Oral Cancer Screening

Your dentist is the first line of defence in screening for oral cancer. It is important that you get checked at least once a year and preferably every 6 months- this is one of the few life threatening moments in dentistry and in itself, a good enough reason to go for a check up.

We (dentists) are all taught at dental school to screen every single patient who walks through the door for an examination. If you only go to the dentist when you have pain, toothache or when you need treatment then most of the time you may miss out on this cancer screening process, as the dentist is likely to be most concerned about fixing your immediate problem.

Dentists need to be on top of this, but so do patients; this is no place for ignorance or complacency.

Do all Dentists Screen? Does your Dentist Check for Oral Cancer?

Well they should. Unfortunately with the pressures of general practice and more patients crammed in every day- this can sometimes be overlooked. You need to know what an oral cancer screening looks and feels like in order to know if it is being carried out. I now often actually say to my patients, ‘I am going to screen you for oral cancer by looking for any lumps, bumps, ulcers etc.’ but I never used to- I just did it out of habit until someone said,’What are you doing?’

How is Oral Cancer Diagnosed?

If the examination reveals something suspect, or an abnormal area that needs to be investigated further, the dentist will tell you. Most of the time, they will offer some , correct any factors that could be causing the ‘abnormal’ appearance, such as an ill- fitting denture or a fractured tooth and arrange to see you again in say two weeks to see if things have healed up. I always show the patient in the mirror where the ‘abnormal’ spot is and get them to keep an eye on it.

A picture with an intra-oral camera can help for comparative purposes to see if the area is healing and shrinking.

While a dentist may suspect a particular lesion is malignant, there’s no way to tell by looking alone, since benign and malignant lesions may look identical to the naked eye.

Most of the time, the lesion has largely disappeared when the patient returns. If it hasn’t or if the area looks particularly cancerous, then referral for a tissue biopsy of that area is needed. This will confirm or rule out the presence of any pre-cancerous or cancerous cells.

If you need a biopsy, the doctor or dentist performing it will be able to answer any questions you may have such as:

  • Will it hurt?
  • How is it done?
  • How long will it take to heal?
  • How much tissue is going to be removed?
  • Will it be sore afterwards? How should I look after it?
  • When will I know the results?
  • What if it is bad news?

The diagnosis of oral cancer is made when a malignant biopsy is confirmed. This is when the cancer cells are seen to have broken the basement membrane of the epithelium under the microscope i.e. there is evidence of the abnormal cells invading surrounding tissues. In this case, the lesion will grow and spread if not dealt with to other areas of your mouth and body.

At this point you will be referred to a specialist team for further tests to evaluate the stage and size of the tumour and to plan for the management of the condition as it develops.

For more information see this useful website; provided by a government resource.

Is there any New Technology for Screening for Oral Cancer?

To improve the survival rate, we need to be able to diagnose oral cancer earlier- and improvements in technology are making this possible.

Visualizing the lesion earlier improves the chances of successful cancer treatment.

Two new products receiving media attention are:

  • Velscope. This handheld machine shows the difference between normal and abnormal tissue. It is able to highlight abnormal cells (potentially cancerous) long before you are able to see any changes with the naked eye. A green colour suggests healthy normal tissue; dark patches suggest something may be going on. This screening may be performed by your dentist or hygienist and investigated further if anything suspect is found.
  • Oral CDX brush test (and associated lab test). This is like a pap smear for your mouth in a non-invasive way (unlike a biopsy). It’s to check for dysplasia (pre-cancer) or cancer in abnormal looking tissues. It is a great way to painlessly test any red or white patches or areas highlighted by the Velscope screening.