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Sharing the value of a home care regimen with patients

Johnson & Johnson is delighted to bring you this article, with the aim of supporting the ongoing CPD needs of dental healthcare professionals in improving and maintaining the oral health of their patients.

This article is equivalent to one hour of Enhanced CPD. To provide feedback on this article, please contact dentalcpd@its.jnj.com

Aims and objectives

The aim of this article is to explore evidence linking lifestyle factors to oral cancer, and offer practical guidance for the dental health care professional to pass on to at-risk patients.

On completing this CPD session, the reader will:

• Understand what constitutes oral cancer

• Understand the prevalence of oral cancer in the UK

• Understand the signs and symptoms of oral cancer

• Understand the preventable risk factors linked to the development of oral cancer

• Understand how to raise patient awareness of oral cancer.

Raising awareness of oral cancer

This article explores evidence linking lifestyle factors to oral cancer, and offers practical guidance for the dental health care professional to pass on to at-risk patients.

Oral cancer has been described as referring, ‘[…] to cancers of the lip, tongue, gingivae, floor of the mouth, palate (hard and soft), maxilla, vestibule and retromolar area up to the anterior pillar of the fauces.’1

It has been reported by Crossman and colleagues (2016) that the incidence of oral cancer is increasing in the UK, with more than 6,500 new cases diagnosed each year.2

It has further been projected that, between 2014 and 2035, the incidence rates for oral cancer will rise by 33% in the UK, equating to 20 cases for every 100,000 people. Figures also suggest that one in 75 men and one in 150 women in the UK will be diagnosed with oral cancer at some time during their life.3

Signs and symptoms

At its earliest stages, oral cancer may be difficult to spot, however there are a number of signs and symptoms that are indicative of a possible problem, as enumerated by the Mouth Cancer Foundation:4

• A sore or ulcer in the mouth that does not heal within three weeks

• A lump or overgrowth of tissue anywhere in the mouth

• A white or red patch on the gums, tongue, or lining of the mouth

• Difficulty in swallowing

• Difficulty in chewing or moving the jaw or tongue

• Numbness of the tongue or other area of the mouth

• A feeling that something is caught in the throat

• A chronic sore throat or voice change (hoarseness) that persists for more than six weeks, particularly in smokers over 50 years old and heavy drinkers

• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable

• Neck swelling present for more than three weeks

• Unexplained tooth mobility persisting for more than three weeks

• Persistent nasal (especially unilateral) obstruction, particularly associated with mucus (clear, purulent, or bloody) discharge causing difficulty breathing through nose

• Unexplained, persistent earache.

Risk factors

While the causes of oral cancer remain unknown, there are a number of factors that increase a person’s risk of developing such a malignancy.5 These include but are not limited to:

• Drinking alcohol – associated with 30% of oral cancers3,5

• Smoking tobacco in the form of cigarettes, pipes and cigars – linked to 65% of oral cancer cases3,5

• Chewing smokeless tobacco or betel quid3 (also known as gutkha, it is a pre-packaged mixture of areca nut, tobacco, slaked lime, the food additive catechu, and flavourings6)

• Human papilloma virus (HPV) infection – infections are linked to oral cancer in 13% of cases.3,5

Raising awareness among patients

Since some of the risk factors are clearly avoidable,3 eliminating or minimising them would seem key to the prevention of oral cancer. It therefore follows that patients need to be educated as to what they can do to help minimise their likelihood of developing such cancers.

For example, it is important for patients to know that avoiding tobacco in any form, as well as betel (areca) nut, will reduce the risks. In addition, in terms of alcohol consumption, people should be advised to drink no more than two to three units a day (in the case of women) and no more than three to four (in the case of men). Consuming five portions of fruit and vegetables a day is also beneficial. It is additionally crucial that people minimise their risk of contracting HPV by practising safe sex. Lastly, when the sun's UV rays are strong, it is advisable to stay in the shade, and to protect the lips with sunscreen and wear a wide-brimmed hat.7

 

The clinical indications of a potential malignancy in the oral cavity have already been mentioned, however it may also be worthwhile to share those possible signs with patients in an easy-to-understand way so that they, too, can look out for the warning signs. Patients may be advised to get to know what is normal for their mouth, and if they spot anything out of the ordinary – such as red or white patches, an ulcer or lump in the mouth for three or more weeks – they should let their DHCP, GP or other health worker know.7

It is also imperative that patients understand the importance of attending the dentist for regular check-ups, as this is something that DHCPs are trained to look for and recognise during every examination, can easily see parts of the mouth they cannot.7

The importance of all these messages cannot be overemphasised. As Scully and Kirby (2014) wrote: ‘There is an urgent need for action against mouth cancer. Although patients’ quality of life during and after treatment has steadily improved, survival rates from the disease have barely increased.’7

‘The stage at which mouth cancer is diag¬nosed has a significant effect on overall survival. When the cancer is still confined to the primary site and small (stage I, less than 2 cm), nearly 90% of people survive for at least two years. But six out of ten mouth cancers are found at a late stage (stages III and IV, greater than 4 cm or with spread), and this means a much lower survival rate (at stage IV, around 45% of people survive for at least two years) and high treatment-related morbidity in those who survive.’7

Action and reaction

West and colleagues (2006) stated: ‘Mouth cancer is largely preventable by avoiding known risk factors and national and international guidelines stress the importance of early detection. The main risk factors are smoking and high levels of alcohol consumption, the two acting synergistically. Use of oral tobacco (chewing tobacco and tobacco mixtures such as paan) has also been linked to oral cancers.’8

Their study indicated that there is work still to be done in relation to raising the public’s awareness as to the risk factors: ‘In particular, smokers need to be better educated about their personal risks and the early signs of disease. GPs and dentists could play a much greater role in this. This could be incorporated into routine advice about smoking and oral tobacco use.’8

What’s more, as written by Decuseara and colleagues (2011): ‘Dentists are qualified to opportunistically screen for oral cancer and to provide preventive advice and counselling interventions during routine examinations. It is vital that dentists have accurate knowledge about oral cancer to identify individuals at risk, examine the mouth to document tissue changes and provide appropriate interventions, thus potentially contributing to the reduction in oral cancer incidence, morbidity and mortality.’9

QUESTIONS: 

References

  1. MacCarthy D et al. Oral and neck examination for early detection of oral cancer – a practical guide. Journal of the Irish Dental Association 2011: 57(4): 195-199

  2. Crossman T et al. Role of general practice in the diagnosis of oral cancer. British Journal of Oral and Maxillofacial Surgery 2016; 54: 208-212

  3. Available at: http://www.cancerresearchuk.org/health-professional/cancer-statistics/st.... Accessed 15 November 2017

  4. Available at: http://www.mouthcancerfoundation.org/get-info/learn-about. Accessed 16 November 2017

  5. Available at: http://www.cancerresearchuk.org/about-cancer/mouth-cancer/risks-causes. Accessed 15 November 2017

  6. Available at: http://www.cancerresearchuk.org/about-cancer/mouth-cancer/risks-causes. Accessed 15 November 2017

  7. Joshi PS et al. Gutkha addiction: nicotine dependence or a conditioned reflex? Journal of International Oral Health 2015; 7(Suppl 2): 45-47

  8. West R et al. Awareness of mouth caner in Great Britain. BDJ 2006; 200(3): 167-169

  9. Decuseara G et al. Oral cancer: knowledge, practices and opinions of dentists in Ireland. Journal of the Irish Dental Association 2011: 57(4): 209-214