The Role of GDPs
Marc Bou Haidar
BDS, MSc Oral Med, MSc Oral Imp,
CHE Oral Surg, CHE Anat Phys, Oral Max Fac Dip
Mouth cancer, also known as oral cancer, is a lesion or tumour that develops on the tongue, floor of the mouth, lip, gums. Less commonly tumours can develop in the salivary glands, throat and pharynx. Presentation of mouth cancer may vary from white, red, dark patches to ulcers, lumps, bleeding mouth, loose teeth, problems or pain with swallowing, a lump in the neck and even earache.
A cancer arising in the epithelial tissue of the skin or of the lining of the internal organs is called a carcinoma. Squamous cell carcinoma is the most common type of mouth cancer, accounting for nine out of 10 cases. Squamous cells are found in many places around the body, including the inside of the mouth and under the skin.
The two leading mouth cancer causes are smoking and alcohol; both alcohol and tobacco are carcinogenic damaging the cell DNA and leading to cancer. Other risk factors are also present mainly chewing tobacco or other smokeless tobacco products, betel nuts with or without tobacco, human papilloma virus, ultraviolet light, chronic candida infection, immunosuppression, syphilis, poor diet and poor oral hygiene.
Mouth cancer, can spread directly via the surrounding tissues or via the lymphatic system to other organs leading to metastatic oral cancer. Most cases of oral cancer develop in older adults, mainly men, who are in between 50-74 of age, however young adult cases are not uncommon especially with the increase of smoking habit and alcohol intake.
There are three main treatment options for oral cancer and most of the time they are used in combinations; surgery, radiotherapy and chemotherapy. Several factors are considered to influence the prognosis of oral cancer:
· Early versus late diagnosis: early diagnosis is by far the most important factor affecting outcome, a complete cure is often possible with combination of surgery radiotherapy and chemotherapy.
· Extent of the disease: Several clinical staging systems exist; the most widely used is the TNM classification.
· Site: in general terms lesions at the back of the mouth have a poorer prognosis, in contrast, cancers of the lip have the best prognosis as they are frequently detected at an early stage and are less aggressive tumours.
· Pathology: the value of histological grading of mouth cancers is controversial due to potential errors in sampling tumours.
· Age: with increasing age, patients are less able to cope with extensive surgery and/or radiotherapy.
The role of the general dental practitioner is very important in early diagnosis of oral cancer, the oral cavity should be thoroughly examined; although teeth might be the main concern of the visit of the patient, it is judicious to examine the whole oral cavity starting from the skin on the outside and looking at the floor of the mouth, palate, tongue and the cheeks not forgetting the throat. This is followed by palpation of the neck looking for lumps in the anterior and posterior neck. Moderate consumption of alcohol is advisable and cessation of smoking is essential. An important consideration in prevention of oral disease is the frequency with which patients should attend for a recall visit. Traditionally a 6 monthly basis visit was advised. However, it is recognised that patients differ in their risk of oral disease, and as oral health improves, a “one-size” fits all recall interval is no longer appropriate.
Look beyond teeth; see what’s inside the mouth!