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Killing mouth cancer: How Dentists Save Lives

Patients see dentists more regularly than almost any other health care worker. Dentists take careful medical histories and are trained to recognise many health related conditions. They are an excellent source for referring patients who are at risk from medically related problems. Regular check ups with dentists could save lives.

For example, cancer in the mouth and throat afflicts 3,500 people each year in the UK, killing approximately half this number. There are about 45 per one million new cases per year in England, and twice that number in Scotland. Survival rates in the UK are under 50% and dentists are committed to improving this figure. Mouth cancer is a serious problem around the world, particularly in developing countries, and the incidence is rising in many countries in Western Europe.

Recently, The Faculty of General Dental Practitioners (UK) headed a joint meeting at The Royal College of Surgeons of England with the AngloAsian Odontological Group and the Eastman Academy to study the growing threat posed by mouth cancer, and how dentists can help in its early detection. Topics for discussion included the global scale of the oral cancer problem, the scientific reasons for why cancer kills, and the measures which dentists can take to help patients prevent it. This edition is devoted to the topics of that meeting.

Mouth cancer is highly preventable. Oral Cancer is predominantly due to high consumption of tobacco and alcohol, and aspects of deprivation, in particular a diet lacking vitamins A and C. A genetic predisposition has been suggested, but much more relevant research on this is required. About three quarters of all cases could be prevented by elimination of tobacco use and moderation in alcohol. A healthy diet with adequate fresh fruit and vegetables also helps to reduce risk. Dentists see a large proportion of the population regularly and can detect health risks and do give advice on how to reduce the risk of oral and other cancers, as well as the common dental diseases. Dentists also examine the mouth thoroughly and can detect any early tell tale signs, such as an ulcer which will not heal. Patients, however, must help their dentists to help them.

Small and early mouth cancers are highly curable but many patients present for diagnosis and treatment at a late stage – some 60% of patients at present are visiting their dentists with lesions over 2cm in diameter. As a result they are faced with the possibility of coping with the debilitating consequences of late treatment, which may include difficulties with speaking, chewing and swallowing, as well as facial disfigurement. Regular dental check ups are therefore especially important for the over 40s – and in particular for those who use tobacco in any form, and drink regularly.

The meeting examined how dentists could screen patients more effectively in order to detect mouth cancer at an earlier stage. Screening for oral cancer in order to detect small, and potentially malignant lesions, is at an early stage of development, but is a key priority for the dental profession. On average, the five year survival rate is anticipated to rise from the current 40% to 80% when mouth cancer is detected early. The meeting also considered the ways in which dentists should discuss the problem with patients, and how to help patients cope with its psychological effects.

It is a shame that there is so much media hype about regular visits to dentists not being useful. Making a visit to a dentist is more than just a dental check up. It is a visit to a health care professional. That professional could save a life. Saving lives is the standard for dentistry

Raj Raja Rayan OBE
Dean, Faculty of General Dental Practitioners (UK)