Oral cancer

Question 1

What is it?

Answer 1

Can affect various areas of the mouth: the soft tissues, salivary glands or the jaw bones. 90% of oral cancers affect the soft tissues initially, as a lesion called Squamous Cell Carcinoma (SCC)

Question 2

Causative factors

Answer 2

Tobacco habits - all tobacco products contain chemicals capable of causing cancer (carcinogens)
High alcohol consumption - alcohol acts as a solvent for the carcinogens + allows their easier entry into the soft tissues
Both together - smokers who drink excessively most at risk of SCC

Question 3

More causative factors

Answer 3

Sunlight- in fair-skinned people, sunlight is associated with SCC affecting the lower lip
Diet - research is ongoing into links between SCC + diets high in fats + red meat or low in vitamin A + iron intake.
Genetics - some people are genetically predisposed to developing SCC

Question 4

Signs and symptoms of SCC

Answer 4

Painless ulcer that has no obvious cause, + fails to heal fully within 2-3 weeks.

• in particular, an ulcer occurring beneath or on the side of the tongue or in the floor of the mouth
• presence of a white or red patch associated with the ulcer

Question 5

What to do

Answer 5

Any suspicious lesions must be referred to an oral surgery hospital department for immediate investigation. Even then, the 5 year survival rate from SCC is only around 55% + is very dependent on early detection + aggressive trt

Question 6

Typical individuals from years ago

Answer 6

60 + male, usually from a lower socio-economic background, who was a lifelong smoker + drinker

Question 7

Typical individuals in recent years

Answer 7

younger patients (even 20s) both male + female, usually smokers and especially binge drinkers. + those who use sunbeds or sunbathe with little ultraviolet protection for their lips - however, greater risk of developing melanoma (skin cancer)

Question 8

Dental team responsibility

Answer 8

To educate pts about the risk factors - especially important with smoking + tobacco usage , whether with cigarettes, cigars or pipes and including the habitual chewing of betel nuts + tobacco paan by some Asian societies.
The effects of smoking on dental and general health should cover the following topics

Question 9

Oral health effects

Answer 9

• Oral cancer
• Development of oral precancerous lesions (especially white patches in the mouth)
• Periodontal disease
• Poor wound healing, especially after extraction
• Tendency to develop dry socket
• Stained teeth
• Halitosis (bad breath)

Question 10

General health effects

Answer 10

• Heart disease - in particular, hypertension + coronary artery disease
• Stroke
• Respiratory disease - in particular, chronic bronchitis + emphysema
• Other cancers - in particular, throat, lung + stomach cancer

Question 11

The department of health

Answer 11

has developed an excellent national ‘quit smoking’ scheme that is freely accessible to anyone wishing to stop + info on local help and support is widely available