Ask The Dentist is a series of columns written by Dr. Mady to answer your questions about dentistry and oral health!
Dear Dr. Mady: My cousin in Nebraska went to see her dentist and during a routine oral cancer screening, he found that she was in the beginning stages of cancer in the mouth. She said that he used a scope-type light and that it was something new. Do dentists in Canada use this scope? I have been smoking for twenty years and would like to have my mouth checked. - Bernice in Colchester
Dear Bernice: Dentists and hygienists today do generally screen for oral cancer when you go for your dental examinations. This is almost always done even though your dentist may not talk about it if there are no abnormal findings.
This type of examination is completed via visual exam by your dentist and by palpation using the fingers. Most practitioners today can tell just from this if there are any lumps, bumps, tissue textures, or colors that don’t belong in your mouth. Dentists are considered the first line of defense in detection of oral carcinomas.
If they find something that does not appear normal, they will create a differential diagnosis of all the potential things that could be occurring and then most likely refer you to an oral surgeon for a biopsy if they don’t do it themselves. The Biopsy is sent to a center where it is examined under microscope and through other tests including histological dye tests. Subsequently, your dental health care professional receives the results of the biopsy and contacts you. You will then be advised if further treatment may be required.
The key, as always, is early detection. This is in stone and will never change.
It is important to routinely examine all patients for diseases of the mouth, especially those at risk of oral cancer. When I say “at risk”, I mean those individuals with a family history of the disease, those who smoke and/or drink regularly, or those who use chewing tobacco. Unfortunately, these are not the only causes of cancer in the mouth and surrounding areas, but they come to mind immediately when the topic is opened for discussion.
Ignorance is the most common cause of cancers going undetected, but by educating yourself through discussions with your physician, dentist and local health unit, one can learn about a healthy lifestyle that will help limit the chances.
In addition to the normal methods for examination that I spoke of above, there is a new instrument available now that dentists can use as an aid to determine if biopsy of oral tissues is indicated or not. It has been available in the United States for some time and has been available for health practitioners in Canada since June 2006.
A device of this type eliminates the “wait and see” predicament and helps answer the question: biopsy or no biopsy?
The process involves what is known as autofluorescence. In detecting oral cancer, fluorescence deals with the shining of a certain wavelength of visible light onto suspected tissues in the mouth as an aid in determining if any of the tissues are abnormal. It is designed to bridge the gap between visible clinical exam and actual biopsy because examining alone can only tell the differences between color and surface texture of an abnormal area versus a normal one.
On the contrary, when a light of specific wavelength induces autofluorescence, the difference between normal and diseased tissues can be seen by changes in its fluorescent pattern, as the light hits the tissues. The pattern changes if the biological makeup of the area has changed. So, basically unhealthy tissues look different under this light than healthy. This type of test provides a clear indication of whether or not an invasive biopsy is warranted.
Many dentists today are beginning to learn about and use this technology and it serves as an advantage with detection, diagnosis and treatment of oral cancers. Current studies estimate that approximately 25% percent of all diagnosed cases of oral cancers are fatal. This is a serious problem and the worst thing about it is that diagnosis is often made when the cancer has progressed too far.