One of our many classes during the brutal second semester of second year is oral pathology. Oral pathology is the class in dental school where you learn about everything that can go wrong in the mouth from pizza burns to much more serious diseases. The textbook we use is Oral & Maxillofacial Pathology, 2nd edition, by Neville, published by Saunders. If you are interested in some good bedtime stories then you can pick up a copy from amazon.
One of the obvious things we learn about is oral cancer. Some fun facts about oral cancer:
- Oral cancer accounts for less than 3% of all cancers in the U.S.
- BUT: Oral cancer is the 6th most common cancer in males and 12th most common in the ladies (in the US)
- In other countries, like India for example it is the MOST common cancer.
- ~94% of all oral malignancies are squamous cell carcinoma (SCC)
- ~34,000 new cases are diagnosed each year and ~8,000 Americans die of this disease each year and out of those 34,000 diagnosed only 50% of them will still be alive in 5 years.
- The majority of oral cancers come from three sources: tobacco use, alcohol use and the human papilloma virus (HPV 16).
The appearance of SCC can be seen at some of the following sites:
University of Iowa Oral Pathology
Most often oral SCC presents on the lateral border of the tongue in smokers and the prevalence increases with age. Black males are affected most followed by white males. Which makes this article very interesting.
In class this past week we had the opportunity to put away our notes, sit back, and listen to Eva Grayzel, who is a Stage IV oral cancer survivor. She was also diagnosed at age 33. This does not fit the normal stereotype of male smoker in their 60′s. Her story was inspirational and helped me and most of my classmates to put into perspective the importance of being a health care provider. Eva had showed the lesion to two dentists and two oral surgeons over the period of 9 months and no one ever thought anything of it. Maybe it was because she did not fit the stereotype of oral cancer, maybe it was because her biopsies were given to a general pathologist and not an oral pathologist, who knows. She went undiagnosed for almost a year before it became so bad that it had become stage IV, which has a mortality rate of 50% or less, one of the lowest five-year survival rates among the major types of cancer, including breast, skin, testis, prostate, uterus, and urinary bladder cancers. In school I have been found getting caught up in facts and statistics and numbers, simply because this is what we are supposed to learn. For a test we are supposed to know that most oral cancers occur in black males who smoke and are in their 60′s. Otherwise we get the answer wrong. We get caught up in this information and listening to Eva helped me realize better how important it is to be a good clinician and to look at the patient as a person, not a number or a dollar sign.
One of Eva’s points was that every patient that comes through your office should be screened for oral cancer. It only takes a few minutes and your patient will appreciate the free screening. In our generation of dentists it is important to be able to provide not only oral health but total body health as it relates to the head and neck region. We don’t necessarily have to treat or diagnose the health problem, but we should be aware of what is not normal and take the proper precautions (like referring to a physician or oral surgeon, etc.). So what are Eva’s steps for a proper oral screening?
It gets a bit risque, but here goes:
SEXtet screening: Six Steps to a Thorough Oral Cancer Screening
- Neck Caress
- Lip & Cheek Roll
- Palate Tickle
- Double Digit Probe
- Tongue ‘n Gauze
- Tonsil Ahhhhhh
For more information you can visit www.sextetscreening.org
Eva also has her own website and travels nationally to speak to groups about oral cancer. The take home message from the lecture we received, and one that we should all remember is that oral cancer IS VERY CURABLE WITH EARLY DETECTION. This means to catch the lesion in a pre-cancerous state, like dysplasia. Anything abnormal on the tongue or oral mucosa could easily be biopsied with a small brush (there are brush biopsy kits available) and sent to your local oral pathologist. If you are a student, then commit to the simple 6 step test (there are also other tests endorsed by the ADA – I’ve seen them in JADA) and if you’re a current dentist and don’t offer this service than please seriously consider offering it. Don’t let one of you patients go through what Eva had to. Treat your patient as a human first and the money will follow, but I guarantee that your patients health will be more valuable.
