Deborah Lyle: “Understanding Mouth Cancer”

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Waterpik's Deborah Lyle adds her voice to “Mouth Cancer Action Month”

Globally the number of people with mouth cancer is growing at an alarming rate. In the UK alone, over 8,000 new cases are diagnosed each year, which is an increase of 135% compared with twenty years ago [1]. Regrettably, late stage oral cancer can have a high mortality rate but when caught early the survival rate can rise significantly.

The dental profession is the first line of defence for the early detection of this devastating disease. However, there is always more to be done to raise awareness, which at present remains low.

Increased patient understanding results in improved self-management, behavioural change and better health outcomes [2]. However, it has been reported that only 8% of British adults feel confident about their knowledge of mouth cancer. As part of the drive to educate patients, the dental team is ideally placed to provide easy to understand information and raise awareness.

Dental professionals can help patients by explaining how mouth cancer can develop, the risk factors associated with the disease and most importantly, the common signs and symptoms to look out for. In this way, patients are better informed, more capable of self-checking and more likely to seek medical attention if they discover anything unusual.

What is mouth cancer?

In nine out of ten cases, mouth cancer (or oral cancer) forms when changes or mutations occur in the squamous cells that line all surfaces of the skin and mucosa, including the inside of the lips, mouth, throat, tongue and tonsils. It is not clear exactly what causes these mutations but squamous cell carcinoma can develop on the surface of the tongue, the insides of the cheeks, on the palate or on the floor of the mouth, as well as on the lips and gums [3].

Other less common types of mouth cancer include adenocarcinomas, which develop inside the salivary glands and sarcomas that develop due to abnormalities in bone, cartilage or muscle. Lymphomas that usually grow from cells in the lymph glands can develop in the mouth and although rare, oral malignant melanomas, which begin in the cells that produce skin pigment can also appear in the oral mucosa [4].

In all cases, early detection is vitally important to catch the disease before it metastasises and to greatly increase the chances of survival.

Mouth cancer can occur in people of all ages but it is slightly more likely to occur in males than females and is strongly related to age. It is most prevalent in the 50-74 age group but it can also affect younger adults, where the human papillomavirus (HPV) infection is thought to be associated with the majority of cases.

People who have a history of head or neck cancers are also at greater risk of developing mouth cancer, particularly if they smoke or drink alcohol.

Risk factors

Patients should be made aware of the main factors that have been shown to increase the risk of developing mouth cancer. These include the use of tobacco products and the consumption of alcohol, which both contain nitrosamines that are known to cause cancer. As mentioned previously, HPV infection is also associated with oral cancer and it has been strongly suggested that the HPV 16 strain is the main driver of HPV related oral cancers [5].

Most people are aware that prolonged exposure to the sun can increase the risk of skin cancer but they may not realise that this includes lip cancer. In addition, chronic irritation to the lining of the mouth may heighten the risk of developing mouth cancer and a diet that is low in fruit and vegetables containing antioxidants has also been implicated [6].

Signs and symptoms

Worryingly, it has been suggested that 75% of adults are unable to identify the major indications of mouth cancer.1 To increase the chances of fighting this disease, patients should perform self-checks between dental visits. Certainly, it is critically important to ensure that all patients are aware of the following signs and symptoms:

• Ulcers or sores that do not heal within 14 days
• White or red patches inside the mouth
• A growth or lump on the lip or in the mouth, throat or neck
• Pain, numbness or bleeding in the mouth area
• Difficulty chewing or swallowing
• Persistent pain in the throat or ear
• Change in voice or speech problems

Patients should be instructed to use a mirror to check the inside of the mouth, tongue and space under the tongue for any abnormalities. They should run their finger around the mouth and tongue to check for any lumps and feel the neck for anything unusual [7]. It should also be stressed that if anything abnormal is noticed or if the patient has any doubts at all, they should seek medical attention immediately.

Author:

Deborah received her Bachelor of Science degree in Dental Hygiene and Psychology from the University of Bridgeport and her Master of Science degree from the University of Missouri - Kansas City. She has 18-years clinical experience in dental hygiene in the United States and Saudi Arabia with an emphasis in periodontal therapy. Currently, Deborah is the Director of Professional and Clinical Affairs for Waterpik, Inc.

Deborah says: “As part of Mouth Cancer Action Month, Waterpik is supporting dental professionals with high-quality oral healthcare products that improve lives. Healthy habits play an important part in reducing the risks of mouth cancer and as part of an effective oral health routine, the Waterpik Water Flosser provides patients a gentle but efficient way to floss.

“Using water pressure and pulsation technology, this outstanding dental adjunct improves oral health by removing plaque from between the teeth and below the gum line where traditional brushing and flossing cannot reach [8].” For more information about Waterpik products, go to www.waterpik.co.uk.

References:

1] Oral Health Foundation: The State of Mouth Cancer UK Report 2018/2019. https://www.dentalhealth.org/Handlers/Download.ashx?IDMF=21dc592b-d4e7-4fb2-98a9-50f06bed71aa [Accessed 19th August 2019]

2] Paterick T.E et al. Improving health outcomes through patient education and partnership with patients. Proc (Bayl Univ Med Cent). 2017 Jan; 30(1): 112–113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242136/ [Accessed 19th August 2019]

3] NHS. Overview: Mouth cancer. https://www.nhs.uk/conditions/mouth-cancer/ [Accessed 19th August 2019]

4] The Oral Cancer Foundation. Resources. Oral Malignant Melanoma. https://oralcancerfoundation.org/facts/rare/oral-malignant-melanoma/ [Accessed 19th August 2019]

5] Sugiyama M. et al. Detection of human papillomavirus-16 and HPV-18 DNA in normal, dysplastic and malignant oral epithelium. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2003; 95(5): 594-600. https://www.sciencedirect.com/science/article/pii/S1079210402916379 [Accessed 19th August 2019]

6] Lucile Packard Children’s Hospital. Oral and Oropharyngeal Cancers. https://www.stanfordchildrens.org/en/topic/default?id=oral-cancer-85-P00716 [Accessed 19th August 2019]

7] The Royal Marsden Foundation NHS Trust. Oral Cancer. https://www.royalmarsden.nhs.uk/your-care/cancer-types/head-and-neck/oral-cancer [Accessed 19th August 2019]

8] Goyal C.R et al. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use. J. Clin. Dent. 2013; 24(2) 37-42. https://www.ncbi.nlm.nih.gov/pubmed/24282867 [Accessed 19th August 2019]

 

Photo by Anna Sastre on Unsplash