Oral Health Topics

• The Importance of Early Detection
• You Should Know
• Regular Dental Check-ups Important
• Facts About Oral Cancer
• Additional Resources 

The Importance of Early Detection

Your dentist has recent good news about progress against cancer. It is now easier than ever to detect oral cancer early, when the opportunity for a cure is great. Only half of all patients diagnosed with oral cancer survive more than five years.

Your dentist has the skills and tools to ensure that early signs of cancer and pre-cancerous conditions are identified. You and your dentist can fight and win the battle against oral cancer. Know the early signs and see your dentist regularly.

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You Should Know

• Oral Cancer often starts as a tiny, unnoticed white or red spot or sore anywhere in the mouth.
•  It can affect any area of the oral cavity including the lips, gum tissue, check lining, tongue and the hard or soft palate.
• A change in the way the teeth fit together
• Oral Cancer most often occurs in those who use tobacco in any form.
• Other signs include:
  • A sore that bleeds easily or does not heal
  • A color change of the oral tissues
  • A lump, thickening, rough spot, crust or small eroded area
  • Pain, tenderness, or numbness anywhere in the mouth or on the lips
  • Difficulty chewing, swallowing, speaking or moving the jaw or tongue.
• Alcohol use combined with smoking greatly increases risk.
• Prolonged exposure to the sun increases the risk of lip cancer.
  Oral cancers can occur in people who do not smoke and have no other known risk factors.
  Oral Cancer is more likely to strike after age 40.
  Studies suggest that a diet high in fruits and vegetables may prevent the development of potentially cancerous lesions.

Regular Dental Check-ups Important

Oral cancer screening is a routine part of a dental examination. Regular check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and pre-cancerous conditions. You may have a very small, but dangerous, oral spot or sore and not be aware of it.

Your dentist will carefully examine the inside of your mouth and tongue and in some patients may notice a flat, painless, white or red spot or a small sore. Although most of these are harmless, some are not. Harmful oral spots or sores often look identical to those that are harmless, but testing can tell them apart. If you have a sore with a likely cause, your dentist may treat it and ask you to return for re-examination.

Dentists often will notice a spot or sore that looks harmless and does not have a clear cause. To ensure that a spot or sore is not dangerous, your dentist may choose to perform a simple test, such as a brush test. A brush test collects cells from a suspicious lesion in the mouth. The cells are sent to a laboratory for analysis. If precancerous cells are found, the lesion can be surgically removed if necessary during a separate procedure. It’s important to know that all atypical and positive results from a brush test must be confirmed by incisional biopsy and histology.

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Facts About Oral Cancer

Incidence and Mortality

• Oral cancer strikes an estimated 34,360 Americans each year.  An estimated 7,550 people (5,180 men and 2,370 women) will die of these cancers in 2007.¹
• More than 25% of the 30,000 Americans who get oral cancer will die of the disease.²
• On average, only half of those diagnosed with the disease will survive more than five years.⁴
• African-Americans are especially vulnerable; the incidence rate is 1/3 higher than whites and the mortality rate is almost twice as high.⁵

Risk Factors

• Although the use of tobacco and alcohol are risk factors in developing oral cancer, approximately 25% of oral cancer patients have no known risk factors.^6, 7
• There has been a nearly five-fold increase in incidence in oral cancer patients under age 40, many with no known risk factors.^{8, 9, 10, 11}
• The incidence of oral cancer in women has increased significantly, largely due to an increase in women smoking. In 1950 the male to female ratio was 6:1; by 2002, it was 2:1.

Prevention and Detection

• The best way to prevent oral cancer is to avoid tobacco and alcohol use.
• Regular dental check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and pre-cancerous conditions.
• Many types of abnormal cells can develop in the oral cavity in the form of red or white spots. Some are harmless and benign, some are cancerous and others are pre-cancerous, meaning they can develop into cancer if not detected early and removed. (American Cancer Society)
• Finding and removing epithelial dysplasias before they become cancer can be one of the most effective methods for reducing the incidence of cancer.
• Knowing the risk factors and seeing your dentist for oral cancer screenings can help prevent this deadly disease. Routine use of the Pap smear since 1955, for example, dramatically reduced the incidence and mortality rates for cervical cancer in the United States.¹²
• Oral cancer is often preceded by the presence of clinically identifiable premalignant changes. These lesions may present as either white or red patches or spots. Identifying white and red spots that show dysplasia and removing them before they become cancer is an effective method for reducing the incidence and mortality of cancer.

