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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.

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.