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Oral Health Topics

Cancer, Oral

Patient Version Dentist Version

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.
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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

ADA Dental Minute

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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Please note: The ADA does not provide specific answers to individual questions about fees, dental problems, conditions, diagnoses, treatments or proposed treatments, or requests for research. Information about dental referrals, complaints and a variety of dental procedures may be found on ADA.org.

Overview

Routine, careful examination of patients for oral and pharyngeal cancer, in addition to an updated health history, can easily be achieved during a regular dental visit. The National Institute of Dental and Craniofacial Research describes one method.1 The stage at which an oral or pharyngeal cancer is diagnosed is critical to the course of the disease. When detected at its earliest stage, these cancers are more easily treated.

Facts About Oral Cancer

Incidence and Mortality

According to statistics available through the National Cancer Institute2:

  • Oral and pharyngeal cancer strikes an estimated 39,000 Americans each year.  An estimated 8,000 people die of these cancers annually.
  • The disease occurs twice as often in men as in women.
  • Although the difference between races in oral and pharyngeal cancer is negligible, the 5-year survival rate doubles for white men over African American men (the difference in survival rates between women is not significant).
  • An estimated 1 in 95 adults will be diagnosed with oral or pharyngeal cancer in their lifetime.
  • The median age at diagnosis is 62 years (that figure may drop to 52 to 56 years for people who have oral or pharyngeal cancer associated with human papillomavirus (HPV) infection.3-7)

Risk Factors

 

  • Tobacco use8,9
  • Alcohol consumption9,10
  • Heavy use of tobacco and alcohol together greatly increases the risk of developing oral and pharyngeal cancer11,12
  • HPV infection is associated with pharyngeal cancer13,14
  • Age: the risk greatly increases after 44 years2
  • Gender: men are twice as likely to develop oral and pharyngeal cancer2
  • Ultraviolet (UV) light exposure is a particular risk factor for lip cancer15 
  • Nutrition: a diet rich in vegetables and fruits is associated with a lower incidence of oral and pharyngeal cancer16

 Signs and Symptoms

  • Leukoplakia or erythroplakia

  • A lump or thickening of the oral soft tissues, or swelling that affects the fit and comfort of dentures

  • Patients may complain of: difficulty chewing or swallowing, or moving the jaw or tongue; a sore throat or feeling that something is caught in the throat; numbness; hoarseness or a change in the voice.

Signs and symptoms that persist for two weeks or more merit further investigation, such as a biopsy or referral to a specialist.

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References

  1. National Institutes of Health: National Institute of Dental and Craniofacial Research. Oral cancer exam. Accessed April 12, 2012.
  2. SEER Fact Sheets: Oral cavity and pharynx. From data collected in: Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2009. National Cancer Institute: Bethesda, MD. Based on November 2010 SEER data submission, posted to SEER website, 2011.  Accessed April 10, 2012.
  3. Smith EM, Ritchie JM, Summersgill KF, et al. Age, sexual behavior and human papillomavirus infection in oral cavity and oropharyngeal cancers. Int J Cancer 2004;108:766-72. 
  4. D'Souza G, Zhang HH, D'Souza WD, Meyer RR, Gillison ML. Moderate predictive value of demographic and behavioral characteristics for a diagnosis of HPV16-positive and HPV16-negative head and neck cancer. Oral Oncol 2010;46(2):100-9. (PDF) 
  5. Fakhry C, Westra WH, Li S, et al. Improved survival in patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 2008;100:261-9. (PDF)  
  6. Dayyani F, Etzel CJ, Liu M, et al. Meta-analysis of the impact of human papillomavirus (HPV) on cancer risk and overall survival in head and neck squamous cell carcinomas (HNSCC). Head Neck Oncol 2010;2:15-25. (PDF)  
  7. Gillison ML, D'Souza G, Westra W, et al. Distinct risk factor profiles for human papillomavirus Type 16-positive and human papillomavirus Type 16-negative head and neck cancers. J Natl Cancer Inst 2008;100:407-20. (PDF)
  8. The health consequences of smoking: a report of the Surgeon General . [Atlanta, Ga.]: Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C.: For sale by the Supt. of Docs, U.S.G.P.O., 2004.  Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2004/complete_report/index.htm Accessed April 12, 2012.
  9. Hashibe M, Brennan P, Benhamou S, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risks of head and neck cancer: Pooled analysis on the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst 2007;99:777-89. (PDF)  
  10. Goldstein BY, Chang SC, Hashibe M, et al. Alcohol consumption and cancer of the oral cavity and pharynx from 1988 to 2009: An update. Eur J Cancer Prev 2010;19(6):431-65. (PDF)  
  11. Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use and the rise in head and neck cancer: Pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev 2009;18(2):541-50. (PDF)  
  12. Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3283-7. (PDF) 
  13. Cleveland JL, Junger ML, Saraiya M et al. The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States: Implications for dentistry. JADA 2011;142(8):915-24. (PDF)
  14. Kreimer AR, Clifford GM, Boyle P, Franceschi S. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: A systematic review. Cancer Epidemiol Biomarkers Prev 2005;14(2):467-75. (PDF)
  15. Gallagher RP, Lee TK, Bajdik CD, Borugian M. Ultraviolet radiation. Chronic Dis Can 2010;29(Supplement 1):51-68. (PDF)
  16. Edefonti V, Bravi F, La Vecchia C, et al. Nutrient-based dietary patterns and the risk of oral pharyngeal cancer. Oral Onc 2010;46:343-8. (PDF)

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The Journal of the American Dental Association

The Journal has published a number of articles related to oral cancer (ADA members and JADA subscribers may search the JADA archives for a complete list). A sampling of those articles appears below:

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Additional Resources

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