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References

1. American Cancer Society.
2. National Institute of Dental and Craniofacial Research, National Institutes of Health, website 2007.
3. American Cancer Society web page.
4. National Institute of Dental and Craniofacial Research, National Institutes of Health, website 2007.
5. American Cancer Society, Facts and Figures for African-Americans.
6. Schantz SP, Yu GP. Head and neck cancer incidence trends in young Americans, 1973-1997, with a special analysis for tongue cancer. Arch Otolaryngol Head Neck Surg. Mar 2002;128(3):268-274.
7. Lingen M, Sturgis EM, Kies MS. Squamous cell carcinoma of the head and neck in nonsmokers: clinical and biologic characteristics and implications for management. Curr Opin Oncol. May 2001;13(3):176-182.
8. Shiboski CH, Shiboski SC, Silverman S, Jr. Trends in oral cancer rates in the United States, 1973-1996. Community Dent Oral Epidemiol. Aug 2000;28(4):249-25.
9. Llewellyn CD, Johnson NW, Warnakulasuriya KA. Risk factors for squamous cell carcinoma of the oral cavity in young people–a comprehensive literature review. Oral Oncol. Jul 2001;37(5):401-418.
10. Corcoran TP, Whiston DA. Oral cancer in young adults. J Am Dent Assoc. Jun 2000;131(6):726.
11. Dahlstrom, K. R et al. Squamous cell carcinoma of the head and neck in never smoker-never drinkers: A descriptive epidemiologic study. Head Neck 2007.
12. American Cancer Society (“In the United States, the cervical cancer death rate declined by 74% between 1955 and 1992, in large part due to the effectiveness of Pap smear screening.”) web facts.

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Additional Resources

ADA JADA Patient Page

• Detecting Oral Cancer Early  (PDF)

ADA Dental Minute

• Oral Health During Cancer Treatment 

National Cancer Institute

• Oral Cancer
  NCI's gateway for information about oral cancer (cancer of the lip or mouth).

National Institute for Dental and Craniofacial Institute

• Oral Cancer
  Information on risk factors, examinations and treatment for oral cancer.

American Cancer Society

• Oral Cancer Fact Sheet
  Quitting tobacco and limiting alcohol sharply reduce any risk of oral cancer, even after many years of use. Find oral cancers early with routine screening.

Support for People with Oral and Head and Neck Cancer (SPOHNC) 
Dedicated to raising awareness and meeting the needs of oral and head and neck cancer patients.

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Overview

Approximately 35,000 new cases of oral cancer are diagnosed each year in the United States. Some 25 percent of those people will die of the disease.  According to the American Cancer Society, oral cancer occurs almost as frequently as leukemia and claims more lives than melanoma or cervical cancer.  Oral cancer’s incidence is rising among women, young people and non-smokers.

Routine, careful examination of patients is appropriate and necessary. This can easily be achieved during a regular dental visit. The stage at which an oral cancer is diagnosed is critical to the course of the disease. When detected at its earliest stage, oral cancer is more easily treated and cured. When detected late, the overall five-year survival rate is about 50 percent.

Facts About Oral Cancer

Incidence and Mortality

• Oral cancer strikes an estimated 34,360 Americans each year.  An estimated 7,550 people (5,180 men and 2,370 women) will die of these cancers in 2007.¹
• More than 25% of the 30,000 Americans who get oral cancer will die of the disease.²
• On average, only half of those diagnosed with the disease will survive more than five years.⁴
• African-Americans are especially vulnerable; the incidence rate is 1/3 higher than whites and the mortality rate is almost twice as high.⁵

Risk Factors

• Although the use of tobacco and alcohol are risk factors in developing oral cancer, approximately 25% of oral cancer patients have no known risk factors.^6, 7
• There has been a nearly five-fold increase in incidence in oral cancer patients under age 40, many with no known risk factors.^{8, 9, 10, 11}
• The incidence of oral cancer in women has increased significantly, largely due to an increase in women smoking. In 1950 the male to female ratio was 6:1; by 2002, it was 2:1.

Prevention and Detection

• The best way to prevent oral cancer is to avoid tobacco and alcohol use.
• Regular dental check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and pre-cancerous conditions.
• Many types of abnormal cells can develop in the oral cavity in the form of red or white spots.  Some are harmless and benign, some are cancerous and others are pre-cancerous, meaning they can develop into cancer if not detected early and removed. (American Cancer Society)
• Finding and removing epithelial dysplasias before they become cancer can be one of the most effective methods for reducing the incidence of cancer.
• Knowing the risk factors and seeing your dentist for oral cancer screenings can help prevent this deadly disease. Routine use of the Pap smear since 1955, for example, dramatically reduced the incidence and mortality rates for cervical cancer in the United States.¹²
• Oral cancer is often preceded by the presence of clinically identifiable premalignant changes. These lesions may present as either white or red patches or spots. Identifying white and red spots that show dysplasia and removing them before they become cancer is an effective method for reducing the incidence and mortality of cancer.

