Frequently Asked Questions

What a dental professional might say to him/herself:

• I only do teeth and gums.
• I may only see one or two cases in my entire career, so I don’t bother.
• It takes too much time.
• I haven’t performed an oral cancer screening in decades; I’m not comfortable with it.

Dentists and dental hygienists in the U.S. are NOT required to take regular continuing education (CE) in early detection of oral cancer. In other words, your dentist or dental hygienist, 20 years out of school, may not have any current knowledge about oral cancer and it’s early signs or be proficient in performing an oral cancer screening. Don’t be embarrassed to ask the receptionist when you make your appointment about the recent continuing education of your dental provider.

Patient demand for screenings will inspire dentists and dental hygienists to choose continuing education courses in oral cancer. If enough patients request oral cancer screenings, the dentist and dental hygienist will want to meet their needs, providing the best care possible.

Article Link from the Journal of the Canadian Dental Association:

Understanding from the dental professional’s perspective why the patients are not receiving an oral cancer screening.

Make a note of the date you first noticed it. Take a photo of it with your digital camera or mobile phone.

Sores, white spots and rough areas should heal within a couple of weeks. After two weeks, if it is still present, schedule an appointment with a dentist or an oral surgeon. If the problem persists, you may want to research a dentist certified in Oral Medicine (AAOM.com). A white spot in a never-smoker has a high index of suspicion.

If a sore or abnormal tissue doesn’t resolve within TWO WEEKS, it warrants a closer look. A screening device which through fluorescence technology shows abnormal blood flow to an area suggesting a problem, may help you make your decision faster. However, a screening device is an adjunct and doesn’t give you definitive answers. The gold standard is a biopsy. The mouth heals quickly. Peace of mind is invaluable. Early detection is key. Oral cancer is very survivable if detected early.

The biopsy will be more proficiently evaluated by an oral pathologist vs a general pathologist. Find an oral pathologist in your area at American Academy of Oral and Maxillofacial Pathologists.

Dysplasia is a pre-cancerous condition. Mild dysplasia should be monitored with scrutiny. ‘Moderate’ and ‘Severe’ dysplasia should be surgically removed and monitored regularly for tissue changes.

Lichen Planus and Erosive Lichen Planus is an inflammatory condition of unknown cause and most are benign without risk of transformation to pre-cancer or cancer. However, the erosive form tends to have an increased risk of developing into dysplasia.

Leukoplakia needs to be followed and can range from a benign hyperkeratotic to a dysplasia. 20% of Leukoplakias in never-smokers are pre-cancer.

Hyperkeratosis appears white and is usually the result of a chronic trauma like chronic cheek biting or tobacco chewing. Stopping these habits will usually cause a reversal of the hyperkeratosis, but it is gradual. A burn from hot coffee or pizza will usually result in a painful ulcer but should resolve in 2 weeks.

Bottom line: ANYTHING THAT HAS NOT IMPROVED AFTER 2 WEEKS WARRANTS A CLOSER LOOK!

When you call an office for your next appointment, ask:

• ‘Do the dental professionals provide oral cancer screenings?’
• ‘Which dental hygienist has the most current education in early detection of oral cancer?’
• ‘In the last two years, has the dentist updated his/her knowledge about oral cancer ?’

Refer to the article linked below to help you make a decision. Studies show the most effective oral cancer screening is a visual and tactile exam that includes palpation of the neck. An adjunct device (Identafi, Oral ID, VELscope) can help identify differences in diseased and healthy tissue. These adjunct devices do not provide a definitive diagnosis; that can only be made through a scalpel biopsy. An adjunct device needs to be used regularly for proficiency.  Something to consider is if a practice is charging to use a device ($20-$125) and some patients don’t want to pay for it, the practice may not be using it as much as necessary to be proficient. The OCF believes the use of adjunctive devices is fine as long as “a proper visual and tactile screening is done first.”

Professional evaluations of the oral cancer screening devices article link from the Oral Cancer Foundation website.

