The tongue is often known as the “strongest muscle in the body”. It is made up of a group of muscles and allows us to swallow, talk, taste, and clean the mouth. A healthy tongue is pink and covered with small bumps we call taste buds or papillae.
When your tongue experiences soreness or discoloration it can be frustrating due to its constant use. The majority of tongue problems are not serious and most can be cared for quickly; however, sometimes a discolored or painful tongue can be something more serious like a vitamin deficiency, oral cancer, or AIDS. Any persisting concerns should have medical advice.
-Leukoplakia: this condition causes excessive cell growth in the mouth causing white patches to grow. Although not always dangerous they can be a precursor to cancer so let your dentist be the judge. It can develop from irritation and is more often found in those using tobacco products.
-Oral thrush: also known as candidiasis. This is a yeast infection of the mouth. It shows up as white patches like cottage-cheese. It is more common in infants and the elderly, especially denture wearers or those with weakened immune systems. Medical conditions like diabetes, or inhaled steroids for asthma or lung disease can increase your risk. Antibiotics can kill off “good” bacteria resulting in this condition. Eating plain yogurt and medications can combat this infection.
-Oral lichen planus: this manifests itself as lacey-white lines on your tongue. Although hard to determine the cause, it often resolves on its own. Keeping up good hygiene and avoiding tobacco can help the healing process. Other Conditions:
-Scarlet fever: contact a doctor if you have a red tongue along side a high fever. An antibiotic is necessary for this condition.
-Geographic tongue: this is known dentally as benign migratory glossitis and looks like a map pattern of reddish spots with a white border; their location often shifts. They are usually harmless and acidic foods can often sting. If discomfort persists you can be prescribed a topical medication.
-Red or strawberry tongue: many factors can cause a normally pink tongue to turn red or even look strawberry-like with enlarged, red taste buds. Vitamin deficiencies like B12 and folic acid can cause such an appearance.
-Black hairy tongue: although this looks scary it is typically non-serious. The small bumps on your tongue grow continually in your lifetime and in some people become excessively long, making it easier to harbor bacteria and cause a dark “hair-like” appearance to form. This is more commonly found in those with poor hygiene, individuals on antibiotics or chemotherapy and those with diabetes.
-Sore or bumpy tongue:
*Trauma can usually occur from biting or burning your tongue. Grinding and clenching can irritate the sides
*Canker sores or ulcers cause soreness. Their cause is unknown but stress can aid their development.
*Burning tongue syndrome can occur in post menopausal women.
*Smoking is an irritant to the tongue manifesting in soreness.
*Medical conditions like diabetes and anemia can result with a sore tongue.
*Enlarged papillae can result from irritated taste buds.
*Oral cancer- a spot that doesn’t resolve in a 2 week period needs to be checked. Many oral cancers do not
hurt in the early stages so don’t assume a lack of pain means you are okay.
Please consult your friendly dental office for an evaluation if any of these conditions arise. It’s better to be safe.
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…
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.
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
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)
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.
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.
Our dental practice has more over 50 year olds than under 50. As aging adults, we need to be aware of certain things that can keep us from retaining our teeth our entire lives.
Judith Ann Jones, DDS, a spokesman on elder care for the American Dental Association and director of The Center for Clinical Research at the Boston University Goldman School of Dental Medicine spoke about 5 things that are especially important to the over 50 crowd.
Tooth Decay: Contrary to what many people believe, adults keep getting cavities! I’m always surprised when people are stunned to learn they have a cavity as an adult. Areas of the teeth that have never had a cavity can decay, but areas where we see more problems are where an old filling is leaking and at the base of an older crown. The best prevention is brushing well each day along the gumline. An electric toothbrush is very helpful in accomplishing this as well as the use of fluoride. An over the counter fluoride rinse nightly is great and in our office we have special prescription strength fluoride that is wonderful for cavity prevention as well as help with sensitivity.
Dry Mouth: Keeping Your Teeth For a Lifetime We see so many people with this problem. “Saliva protects our teeth. The calcium and phosphate present in saliva prevent demineralization of your teeth”, Jones says. Many drugs cause dry mouth as well as some diseases and as we get older, we are on more medications thus we see this commonly in older adults. This is a difficult one to deal with for those affected. The best thing is to drink lots of water, use saliva substitute and try xylitol products. Also, if you smoke, stop, it just makes your mouth drier.
