The Importance of Routine Oral Care Screenings
May 9, 2023 Each April, Oral Cancer Awareness Month is meant to raise awareness of the importance of routine oral care screenings, but is one month enough? Unless a patient happens to have a dental appointment in April when campaigns are plentiful, the urgency may never cross their mind. Oral cancer screenings are vital.
What Is Oral Cancer Oral cancer is a cancerous lesion or growth on or inside the lips, inside the cheeks, on the gums, on the tongue, or on the roof of the mouth or skin under the tongue. You might experience a sore on the inside of your lip that doesn’t go away or a lesion on your cheek that keeps opening up and bleeding. All of those issues can be signs of cancer, but they could also be something less alarming. If it is cancerous, it will be one of these types.
The thing is that some of the lesions or growths found during an oral exam are not always cancerous. Some lesions or growths are benign. This includes:
- HPV-related cancer – The human papillomavirus (HPV) can cause oral cancer, typically leading to squamous cell cancer forming in the oropharynx, which is the area at the top of the throat.
- Lymphoma – Lymphoid tissue is part of the immune system and can develop a form of cancer known as lymphoma. This cancer typically forms in the base of the tongue and the tonsils.
- Salivary gland cancer – Different types of cancer that always start in the salivary glands in the mouth and throat.
- Squamous cell carcinoma – Cancer cells form in the epithelium (top layer of the cells) and start to spread deeper.
- Verrucous carcinoma – A rare form of squamous cell cancer that forms in the gums and cheeks. It’s slow-growing and doesn’t often spread.
There are also precancerous lesions that may be white or grayish or red, depending on the type. They’re more common in people who use chewing tobacco or smoke.
- Fibroma – Scarring that occurs due to long-lasting irritation.
- Granular cell tumor – A non-cancerous tumor that typically forms on the tongue.
- Neurofibroma – A benign tumor that forms on the floor of the mouth.
- Oral hemangioma – A benign tumor that occurs due to excessive cell production.
- Peripheral giant cell granuloma – A purplish-red nodule that’s caused by excessive cell production.
- Pyogenic granuloma – Small raised bumps that are reddish in color that contain a lot of blood vessels and therefore bleed easily.
- Schwannoma – Cells that protect the nerves grow in abundance and develop a rare, usually non-cancerous tumor.
When these areas are identified during an oral exam, it can be an indicator that cancer is present or that there’s a precancerous lesion that needs attention. They can also be nothing concerning, such as dentures or braces rubbing on the gums or inside of the cheeks. A dentist can examine the area and determine if a biopsy is necessary.
- Erythroleukoplakia – Patches that can be red or white.
- Erythroplakia – Raised or flat patches that are red and bleed easily.
- Leukoplakia – Gray or white patches that don’t scrape off.
The Facts About Oral Cancer Men have a 3x higher risk of developing oral cancer, and while the rates aren’t high, the older you are, the higher that risk gets. Per 100,000 U.S. adults, oral cancer rates are:
As mentioned, men have a higher risk.
- Ages 15 to 39 – 1.4 people
- Ages 40 to 64 – 17.8 people
- Ages 65 to 74 – 43.7 people
- Ages 75 or older – 44.8 people
There are a few other things to keep in mind. Race does seem to have an impact. A higher percentage of non-Hispanic Caucasian people have the highest rates at up to 74.9 out of 100,000 men 75 or older and 50 out of 100,000 for both genders in that age group. A five-year survival rate is the percentage of patients who are still alive at the five-year mark. When oral cancer is caught early, five-year survival rates are highest at 86.3%. Overall, the five-year survival rate is 68%. If caught after the cancer has spread to other areas of the body, the rate drops to 40.4%. Cancers are staged using the TNM system:
- Ages 15 to 39 – 1.6 men vs. 1.3 women
- Ages 40 to 64 – 27.1 men vs. 8.9 women
- Ages 65 to 74 – 68.9 men vs. 21.9 women
- Ages 75 or older – 67.3 men vs. 29 women
Once these questions are answered, the cancer is staged between 0 and IV (up to IV-C).
- T – Tumor size (How large is the primary tumor?)
- N – Nodes affected? (Spread to the lymph nodes?)
- M – Metastasized? (Spread to distant organs like the liver or lungs?)
HPV-related cancers are graded similarly, but the ratings stop at IV and do not get broken down further. If a suspicious area is seen during an oral cancer screening, a biopsy is the first step. If it’s cancerous, surgery is often the first course of action. After that, chemo and radiation treatments may be recommended. Immunotherapy and targeted therapy are other options. An oral cancer treatment plan depends on the cancer’s stage. Your dentist would refer you to an oncologist for oral cancer treatment.
- 0 – Cancerous cells are still within the epithelium.
- I – 2 centimeters or smaller and hasn’t spread to nearby tissue or lymph nodes.
- II – Over 2 centimeters but not larger than 4 centimeters and hasn’t spread into nearby tissue or lymph nodes.
- III – Cancer is larger than 4 centimeters and has no spread to nearby lymph nodes or other sites or it’s any size and has grown into nearby areas and at least one lymph node.
- IV-A – Cancer has grown to nearby areas like bone, deep muscle, and sometimes lymph nodes, but the lymph nodes are not larger than 6 centimeters.
- IV-B – Cancer has spread to at least one lymph node and is larger than 6 centimeters but hasn’t spread outside the lymph node or to distant organs.
- IV-C – Cancer is any size and has grown into other areas.
What Happens During an Oral Cancer Screening? The dental hygienist or dentist will examine all areas of your mouth using mirrors as needed to inspect under your tongue, the back of your throat, your gums, the roof of your mouth, your tongue, and your lips. The exam also includes the doctor or hygienist feeling your neck and throat area while you swallow or move your head in certain directions to feel for lumps. It’s a quick, painless procedure. If you haven’t had x-rays of your jaw and teeth taken lately, that also happens. This is also a quick, easy procedure, but it may be a little uncomfortable if you have a smaller jaw and have the films digging into your cheeks or gums when the dental film holder is placed. It’s temporary and essential when it comes to early detection. Jody Jones DDS is happy to perform oral cancer screenings. While anxiety might be keeping you away, it’s so important to get screened. The Nashville dentist has techniques in place to help patients with dental anxiety, so don’t let your fear and anxiety keep you from being proactive about your health. Schedule an appointment with Jody Jones DDS online or by phone. Virtual consultations are available if you want to discuss your dental anxiety and what options are available to make a dental exam stress-free.