Studies are ongoing on HPV and oral cancer. We know that it is transmitted sexually, but not in all cases. We know that the majority of our population is infected but most don’t even know it and shed the virus within two years. Currently, the only way to reduce the epidemic rise in oral cancer due to HPV is the Gardasil Vaccination. This article explains the connection: Oral Cancer Foundation website.
See also: CNN report on HPV

My favorite entertaining video on HPV. Click here.

In medical terms, there is no such thing as “throat cancer”. Internally, the ‘throat’ includes three parts of the pharynx: Oropharynx, Nasopharynx and Laryngopharynx. These cancers can affect the throat and fall into the category of Head and Neck Cancer.

Oral Cancer includes the tongue, cheeks, floor of mouth, roof of mouth and lips.

Oropharyngeal Cancer is at the back of throat starting behind the tonsils and extending to the base of the tongue, Nasopharyngeal Cancer is a small box like chamber which lies just behind the nose and is part of the pharynx (throat)

Laryngeal Cancer affects the voice box.

Salivary Gland Cancer is a rare type of cancer which accounts for only 2% of head and neck cancers. They arise in one of the three paired major glands around the mouth or from one of the many tiny minor salivary glands found throughout the mouth. Most of these tumors are not cancerous, but left untreated, they may grow very large. Some of the tumors arising in salivary glands are cancerous, especially those that start in the smaller glands. The first sign of a salivary gland tumor may be a persistent lump on the roof of the mouth, in the lips, in the neck under the jawline or on the side of the face under the earlobe.

Thyroid Cancer is found at the front of the neck and sits close to the skin, just below the Adam’s apple. The thyroid is an endocrine gland. Cancer arising in this gland is different (type, risk factors, age, gender distribution etc.) than the bulk of head and neck cancers that arise from the tissues lining the mouth, pharynx and larynx.

These cancer can affect the mouth and throat but do not fall into the Head and Neck cancer category:

• Brain Cancer
• Cancer of the ears and eyes
• Esophageal Cancer is the area connecting the stomach to the throat.
• Lung Cancer, well, we all know about that.

Most head and neck cancers are called squamous cell carcinoma, arising from lining tissue (similar to skin). While the esophagus and lung cancers are not found in the head and neck region, they are often discussed along with H&N cancer since the same lining tissue that starts in the mouth continues all the way down into the esophagus and lungs.

Oral and Maxillofacial Pathologists have specific and extensive training in diseases of the oral and maxillofacial region. As a result, these specialists provide the most accurate, efficient and cost-effective diagnostic services for oral biopsies.

Their previous dental training allows them to better connect the microscopic features of a biopsy specimen with the unique clinical setting of every patient, further improving the accuracy of each final diagnosis,. In addition, having the same background of dental training makes it easier for oral pathologists to more specifically communicate with dentists or dental specialists regarding the diagnosis and management of a particular oral disease or lesion.

Oral pathologists use a different classification scheme than general pathologists.

Research the name of the pathologist on the Oral and Maxillofacial Pathology website. General pathologists use the term ‘low or high grade’ for dysplasia. Oral pathologists use the terms mild, moderate, severe, in-situ (stated in increasing amounts) and invasive carcinoma.

Dysplasia is a pre-cancerous condition. Mild dysplasia should be monitored with scrutiny. Moderate and Severe should be surgically removed and monitored for change frequently.

Lichen Planus and Erosive Lichen Planus is an inflammatory condition of unknown cause and most are benign without risk of transformation to pre-cancer or cancer. However, the erosive form tends to have an increased risk of developing into dysplasia.

Leukoplakia needs to be followed and can range from a benign hyperkeratosis to a dysplasia. Hyperkeratosis appears white and is usually the result of a chronic trauma like chronic cheek biting or tobacco chewing. Stopping these habits will usually cause a reversal of the hyperkeratosis, but it is gradual. A burn from hot coffee or pizza will usually result in a painful ulcer but should resolve in 2 weeks.

Bottom line: ANYTHING THAT HAS NOT IMPROVED AFTER 2 WEEKS WARRANTS A CLOSER LOOK!