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Oral Cancer Examination

What is Oral Cancer?
Oral cancer is cancer that forms in the tissues of the oral cavity (the mouth and lips) or the oropharynx (the part of the throat that begins at the back of the mouth).
Each year in the United States, approximately 35,000 men and women are diagnosed with oral cancer and about 7,600 people die from the disease. Of those newly diagnosed individuals, only slightly more than 50% will be alive in 5 years. Why is the death rate for oral cancer so high? It is because mouth cancer is often diagnosed when it is already in a later stage of development, making it more difficult to treat. Often it is discovered after the cancer has metastasized (spread) to another location in the body, such as the lymph nodes of the neck. Once the cancer has metastasized, the prognosis is much worse than if it had been caught when it was a small localized cancer in the oral cavity or throat.
Oral cancer, if caught early, can be treated successfully. However, the difficulty in discovering these cancers at an early stage lies in the fact that people often have no pain or symptoms associated with oral cancer and do not notice small lesions forming in their mouth or throat. Therefore, it is extremely important to learn the risk factors and warning signs of mouth cancer and to see a dentist regularly for examinations and oral cancer screenings. Seeing a dentist on a regular basis for oral cancer screenings can literally save your life!
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Risk Factors
There are certain risk factors which make some individuals more likely to develop oral cancer than others. Understanding these causative factors will help contribute to the prevention of this disease. The risk factors include:
Tobacco is considered the primary cause of oral cancer in individuals over 50. Cigarettes, pipes, cigars, and smokeless tobacco (chewing tobacco) are all causes of oral cancer. Heavy smokers who have smoked for many years have the highest risk of developing mouth cancer. The risk is even greater for tobacco users who also consume a lot of alcohol, because the two act synergistically. People who both smoke and drink are at a 15 times greater risk of developing mouth cancer than those who do not.
Heavy alcohol use:
Heavy drinkers are more likely to develop oral cancer than those who do not consume alcohol. The more alcohol a person drinks, the greater their risk. The risk of developing oral cancer increases even more if a person drinks alcohol and uses tobacco products.
HPV infection:
The human papilloma virus, or HPV, is a very common sexually transmitted virus which affects nearly 40 million Americans. One strain of HPV in particular, HPV16, has been definitely implicated in oral cancer. HPV16 and HPV18 are also the causative agents of more than 90% of all cases of cervical cancer. Oral cancer caused by HPV16 most often occurs at the base of the tongue, the back of the throat, in the soft palate, or in the tonsils.
Throughout history, the majority of people diagnosed with oral cancer have been over 50 years old. Recently, however, this demographic has been changing and mouth cancers are now occurring more frequently in younger populations due to HPV. In fact, the Oral Cancer Foundation believes, based on published data, that HPV16 may be the primary cause of mouth cancer in individuals under the age of 50.

Ultraviolet radiation from sun exposure is a causative agent in cancers of the lip as well as other skin cancers. Using a lotion or lip balm with sunscreen can reduce your risk of developing cancer. The risk of developing cancer of the lip increases if a person smokes.
Some studies suggest that people who eat diets that are lacking in fruits and vegetables may have an increased risk of developing mouth cancer.
Betel nut use:
Although uncommon in the United States, chewing betel nut is fairly common in Asia. Betel nut is a type of palm seed wrapped with a betel leaf and often mixed with sweeteners, spices, and tobacco. Chewing betel nut causes oral cancer, and the risk increases if a person also drinks alcohol and uses tobacco.
Age is often considered a risk factor for oral cancer because historically, the majority of individuals diagnosed with oral cancer have been over the age of 50. This may be due to a biological process that takes place in aging cells that allows for the malignant transformation of the cells. Or, perhaps, our immune systems begin to diminish with age, making us more vulnerable to developing cancer. Recent scientific data, however, has shown that the fastest growing segment of the oral cancer population are non smokers under the age of 50. This paradigm shift is thought to be due to the increasing incidence of HPV among younger populations.

Oral cancer occurs more often in the black population than the white population. Furthermore, survival statistics are poorer with a 33% 5 year survival rate for black people and a 55% 5 year survival rate for white people. While there may or may not be a genetic component to this, lifestyle choices remain the biggest cause.
The more risk factors that an individual has, the greater the chance that oral cancer will develop. However, most people with risk factors for oral cancer never end up developing the disease.
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Signs and Symptoms
The survival rate for oral cancer is low because, in its early and treatable stages, oral cancer can go unnoticed. It can be painless, and physical changes to the oral tissues can be so slight that an individual may not even notice they are there. Your dentist, however, can see most cases of oral cancer while they are small and in their earliest stages. Therefore, it is extremely important to see your dentist regularly for examinations and oral cancer screenings. It is also important to learn some of the warning signs and symptoms of oral cancer and to see a dentist or physician if these symptoms develop:
  • A white or red patch of tissue in the mouth
  • A sore or ulcer in the mouth or on the lip that does not heal
  • Bleeding in the mouth
  • Loose teeth
  • A lump or mass in the neck or mouth
  • Difficulty swallowing, speaking, or chewing
  • A wart-like mass in the mouth
  • A persistent earache
  • Hoarseness in the throat which lasts for a long time
  • Numbness in the oral/facial region, including the lower lip and chin

If you have any of these signs or symptoms, you should notify your dentist or physician as soon as possible.  Although these symptoms are most likely not from oral cancer, it is still very important to have them checked by a professional.

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Abnormal Mouth Lesions
The following is a series of atypical mouth lesions. Some of these lesions were normal variations of anatomy or benign growths, while others were more serious oral pathologies.
If you or anyone you know presents with any unusual or abnormal lesions in the mouth, see a dentist immediately for an oral cancer screening.

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The Oral Cancer Examination
All patients should receive an oral cancer examination every 3-6 months, depending upon family history and risk factors. An oral cancer examination should include the following ten parameters:
  1. Full dental/medical history
  2. Family history of cancer or abnormal tissue growth
  3. Digital panoramic x-ray to examine the jaws and sinuses
  4. Intra-oral digital photograph of any abnormal lesion found in and around the lips, cheeks, tongue, and throat
  5. Limited periodontal exam to ascertain the presence of chronic oral inflammation
  6. Examination of the teeth for any sharp or broken edges that may contribute to pre-cancerous lesions forming in response to chronic irritation
  7. Examination of abnormal occlusal relationships that may contribute to chronic irritation of soft tissues
  8. Detailed description of the color, shape, and size of any suspicious intra oral lesions
  9. ADA approved velscope analysis of any suspected pre-cancerous lesion
  10. Lifestyle analysis for any factors that commonly contribute to oral cancer

Dr. Kurpis performing an oral cancer examination
Suspicious patches, bumps, and lesions are sometimes difficult to diagnose and may require a biopsy so that the cells of the abnormal tissues can be studied under a microscope. Although classic pre-cancerous and cancerous lesions have typical signs and symptoms, atypical lesions may also be pre-cancerous. Any patch, bump, or lesion that is abnormal in appearance should be examined by a dentist familiar with oral pathology as quickly as possible.
We can help!
Please schedule an appointment at the Kurpis Center for Advanced Dentistry for a comprehensive oral cancer examination. Remember, early detection saves lives!
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