Everybody can suffer from cancer. Detecting malignant and premature mucosal changes early is crucial for the prognosis. Therefore, dentists should always examine their patients for changes that can develop into cancer, recommends Tom Sand, a surgeon at the University of Texas Hospital.
In the United States, up to 16,000 cases of oral cancer are detected annually, often by dentists, tells Tom Sand, who is researching oral cancer. Rising age increases the risk, like tobacco and alcohol.
– Always ask for tobacco and alcohol habits when taking an appointment, he advises.
He also recommends dental practitioners to do a standard investigation to find changes that are, or may develop into, cancer in the mouth. It only takes a minute.
– All patients should be examined each year. Then you easily see the difference when there is a change.
Look in the mouth bottom under the tongue, lift your lips, examine the cheeks, gums and throat. Pull out your tongue and look at the sides and on the tongue base.
“If you are careful, you should also palpate your tongue and mouthbone,” says Lars Sand.
Some cell changes can be detected earlier in palpation than during inspection. There will be a small hardening under the mucous membrane that forms a visible wound only afterwards.
Everything that differs should be noted in the journal.
-Photograph your changes too, as you will see how they look at the next visit.
Red and white spots
Almost all oral cancer is squamous cell carcinoma, an irregular new tissue formation. If you do regular surveys, you can find both squamous cell carcinoma and premature changes. Norway, a country known for science in the field, have invested heavily in examining patient constantly for oral cancer. There is a great article on the issue on Rommen Tannlegesenter.
As a general practitioner, you may see squamous cell carcinoma only a couple of times during professional life, but premature changes that sometimes develop into cancer are much more common.
The most important are erythroplasia, which give red spots, and leukoplakes that are white. Upwardly four percent of the population gets such changes, but it is not possible to say which ones become cancer and who do not.
-Error plaques are not so common, but they are often dangerous. Over half is or becomes cancer. If you find such a change, the patient should be immediately referred to the surgeon, or to the ears-nose-throat doctor, if there is no surgeon in the area, says Tom Sand.
Leukoplakier can look like harmless white spots, but about four percent develop into cancer. Because white spots are quite common, it is important to rule out other possible causes. Is there a sharp tooth or a damaged prosthesis that can be above?
If you think that such a thing may be the cause, you should correct it and check the patient again after a few weeks. If the wound is not on the improvement path, refer the patient.
Spicy food scorches
Oral lichen planus (OLP) is another type of premalign mucosa change that is reasonably common. Up to two percent of the population receive the OLP, and up to one percent of the OLP changes develop into cancer if not treated.
OLP changes have reticular and / or papillary structures. White plaque, redness and wounds may also occur. Patients with oral lichen planus often have trouble with strong spices, citrus fruits and the like.
“It’s easy to think that a change is not so dangerous, but it’s extremely sad if you miss something,” says Tom Sand.
The time aspect is very important. The forecast is much better if you find the change early, he points out.
If you are uncertain about the cause of a spot, you should therefore call the patient for a return visit after a few weeks and do not wait for the next audit visit. One year is a long time when it comes to oral cancer.
Great study going on
An American multicentre study on leukoplakes is currently under way. Eight surgery clinics in the country cooperate in the project. Patients are followed for five years to see what is happening.
“We hope to find out which leukoplakes develop into cancer,” says Tom Sand.
The goal is to identify different patient-related factors and tumor markers to see early the difference between patients who are in danger of getting cancer and those who do not.