Safeguarding Smiles

Mastering the art of early detection of oral cancer

Dee Dee Meevasin, DMD

As April unfolds, so does National Oral Cancer Awareness Month, which is aimed at raising awareness about the risks, prevention, and early detection of oral cancer and urging individuals to prioritize their oral health for a brighter and healthier future. According to the American Cancer Society, in 2024, it's anticipated that there will be 58,450 new cases of oral cavity or oropharyngeal cancer diagnosed across the United States.¹

Dentists can play a crucial role in detecting oral cancer through regular dental check-ups and oral cancer screenings. During routine examinations, it's important to thoroughly examine the mouth, tongue, throat, and surrounding tissues for any abnormalities, such as unusual lumps, lesions, or discolorations, which could be indicators of oral cancer. In addition, dentists can utilize advanced technologies and oral cancer screening devices to aid in the early detection of potentially cancerous lesions that may not be visible to the naked eye.

Preventive Measures

Dentists should take steps to help identify oral cancer in its early stages because this is when treatment is most effective and able to save lives. At our practice, we conduct an oral cancer screening on every new patient and then once a year on existing patients at one of their hygiene appointments. Our oral cancer screenings include the following:

· Visual. The inside of the mouth is examined by lifting the lip up, checking under the tongue, in the back of the throat, on the cheek and throughout the entire oral cavity.

· Palpation. This is performed to check the muscles on the face, the back of the head, down the neck, and the clavicle area.

· Blue, fluorescent light. This reveals oral mucosal abnormalities by illuminating darker colors (ie, 435 to 460 nanometers for oral cancer and precancer). This is the same technology that physicians use to examine the gastrointestinal tract, cervix, lungs, and skin.

Case in Point

Our practice had a patient with a history of oral melanoma that had resulted in the loss of part of her maxilla on the right side and all of her upper right teeth. When she came in for a routine hygiene appointment in November 2023 and removed her prosthesis for cleaning, she mentioned feeling a bump that was irritating her. Despite its seemingly small and benign appearance, given her medical history, we referred her to her oncologist at UCLA for examination.

On January 2, 2024, she returned to our practice for an emergency appointment, complaining of widespread pain in her lower right teeth that was making it difficult for her to sleep. A radiograph showed no abnormalities, but a noticeable foul odor emanated from her mouth during the examination. When asked if she had seen her oncologist at UCLA yet, she revealed that she had contracted COVID-19 and then went on a Christmas cruise, so she had not. We requested that she remove her prosthesis so we could take a closer look, and this revealed a significantly enlarged and abnormal looking bump that was emitting a foul stench. The tissue appeared black and hairy-like and bled profusely. After cleaning the area, we urgently advised her to visit UCLA or a local oncologist.

The very next day, the patient informed us that she had undergone a biopsy at UCLA and that it was a confirmed case of oral melanoma. She is currently undergoing immunotherapy and still visits every few weeks for assistance with cleaning and managing food particles around the cancerous area. Unfortunately, because this patient's oncologist team is an institution, we lack direct communication and have to rely on updates from the patient while we observe fluctuations in the size of the lesion without clarity on the implications.

Going Forward

I encourage all dentists to be vigilant about performing thorough oral examinations because early detection can play a critical role in oral cancer cases. Given that patients often visit us more frequently than their primary care physicians, we are uniquely positioned to identify abnormalities-oftentimes earlier than primary care providers.

Regarding interdisciplinary care, I anticipate ongoing improvements in communication between dentists, physicians, and oncologists. As head and neck specialists, we conduct screenings to detect abnormalities, including cancer. When cancer is detected, staying informed about patients' treatment plans is instrumental in enhancing patient care because it enables us to formulate improved preventive strategies that foster patients' overall well-being throughout the entire treatment process.

Reference

1. American Cancer Society. Key statistics for oral cavity and oropharyngeal cancers. American Cancer Society website. https://www.cancer.org/cancer/types/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html. Updated January 19, 2024. Accessed April 4, 2024.

About the Author

Dee Dee Meevasin, DMD, maintains a private family and cosmetic dentistry practice in Las Vegas, Nevada.