Gum Disease: If your gums are swollen, red, or bleed easily, you have gum disease. If left untreated, gum disease (gingivitis) will become more serious and will cause deterioration of the bone that holds the teeth, we call this periodontitis. If this condition continues without treatment, it can cause the loss of the teeth. The best way to prevent gum disease is to clean your teeth well each day with brushing, flossing, and use of interdental cleaners like soft picks or go betweens. And of course, seeing your friendly dental hygienist as often as recommended. We can remove the mineralized bacteria from your teeth that you can’t remove with brushing.
Tooth Crowding: “As you age, your teeth shift”, according to Lee W. Graber, D.D.S., M.S, Ph.D., Past President of the American Association of Orthodontists. And “that can be problematic, not because you’ll look different, but because it can make your teeth more difficult to clean, leading to more decay. It’s also of concern because misaligned teeth can lead to teeth erosion and damage to the supporting tissue and bone”, Graber says. “Add to that the tendency of older adults to have periodontal disease, and you could end up losing your teeth even faster.” If your teeth have really shifted, and you find you are having a difficult time keeping your teeth clean and food keeps getting caught in certain areas, ask our doctors about orthodontics. We offer Invisalign to our patients and we’ve had patients in their later years choose to straighten their teeth. I just finished with my invisalign treatment. I had braces when I was a teenager but my teeth had shifted and I was experiencing these problems I just mentioned. I decided to do Invisalign. It’s easy to do and my teeth are so much straighter. They are now in the correct alignment and my teeth and gums will be healthier. If you choose not to do orthodontics, more frequently exams and cleanings may be necessary.
Oral Cancer: According to The Oral Cancer Foundation, more than 43,000 Americans will be diagnosed with oral cancers this year, and more than 8,000 will die from it. “Oral cancer incidence definitely increases as you get older”, Jones says, and “is very often linked to smoking and heavy alcohol use.” Jones also said, “Only about half of people who develop oral cancer survive the disease.” If discovered early, there is an 80 percent chance of surviving for five years. When we do your periodic exams when you come in for your cleaning, you will be checked for oral cancer. We also offer Velscope, Identafi, or Oral ID technologies to help in finding oral cancer earlier.
Keep brushing, flossing and smiling! We want to help you keep your teeth healthy your entire lives!
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.
April is Oral Cancer Awareness Month and, as dental professionals, we want our patients to understand the significance of routine oral cancer screenings. When you get your teeth cleaned, the dental hygienist or dentist will look at all the areas in your mouth, including your tongue. They will also check for any swelling along the neck. We do this on every patient regardless of age or habits.
Another way to identify a possible oral cancer lesion is to be aware of what is in your own mouth. Look at your tongue, the tissues of your cheeks and around the teeth. If you notice something like a red or white patch, take note of the appearance. If the lesion doesn’t go away after 2-3 weeks, go see your dentist for his opinion. He may check the area again after 2-3 weeks or he may refer you to a specialist to have the area evaluated.
“There is much that can be done for those who are diagnosed with head and neck cancer. Since early detection and treatment is critical, it’s important to see your dentist regularly and to promptly see a medical professional if there are any warnings signs,” — The Oral Cancer Foundation
Oral cancer symptoms:
Persistent mouth sore: A sore in the mouth that does not heal is the most common symptom of oral cancer
Pain: Persistent mouth pain is another common oral cancer sign
A lump or thickening in the cheek
A white or red patch on the gums, tongue, tonsil, or lining of the mouth
A sore throat or feeling that something is caught in the throat that does not go away
Difficulty swallowing or chewing
Difficulty moving the jaw or tongue
Numbness of the tongue or elsewhere in the mouth
Jaw swelling that makes dentures hurt or fit poorly
Loosening of the teeth
Pain in the teeth or jaw
A lump in the neck
Persistent bad breath
Again, if you notice any of these things, come into the office and get things checked out. The earlier oral cancer is identified, the better the outcome.
Early detection is key with oral cancer. When found early, oral cancer patients can have an 80 to 90% survival rate. Unfortunately 40% of those diagnosed with oral cancer will die within five years because the majority of these cases will be discovered as a late stage malignancy.
Oral cancer is particularly dangerous, because the patient may not notice it in its early stages. It can frequently prosper without producing pain or symptoms. As a result, Oral Cancer often goes undetected until it has already metastasized to another location.
Who does oral cancer screenings?
Most oral cancer screenings are done by a Dentist or Hygienist. It is very important at all of your dental appointments you have a screening completed.
When should I have my first oral cancer screening?
More people are being diagnosed with oral cancer than ever before. But surprisingly, research shows this increase is not due to the traditional risk factors of drinking, smoking and using chewing tobacco. Rather oral cancer is now being found in a younger population of men and women because due to their exposure to the HPV (Human Papillomavirus). That is why the Center for Disease Control recommends that all patients over the age of 17 be screened annually for oral cancer.