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References

1. American Cancer Society.
2. National Institute of Dental and Craniofacial Research, National Institutes of Health, website 2007.
3. American Cancer Society web page.
4. National Institute of Dental and Craniofacial Research, National Institutes of Health, website 2007.
5. American Cancer Society, Facts and Figures for African-Americans. 
6. Schantz SP, Yu GP. Head and neck cancer incidence trends in young Americans, 1973-1997, with a special analysis for tongue cancer. Arch Otolaryngol Head Neck Surg. Mar 2002;128(3):268-274.
7. Lingen M, Sturgis EM, Kies MS. Squamous cell carcinoma of the head and neck in nonsmokers: clinical and biologic characteristics and implications for management. Curr Opin Oncol. May 2001;13(3):176-182.
8. Shiboski CH, Shiboski SC, Silverman S, Jr. Trends in oral cancer rates in the United States, 1973-1996. Community Dent Oral Epidemiol. Aug 2000;28(4):249-25.
9. Llewellyn CD, Johnson NW, Warnakulasuriya KA. Risk factors for squamous cell carcinoma of the oral cavity in young people–a comprehensive literature review. Oral Oncol. Jul 2001;37(5):401-418.
10. Corcoran TP, Whiston DA. Oral cancer in young adults. J Am Dent Assoc. Jun 2000;131(6):726.
11. Dahlstrom, K. R et al. Squamous cell carcinoma of the head and neck in never smoker-never drinkers: A descriptive epidemiologic study. Head Neck 2007.
12. American Cancer Society (“In the United States, the cervical cancer death rate declined by 74% between 1955 and 1992, in large part due to the effectiveness of Pap smear screening.”) web facts.

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The Journal of the American Dental Association

• Evidence-Based Clinical Recommendations Regarding Screening for Oral Squamous Cell Carcinomas (May 2010)
• Preventing and Detecting Oral Cancer (May 2005)
• Risk Management Considerations for Oral Cancer (November 2005)
• The American Dental Association's Oral Cancer Campaign: The Impact on Consumers and Dentists (September 2004)
• Squamous Cell Carcinoma Arising in an Oral Lichenoid Lesion (June 2004)
• Special Supplement on Oral Cancer: Combating Oral Cancer: The Dentist's Role in Preventing, Detecting a Deadly Disease
• Characteristics of Oral Cancer in a Central European Population: Defining the Dentist’s Role (March 2003)
• Oral Cancer Knowledge, Risk Factors and Characteristics of Subjects in a Large Oral Cancer Screening Program (August 2002)
• The Impact of Gene Therapy on Dentistry: A Revisiting After Six Years (January 2002)
• Evaluating, Documenting and Following Up Oral Pathological Conditions: A Suggested Protocol (March 2001)
• Perspectives of Maryland Dentists on Oral Cancer (January 2001)
• Ask the Expert: What Are the Diagnostic Protocols for Oral Cancer Screenings? (January 2001)
• Oral Pharyngeal Cancer Prevention and Early Detection: Dentists' Opinions and Practices (April 2000)
• Survey of U.S. Dentists' Knowledge and Opinions About Oral Pharyngeal Cancer (May 2000)
• Improving Detection of Precancerous and Cancerous Oral Lesions: Computer-Assisted Analysis of the Oral Brush Biopsy (October 1999)
• Editorial — "One More Time" (July 1999)
• Scientific Progress in Understanding: Oral and Pharyngeal Cancers (June 1998)
• Knowledge, Opinions and Practices of General Dentists Regarding Oral Cancer: A Pilot Survey (May 1998)
• Dental Considerations and Treatment of the Oncology Patient Receiving Radiation Therapy (February 1998)

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Additional Resources

• Science Brief on Alcohol-Containing Mouthrinses and Oral Cancer (PDF)
• 2007 ADA Audio News Conference Advisory (PDF)
• Oral Cancer JADA Article: Improving Detection of Precancerous and Cancerous Oral Lesions (JADA, Vol. 130, October 1999) (PDF)
• 2007 ADA Oral Cancer Awareness Campaign Ads (PDF)
• For the Dental Patient—Oral Cancer: How to Protect Yourself (PDF)
• Fanconi Anemia and Oral Cancer
• MedlinePlus: Genes and Gene Therapy
• National Cancer Institute
• National Center for Biotechnology Information (p53 tumor suppressor protein)
• National Cancer Institute 
  NCI's gateway for information about oral cancer (cancer of the lip or mouth)
• National Institute for Dental and Craniofacial Institute 
  Information on risk factors, examinations and treatment for oral cancer
• Support for People with Oral and Head and Neck Cancer (SPOHNC)
  Dedicated to raising awareness and meeting the needs of oral and head and neck cancer patients.
• Brochures available through ADA Catalog:
  • Get the Facts About Oral Cancer W151Why Do I Need an Oral Exam W103
  • Think Before You Chew: Smokeless Doesn’t Mean Harmless W190
  • Quit Smoking: Better Health, Better Life, Better You W126

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