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The Business of Saving Lives: Dentistry and The Fight Against Oral Cancer

You may think of yourself as being in the business of cavities and crowns, but you’re also in the business of saving lives. April marks Oral Cancer Awareness Month. Instances of oral cancer are on the rise, and dentists play a pivotal role in its early detection. Since most people see their dentists more often than any other healthcare provider, you are positioned to be the first to spot the disease.
Sarah Handzel, BSN, RN
PUBLISHED: Tuesday, April 11, 2017
 
A NEW CANCER RISK FACTOR
Infection with human papillomavirus (HPV) has recently emerged as a major risk factor for the development of oropharyngeal cancers.7 Most commonly, HPV infection is associated with squamous cell carcinoma of the tonsils and the base of the tongue2. In the U.S., HPV infection has been shown to account for more than 60 percent of all oropharyngeal cancers1.
 
There is now some debate over whether HPV infection could be a causative factor in the development of oral cavity squamous cell carcinomas. HPV colonization within the oral cavity can be identified in 2-8 percent of the healthy adult population, but studies suggest these infections typically resolve within a year.4 In individuals engaging in frequent high-risk oral sexual behavior, or those with weakened immune systems, HPV infections are more likely to persist and may be a critical factor for the development of HPV-related cancers4.
 
In the body, HPV infects basil epithelial cells and can remain latent within these tissues. Research has shown HPV can infect gingival tissue, invading the periodontal pocket where basil cells are exposed to the enviornment4. In individuals with periodontitis, chronic inflammation leads to increased basil cell proliferation, which in turn leads to higher viral loads in the oral cavity and saliva. There is some speculation that this process could create a reservoir within the oral cavity, leading to sustained HPV infection and the development of oral cancers4.
 
However, there is still no clear association between HPV infection and the development of oral cavity squamous cell carcinoma4. As Hill says, “At the end of the day, the ubiquitousness of this virus is unlike anything that we’ve had to deal with in the dental community ever before.”
 
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WHY IS IT SO HARD TO DETECT ORAL CANCERS EARLY?
Unfortunately, oral and oropharyngeal cancers often remain undetected until later stages, when treatment is difficult and often unsuccessful. For individuals with cancer that is diagnosed after metastasis, the five-year relative survival rate is about 38 percent.7 This rate hasn’t improved substantially for many years.
 
Traditionally, dentists have used oral examinations, including visual inspection and palpation, to screen for oral cancers, but it is possible for smaller, more subtle lesions to remain undetected, especially in the oropharyngeal region.
 
 “It’s a difficult area to examine. Dentists are formally trained to examine both the inside and outside of the mouth, and part of the examination of the inside of the mouth would be the base of the tongue and the tonsils,” Schmidt says. “However, it’s hard to see those areas – sometimes directly examining the base of the tongue and the tonsils can be difficult.”
 
Unfortunately, many dentists do not encounter patients until the cancer has metastasized.
 
“Many of the oropharyngeal cancers that are related to HPV present with metastasis to the neck,” Schmidt says. “These patients will often present with a lymph node in the neck that the dentist can palpate. They might not show anything in the mouth.”
 
“Dentists are very good at picking up oral cancers early, but for certain populations – and it depends on access to care – some of these cancers are picked up later,” says Schmidt.
 
Typically, elderly, low-income, or uninsured patients present with later staged cancers because of economic factors and other barriers to regular dental screening and care.8,9
 
Story continues on the next page.


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