Going to the dentist twice a year for a checkup can do more than prevent cavities; it can help detect oral cancer early, when it is most treat

Going to the dentist twice a year for a checkup can do more than prevent cavities; it can help detect oral cancer early, when it is most treatable, because most of these cancers are diagnosed by the dentist.

If caught early, oral cancer can be treated and cured in most patients. Oral cancer discovered late can require extensive—often disfiguring—surgery to the tongue, jaw, and other areas of the mouth that can make it difficult to talk, eat, and swallow.

When found early, patients require less extensive surgery to remove the cancer; therefore, most activities like talking, eating, and swallowing are closer to normal after the surgery.

The moral of this story: go to the dentist twice a year for a checkup and make sure the dentist performs a screening exam to evaluate for precancerous and cancerous oral lesions, as well as gum disease and cavities.

Be Your Own Advocate

Unfortunately, not every dentist automatically checks the mouth for cancer, so patients might have to ask for this additional examination. The exam doesn’t hurt; so speak up!

“Most dental insurance plans pay for regular dental checkups, which is great. Screening twice a year is a wonderful way to pick out these lesions before they become cancer,” says Susan Mallery, DDS, PhD, a professor in the College of Dentistry at The Ohio State University.

“The dentist should take the time to examine the whole mouth and look at the tongue, floor of the mouth, roof of the mouth, back of the mouth, even the lips. Early detection of the precancerous lesions would be the best way to save people’s lives. If your dentist doesn’t take the time to do that, find a new dentist.”

Types of Oral Cancer

Doctors separate oral cancers into two general categories based on their location. Oral cancers occur in the front portion of the mouth, such as on the tongue, cheek, roof and base of the mouth, jaw, and gums—all areas that you can see when you look in the mirror. The second type of oral cancer is called oropharyngeal cancer, and these occur in the back of the mouth, including the soft palate, the base of the tongue, and the tonsils.

“These are anatomically different sites, and they are associated with different risk factors,” says Miriam N. Lango, MD, a head and neck surgeon at Fox Chase Cancer Center in Philadelphia.

The leading risk of oropharyngeal cancer is human papillomavirus (HPV), a virus that causes genital warts. People become infected by having oral sex with someone who has HPV. Unfortunately, there may be no sign that the person is infected.

Risk Factors

The leading cause of oral cancer is using tobacco products, particularly any kind of smoking (cigarettes, cigars, and pipe smoking). Chewing tobacco can also cause cancer, but the risk is lower. Heavy drinking, especially among smokers, increases the risk of getting oral cancer.

Other risk factors include too much sun exposure, and perhaps a family history of cancer. Oral cancers have been diagnosed in people who don’t smoke or drink, so doctors think there can be a genetic association, but they have not found a specific gene, or set of genes, for oral cancer yet.

Not smoking is the best way to prevent oral cancer. An estimated 42,000 Americans will be diagnosed with oral cancer this year and most of them are smokers. If you already smoke, quit. Quitting can decrease your risk dramatically. Every year that you don’t smoke, your risk is lowered. After 15 years of not smoking, your risk becomes similar to the general population, according to Lango.

Smoking marijuana is also a risk factor, but it is not as high as cigarette, cigar, and pipe smoking.

Some people like firefighters worry that occupational exposures—inhaling smoke while fighting fires—increases their risk, but studies have not shown any correlation.

Signs and Symptoms

You should consider getting your mouth checked if you have a mouth sore or ulcer that doesn’t heal within a reasonable time, usually within 2 weeks. Sometimes people feel a small bump or have lacy white patches or sores that can be painful, called lichen planus (LIE-kun PLAY-nus).  It is important to distinguish between lichen planus (a reaction of the immune system) and precancerous oral lesions.

Another sign is thickened, white patches that can form on the gums, cheeks, bottom of the mouth or tongue, called leukoplakia (loo-ko-PLAY-key-uh). Although most leukoplakia lesions are not painful or serious, they can sometimes signal cancer, which is called precancer or dysplasia.

Some patients also feel unexplained numbness or tingling in the face, mouth, or neck. If the cancer is advanced, patients might have problems chewing, speaking, or swallowing.

If your dentist or doctor suspects that you have oral cancer, a biopsy will be recommended, in which a small portion of the area will be removed and examined under a microscope to determine whether abnormal cells are present.

Treatment

Surgery is the usual treatment for oral cancers. Surgeons will remove the cancer or precancer and some surrounding unaffected tissue (to make sure they remove all the cancer). If the cancer is large, aggressive, or more advanced, your surgeon might also order radiation therapy after surgery.

A head and neck surgeon is usually on the team that treats oral cancers because treatment requires surgery to remove the cancer or precancer (abnormal tissue that could become cancer). Some patients also require radiation therapy, and sometimes chemotherapy.

But many oral cancers can be treated just by surgery, and these patients usually do quite well.

“How well the patient does depends on the stage of the disease,” says Lango. “If it's localized, most institutions recommend surgery as the initial treatment approach because after the surgeon removes the cancer, the pain goes away, and function is frequently well preserved.”

After surgery, patients do best if they are enrolled in a rehabilitation program early. Speech and swallowing therapy will improve the ability to articulate words and help patients adjust to any swallowing changes. 

If the surgery is disfiguring, reconstructive surgery can improve the way the person looks. Doctors have made great strides in some reconstructive surgery for extensive mouth cancers. For instance, if the cancer spreads into the jawbone area, in many cases the jaw can be reconstructed.

“Fortunately, we have very good reconstruction techniques available today. A jaw can be recreated using other structures in the body. For instance, a bone in your leg can be used to reconstruct a jawbone,” says Lango.

Patients who have the most trouble are those that lose very large portions of the tongue, because the tongue is so essential to being able to talk and eat. Unfortunately, surgeons cannot reconstruct a usable tongue when the entire tongue was sacrificed to remove the cancer. However, using new reconstructive techniques and a good rehabilitation program after surgery, removal of even three-quarters of the tongue can result in good speech and swallowing function.

“The goal of the cancer treatment team is always to cure the cancer with as much preservation of function as possible,” Lango added.

No matter how well a person does after surgery, he or she will probably notice some changes in speech and swallowing. And patients may experience problems with dry mouth, especially if some salivary glands had to be removed or they received radiation treatment.

This is definitely a case where prevention is better than cure. So get in the habit of visiting the dentist twice a year, and stop smoking and drinking.