising them of why quitting is recommended; specific referrals to local quit lines; and options for Web-based cessation programs. Also, a variety of in-office handouts and reference sheets is available for immediate download or by request from the ADHA website for clinicians.

The “Ask, Advise, Refer” program recommends offering some type of smoking cessation medication in addition to a behavioral program. One option is a traditional nicotine replacement therapy, or pharmacotherapy. FDA-approved traditional nicotine replacement therapy products include gum, lozenges, transdermal patches, nasal sprays, and oral inhalers. There are several success stories of individuals sucking on hard candy day after day.  Unfortunately this may cause cavities, but if this can stop someone from using tobacco products then it is a success.  Bupropion SR and varenicline are medications used to aid in cessation.

E-cigarettes have not been evaluated by the United States Food and Drug Administration (FDA), and the levels of nicotine or other chemicals they contain are unknown. The FDA is concerned that e-cigarettes are sold to young people and do not contain “health warnings comparable to FDAapproved nicotine replacement products or conventional cigarettes.” The administration is developing a strategy to regulate this emerging class of products.

Conclusion

In response to the decreasing number of adult cigarette smokers, the tobacco industry is trying to attract young people with “healthier” tobacco products in hopes of expanding the market. None of these products is free of carcinogens, and most still contain enough nicotine to pose an addiction risk. All of them increase users’ risk of oral cancer.

The challenge for dental professionals is to identify users of these products as they may lack the typical signs of tobacco use, such as tobacco stains and odor, and the appearance of tissue changes in unusual areas, such as under the upper lip. Clinicians can play a critical role in educating patients about the nicotine content and potential harmful effects of these new tobacco products. Not only can dental professionals provide cessation support or referral for counseling, but they can also help prevent nicotine addiction in the first place.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-cigarette) on smoking reduction and cessation: a prospective 6-moth pilot study. BMC Public Health. 2013;

American Lung Association Smoking Cessation: The Economic Benefits. Available at: lung.org/stop-smoking/tobacco-control-advocacy/reports-resources/cessation-economic-benefits/states/united-states.html. Accessed April 21, 2014

US Food and Drug Administration. FDA and Public Health Experts Warn About Electronic Cigarettes. Available at: www.fda.gov/NewsEvents/ Newsroom/PressAnnouncements/ucm173222.htm. Accessed September 1, 2013

Centers for Disease Control and Prevention. 2013 Smoking and Tobacco Use. Available at: www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm. Accessed September 1, 2013

http://www.askadviserefer.org/