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 Quality Dentistry for Discerning Adults


An important message before you read this article from the New York Times:

A recently published article in the New York Times is a good source of information everyone should know about.

Despite the author's suggestions otherwise, oral cancer examinations have been routinely done by conscientious dentists for over thirty years.  Dental schools have stressed the importance of this type of examination even longer.

Dr. Fox has routinely examined each of his patients for oral cancer (as well as hundreds of other diseases that can affect the mouth, head, or neck) for over thirty-five years.  He started doing this as a dental student, and has continued this important part of every patient's examination since then.

He has also taught his own students to examine their patients for signs of oral cancer.  While the article that follows is well researched, we strenuously object to the author's suggestion that any competent, conscientious dentist would omit evaluation of the mouth, throat, face, head, or neck.  This part of a complete patient examination has been taught for many years in dental schools around the world.

Dr. Fox periodically examines everyone under his care for oral cancer, both at their initial diagnostic appointments and on a regular schedule afterwards, during appointments for routine preventive care.  He has done so for almost thirty-five years, as have many of his dentist colleagues.

If your dentist is not regularly examining you for oral cancer, ask him or her to do so ... before it is too late.

Reprinted from The New York Times (August 15, 2000)
Copyright 2000 The New York Times Company


Fighting Oral Cancer, by Looking for It


At a recent visit for a periodic dental cleaning, my periodontist took a few extra minutes to examine the roof and floor of my mouth, upper reaches of my gums and my tongue for white or red patches that were possible signs of an oral cancer or precancer.

The periodontist, Dr. Stephen F. Goodman, a past president of the American Academy of Periodontology, told me he had begun such checkups for all his patients a few months earlier after realizing that no one -- not primary care physicians, regular dentists or ordinary people -- has been assigned this responsibility. And in those first few months he'd already found three cancers and several precancerous lesions.

Oral cancer is one of those diseases that should never happen. Its leading causes -- the use of tobacco primarily and, to a lesser extent, excessive alcohol consumption -- are totally preventable. As with superficial skin cancers, before oral cancer becomes a potentially deadly disease, it usually forms precancerous lesions that can be readily seen. And outside of the skin, the mouth is probably the easiest place to look for signs of abnormal tissue growth.

photo by Linda Rosier for The New York Times

Cigarette smoking and other uses of tobacco are the leading causes of oral cancers.

Yet, each year more than 30,000 cases of oral cancer are diagnosed in the United States and 8,000 people die of this disease. There has of late been a reduction in overall deaths from oral cancers, primarily the result of the drastic decline in cigarette smoking among American adults.

But despite notable progress made in curing several of the more hidden cancers, once oral cancer develops, the chances of surviving it have not improved for decades.

Dismayed experts insist that this need not be the case. Few deaths from oral cancer would occur if dentists and physicians regularly examined their patients' mouths. The death rate is so high "because the early cancers are not being caught," said Dr. Arnold Rosenheck, associate dean at the New Jersey Dental School. "If you find the oral lesion before it metastasizes, the cancer can be cured."

Slipshod Detection

In a recent report, "Oral Health in America," the surgeon general said that adults generally were "ill-informed regarding risk factors for and signs and symptoms of oral cancers."

"One national survey" it continues, referring to a 1995 report, "found that only 14 percent of adults 40 and older reported that they had ever had an oral cancer examination. Of those, only 7 percent had had an exam within the last year."

In a national survey of dentists three years later, 70 percent said they provided annual oral cancer exams to patients 40 and older, a statistic that strikes me more as wishful thinking than fact. I do not live in the boondocks and I've been to at least four different well-trained dentists since 40. Yet the exam this year by my periodontist was the first such checkup I'd ever received.

So it may be up to you to ask your dentist or health care provider to include an oral cancer exam as part of a routine checkup.

You should also know the signs and symptoms of a possible oral cancer or precancerous lesion and make sure that any you may find are promptly examined by a knowledgeable health professional. In a booklet, "What You Need to Know About Oral Cancer," the National Cancer Institute points out that while oral cancer usually occurs in people over the age of 45, it can develop at any age. The institute lists these symptoms to watch for:

• A sore or lump on the lip or in the mouth or throat.

• A white or red patch on the gums, tongue or lining of the mouth.

• Unusual bleeding, pain or numbness in the mouth.

• A sore throat that does not go away, or a feeling that something is caught in the throat.

• Difficulty or pain with chewing or swallowing.

• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.

• A change in the voice.

• Pain in the ear.

Cause and Prevention

It has been known for many decades that repeated exposure of the oral tissues to cancer-causing substances is the primary cause of oral cancer. Cancers were found among the peoples of the South Pacific who regularly chewed carcinogenic betel nuts. In this country, 80 percent to 90 percent of oral cancers result from exposure to the carcinogens in tobacco, whether it is smoked, chewed or stuffed in a cheek pouch.

Excessive alcohol consumption is the second main risk factor, and when alcohol and tobacco exposure are combined, the risk is especially high since their combined effect is more than additive. Sunshine is another factor; excessive exposure can cause cancer of the lip. So can pipe smoking. Quitting the use of tobacco products can greatly reduce the risk of oral cancer.

Many people who eventually develop oral cancer have a history of forming whitish patches inside their mouths called leukoplakia, usually in the areas that are subjected to chronic irritation, such as the lower lip of a pipe smoker or the gums and mouth lining of people who use smokeless tobacco.

Red patches called erythroplakia, most often found in people in their 60's, are another warning sign. Both leukoplakia and erythroplakia can be found even in adolescents who use smokeless tobacco.

The Treatment

The usual route for treating oral cancers is surgery to remove the tumor in the mouth and enough surrounding tissue to make sure all the cancer is gone. If there are indications that the cancer may have spread, the surgeon will also remove lymph nodes in the neck to check for the presence of cancer cells. In still more advanced cases, the operation may involve removal of muscles and other tissues. Large tumors may necessitate removal of part of the palate, tongue or jaw, which can permanently impair the patient's ability to chew, swallow or talk.

The second line of treatment involves radiation therapy, which may be given before surgery to shrink the tumor as well as after surgery to try to destroy any residual cancer cells. The side effects, which may include soreness of the mouth and permanent dryness, can make eating a challenge. An acceptable diet is likely to include soft, bland foods moistened with a sauce or gravy, soups, puddings, nutritious shakes and nutrient-rich liquid supplements.

After treatment, patients may need reconstructive surgery to recreate lost structures in the mouth and training to use dental or facial prostheses. Speech therapy and dietary counseling are also often helpful.

The cancer institute's booklet on oral cancer can be obtained free by calling the Cancer Information Service at 1-800-4-CANCER or (800) 422-6237.

The previous page on this website also contains links for further information.