What types of screenings are there?
A routine “recall” exam usually includes a visual search for lesions and abnormal structures in the oral cavity with palpitations on neck, throat, tongue and cheeks.
The Identafi system uses the Identafi Multi-Spectral Fluorescence and Reflectance technology to enhance visualization of mucosal abnormalities such as oral cancer or premalignant dysplasia that may not be apparent to the naked eye. Unlike other fluorescence technologies and dye systems, the Identafi is Multi-Spectral with three distinct color wavelengths, making it easier to distinguish lesion morphology and vasculature.
The VELscope® Vx system is an adjunctive device which means it must be used together with and as a supplement to the traditional intra and extra oral head and neck exam. Unlike other adjunctive devices used for oral examinations, the VELscope® Vx does not require any dyes or prolonged testing procedures. In fact, a VELscope® Vx exam can be performed during a routine hygiene exam in about two minutes at your dental office.
Dentists, Hygienists, Periodontists, Oral Surgeons, Primary Care Physicians and Otolaryngologists now have the technology to detect morphological and biochemical changes which may lead to oral cancer and potentially save lives, thanks to the Identafi® and VELscope® Vx systems.
Where do I go if there is any concern with my screening?
You will be referred to an Oral and Maxillofacial Surgeons where they will check for lesions and abnormal tissue structures and perform a biopsy.
Oral Surgeons are not front-line detectors, because their patients are typically referred by dentist and other medical professionals as a primary source for cancer diagnosis and treatment.
In my short time as a dental hygienist I have had many patient ask me about “weird” things they have noticed inside their mouths. Many patients are worried or scared they might have oral cancer. While oral cancer should be checked regularly, many times the things patients are worried about are completely normal. In general, most mouths have the same or similar anatomy. However, there are variants of normal that one person may experience over another. I have listed a few of these normal variants here:
Tori: A torus or tori (plural) is simply an excessive growth of normal compact bone, either on the floor or roof of the mouth. They develop gradually and are asymptomatic. Tori can grow into many different shapes and sizes and are covered by the normal soft tissues of the mouth. Tori may make taking radiographs very uncomfortable or painful. No treatment is needed unless the patient is having problems speaking or swallowing. Even upon removal tori may grow back.
Fordyce granules: Fordyce granules are simply a cluster of sebaceous glands (glands that secrete oil, similar to a pimple) inside the mouth. Usually they occur on the inside of the cheeks or on the lips. They are yellow in color and more than 80% of adults over the age of 20 experience them. Fordyce granules are also asymptomatic and do not require treatment.
Lingual varicosities: Lingual varicosities are veins under and on the sides of the tongue. They can be red, blue, or purple in color and generally occur in clusters. Everyone has veins in and around the tongue that may vary in size, shape, or color.
Linea alba: Linea alba is a raised, white line usually along the inside of the cheek. It occurs as a result of clenching or biting the inside of one’s cheek. No treatment is necessary.
Luekoedema: Leukoedema is a generalized opalescent appearance of the inside of the mouth. It most commonly occurs in black adults but can be seen with any ethnicity. When the mucosa is stretched the opalescence is less noticeable. No treatment is necessary.
Amalgam tattoo: Believe it or not, I have seen tattoos inside the mouth! However, an amalgam tattoo is a little different. These “tattoos” result from previous amalgam (silver) fillings where part of the filling material seeps into the tissue. It creates a bluish-gray lesion and they can occur anywhere an amalgam filling has been placed. Amalgam tattoos can look very similar to oral cancer because of their color. A biopsy can determine the difference. Amalgam tattoos generally do not require treatment.
Fissured tongue: Believed to be a result of familial genetic patterns, this variant is seen in about 5% of the population. It involves deep fissures or grooves on the dorsal (backside) of the tongue. Sometimes the tongue can become irritated if food or bacteria remain in the grooves for an extended period of time. No treatment is needed other than brushing the tongue to remove food/bacteria from the surface.
Geographic tongue: Geographic tongue appears as small, red patches on the dorsal (backside) of the tongue that are surrounded by a yellow or white perimeter. The appearance is similar to that of landmasses on a globe, hence the name “geographic” tongue. The patches may go away and return again in different areas. Stress can be a contributing factor to this condition. No treatment is needed.
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.
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.
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.
How to perform a monthly self-exam:
Supplies: Flash light and a mirror
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:
Sores that fail to heal
Lumps, bumps or masses
Any areas that are differ from one side to another