We are always delighted to welcome to welcome a guest blogger to the SCPN blog. Professor Graham Ogden, Professor of Oral Surgery, University of Dundee is our guest blogger this month. Graham is an eminent specialist in Oral Surgery and Oral Medicine who has published widely on the topic of oral cancer.

Why do I need to go to the dentist?

I clean my teeth every day (twice a day in fact), my gums don’t bleed and my teeth don’t hurt. Isn’t that all they check?

Well, no it isn’t…..

I was reminded the other day of how frustrating it is that our patients go to their doctor in preference to their dentist, when they have something wrong with the inside of their mouth.

A medic pal of mine from University days contacted me to say that her brother had just been diagnosed with mouth cancer. He’d been going to see his doctor for some months apparently, regarding a change in the lining of his mouth. He’d noticed this ulcer on the side of his tongue, that wasn’t particularly painful and had been to see his GP a few times. His doctor eventually referred him into hospital. He is 54, a Cambridge graduate and my pal was phoning for advice regarding her brother. He’d just had most of his tongue chopped off, and could hardly speak.

After putting the phone down I wondered why it was that he hadn’t gone to ask his dentist about the ulcer. Surely a bright guy like that would know that his dentist would be more familiar with the significance of any change within the mouth than his doctor. But why would he if his dentist didn’t actually tell him that?

Dentists are taught to screen the mouth every time they see a patient, regardless of the reason for their visit. They are on the look out for any changes which might be suggestive of early malignant change i.e. an early cancer. That is because the earlier it is caught, the better the outcome. In fact many mouth cancers can be cured   if removed at an early stage.

What does early mouth cancer look like?

Well it can vary from mild colour change (white patch, red patch or a red/white patch), which can be quite subtle to detect to that of an ulcer that has raised firm margins (a late sign).Fig 1 Blog Fig 2 Blog

In general, any change that has been present for more than 2 to 3 weeks should be checked out and urgently referred (if cancer is suspected).

The changes in the mouth can include: colour change (as described above), a swelling (with no obvious cause), an ulcer (that doesn’t heal), persistent discomfort, bleeding or a numb feeling.

What causes mouth cancer?

We’ve known for a long time that tobacco and alcohol are important risk factors. If you smoke a packet of cigarettes a day then your risk might increase by x10. However if you smoke and drink above the recommended safe limits (14 units/week for women and 21 units /week for men) then it greatly raises your risk, to at least x40! Eating a diet rich in fresh fruit and fresh vegetable should help protect us from these damaging carcinogens, (due in part to the cancer protecting chemicals contained within them).

Recently the role of HPV has been considered. Yes, you’ve heard that can cause cervical cancer, but surely not mouth cancer? However,  the same types of virus that cause cervical cancer have been associated with many oropharyngeal cancers (and some oral cancers). The route of transmission is by oral: genital contact. I can highly recommend sourcing the BBC3 documentary made by Jamie Winstone a few years ago, entitled  “Is oral sex safe?” for an interesting and thought provoking insight into the topic.

If by now you’ve noticed something in your own mouth as you’ve been reading this, don’t panic! Just remember that there are many more benign reasons for such change than nasty ones, despite the fact that mouth cancer rates have gone up over 300% in the last 30 years. So if you or a family member notices anything don’t worry, get it checked out by your dentist (if you have one). If you don’t, then it might be a good time to find one. However if your GP can see you sooner, get along there.

Why do I say, see your dentist initially?  

Well they get a lot more training on the changes that can affect the lining of the mouth, than the medical students do. There is a great deal that competes for the time of the medical undergraduate, as they study the whole body, such that time spent studying the mouth (by necessity) is really quite small. Dentists’ whole training is related to the mouth. Furthermore, the General Dental Council (the organization that regulates the dental profession) has recently made oral cancer a recommended topic for Continuing Professional Development. In other words every 5 year cycle, they must refresh their knowledge of what mouth cancer is, what causes it etc.

I started this blog off with a reference to my friends’ brother. I will end by describing what happened to Christine, a 25 year old cancer scientist, who attended her GP many times regarding discomfort and ulceration within her mouth. Eventually she showed it to a work colleague who swore and told her to get referred in to a specialist (an oral & maxillofacial surgeon). Even then the GP hadn’t marked it ‘urgent’ as they’d said she was too young to get mouth cancer and didn’t have any risk factors. Read more about Christine’s story.

Christine’s story appears on the Ben Walton trust website (www.benwaltontrust.org). Ben was diagnosed with tongue cancer whilst in his early twenties, when he was still at University. He sadly succumbed to the disease very quickly. His family set up the organization to raise both public and professional awareness of the condition, and have been responsible for many educational activities, including more recently the BMJ Learning module on mouth cancer.

Whilst it’s true that the majority of mouth cancers occur over the age of 50, 1 in 10 now arise in those less than 45 years. And although tobacco and alcohol are frequently associated with the disease, around 25% (1 in 4) have no obvious risk factor!

So without wanting to worry you unnecessarily, you are never too young to get mouth cancer (although the chances are much reduced in younger people).

So I hope that for those who have a dentist, I’ve given you another   reason as to why you should see them regularly. And for those of you who don’t have a dentist, maybe it’s time to find one………