Oral Cancer Exam
The oral cancer exam that we do at Dentistry on Coolum involves a comprehensive exam of your head and neck region. Starting on the outside of the mouth, then working inwards, assessing lymph nodes, muscles, jaw, lips, cheeks, gums and tongue, we visually inspect and palpate these regions looking and feeling for any lumps, areas of pain, asymmetry, and areas which may appear as altered tissue.
Potential Oral Cancer Exam Findings
There are a vast number of potential findings from an oral cancer exam. These include a simple freckle on your face, a swollen lymph node from an infected tooth, an ulcer from biting your cheek or a burn mark from drinking your morning coffee a bit too fast.
Other findings are a bit rarer including a change in tissue due to a fungal infection, an autoimmune disorder which you may or may not be aware of, benign growths and tissue colour changes from an identifiable reason.
The other possible findings are things which we cannot immediately identify and clinically diagnose. These findings are discussed, and we often take a photo to assess and document the area, then we can refer for a biopsy of the area so that the tissue can be examined under a microscope and see what the cells of the area look like. This is the only way to definitively diagnose or exclude a cancer and other pathologies.
Head and Neck Cancer Treatment
I would like to mainly focus on cancers of the head and neck, the risk factors and how cancer treatment and dentistry overlap.
Early detection and prevention are the best way to ensure any cancer is limited and to increase the prognosis. Regular dental visits to assess for any abnormal changes in tissues or growing tumours is perhaps the most important aspect of a dental visit.
How to Reduce Oral Cancer & Other Cancer Risks
Reducing risk is always a huge aspect of preventing cancers. Minimising high risk behaviours is key, these include:1
- Chewing tobacco or areca nut and betel nut
- Contact with known carcinogenic materials (such as asbestos)
- Weakened immune system or previous predisposing condition such as HPV or Epstein Barr Virus
Other factors that impact are family history, genetics play a role in your likelihood of obtaining certain cancers. In Addition, when it comes to head and neck cancers, gender plays a large role with males being 3 times more likely to develop these types of cancers.
Symptoms of Head and Neck Cancer
It may be difficult to recognise early symptoms yourself as sometimes, symptoms are noticed only once the cancer has progressed.
But some early symptoms include a growth or nodule, change in sensation such as numbness or tingling in lip, skin or jaw, pain, altered sense of smell or taste, red or white patches, mobile teeth or ill-fitting dentures.
Areas such as the floor of the mouth or under the tongue, inside the lips and the gums are sometimes difficult to inspect in a mirror and a clinically significant finding may go unnoticed if not examined carefully.
Similarly, areas in the bone which are abnormal may go unnoticed if not for a thorough oral cancer dental exam. To catch these areas early, before they become symptomatic, is mainly possible through examining these areas.
For many patients who have had or are currently being treated for cancer, specifically cancers associated with the head and neck region, oral health is of significant importance.
Many cancer therapies cause some adverse side effects in the mouth from dry mouth to mucositis. Some of the side effects can be extremely painful, alter taste, increase risk of dental decay, make it difficult to swallow and impact gum health leading to tooth loss.
Some treatments are excisions and surgical resection of the tumour, which can lead to severe deformities and disabilities. Losing a portion of the tongue affecting speech and swallowing, or large resections of bone requiring prosthetic replacement. Many people diagnosed with a cancer in the head and neck region are left to spend the rest of their life completely changed both physically and emotionally.
Different cancer drugs and therapies have many drug interactions and it is essential for your dentist to know a thorough medical history prior to any treatment. Medications are often altered numerous times, so it is important to update your dentist every time you go in.
Sometimes the treating doctor may ask for a dental clearance prior to commencing radiation or chemotherapy. This means before you can not start chemotherapy or radiation, all potentially problematic teeth need to be sorted out. Often this is to eliminate the risk of having to complete extractions while undergoing cancer treatment.
While receiving high doses of radiation specifically to the head and neck region, or certain pharmacotherapies, there is a risk of osteonecrosis of the jaw. This is when the jaw bone is exposed and begins to die off resulting in the area not able to heal over. This complication can lead to pain and possible deformity if the region is large. Bone can be exposed after an extraction when the socket does not heal over.
When treating someone who has a complicated medical history or are a very high risk for complications, it may be needed to refer treatment to a hospital setting where additional precautions can be taken.
Not all dental emergencies can be prevented but limiting the major work needed while completing cancer therapy is very important. Increasing the frequency of examinations to monitor the teeth, increasing oral hygiene and identifying areas to be improved, as well as discussing diet and lifestyle are all important measures to ensure we can get through the incredibly challenging time as smoothly and positively as possible. There will be many challenges a cancer patient, their family and peers face, making dental health a source of positivity may be a spark of happiness for some.
If you would like more information or want anyone to talk to, do not hesitate to contact us or access publicly available information from government or medical practitioners.
References and additional information:
1. 2019. Understanding Head And Neck Cancers. Sydney: Cancer Council Australia.