Dr Phillip Palmer, October 2016 

In the last seven years, two people in my life have been personally impacted by oral cancers. The two cases had very different outcomes, as we will see below.

Being a dentist has made me take a much closer look at oral cancer, and the vital role that we play - and can play - as dentists in preventing tragic outcomes.

Case #1.

About seven years ago, a 32 year old, long-time friend of my kids’ was diagnosed with tongue cancer. It was late stage and had spread to lymph glands.

She had healthy teeth and most of her tongue removed. She had practically all of her salivary glands removed. She had to re-learn to talk. She had to re-learn to eat and swallow. She had to use aids to give her saliva.

She passed away about 15 extremely painful months later.

She had been recently married, with a successful career and a great attitude towards life… she had her whole life ahead of her.

Case #2

Earlier this year my niece’s 40-year-old husband, living in a small town in Idaho, in the United States, called me in a panic.  His local dentist had seen something on his tongue that he thought was suspicious, and had referred him to an oral surgeon for proper diagnosis. That oral surgeon thought it was a tongue cancer, and referred him to a surgeon in a bigger town, Seattle, who specialised in oral cancers. “What will they do?” “What’s the prognosis of tongue cancer?” I helped as much as I could from the other side of the world.

A week later, the surgeon in Seattle performed the surgery to excise the cancer, removing a couple of adjacent salivary glands (for pathology testing). A few days later, my niece’s husband got the call. The cancer had been completely contained, and there was no spread, whatsoever.

Who can detect early stage mouth cancers?

Oral cancer isn’t like skin cancer… there can be no self-assessment and monitoring in early stages, which is when it needs to be found!

A GP doctor doesn’t see anywhere near the number of mouths that a GP dentist sees, and can’t be expected to have the same knowledge about the oral cavity and environment as a dentist.

The general dentist, as a rule, is the only one capable of looking thoroughly in all areas of the mouth, in a way that can be conducive to screening for early signs of oral cancer.

The dentist’s view of oral cancer

I remember learning little about oral cancer at university (yes…it was a long time ago!). It certainly wasn’t something that was given emphasis as far as our role was concerned. And yet, there is probably no greater health risk where we can help our patients as dentists.

In the last few years I have been routinely (informally) asking dentists I meet if they perform an oral cancer screening on their patients… the results have been mixed.

Most say they do “if they remember” or “if the patient meets the risk profile”, which typically means men over 50, smokers or tobacco chewers, heavy drinkers…. (All things that the two cases I have been involved with were not!). And of the ones that do an oral cancer screening, few will actually tell the patients that they are doing it at the time, “because they don’t want to freak them out”.

Some things to take away from these two cases are: 

• The incidence of oral cancers is rising, both on a total and a per capita basis.  
• While there is a higher risk profile (see above), oral cancers can appear in the young and old, the smokers and non-smokers, men and women.

The general public know that they should be getting regular prostate checks, mammograms, glaucoma screenings, skin cancer checks…Why is it that no one promotes oral cancer screenings? Why is it that when dentists are challenged to make patients visit regularly, they are hiding or underplaying this vital reason why the patients should come? Aren’t we, as dentists, looking for ways to add value to the ‘check-up’ visit to the practice?

By overtly telling patients that you do an oral cancer screening at every maintenance visit:

• You would be able to catch oral cancers in an early, easier-treated stage and improve mortality rates.
• You would give your patients another reason to come in regularly (currently, many of them think it is “only for a cleaning”).

It should be a win-win!

If those aren’t enough reasons (carrots) to do our duty, then there’s always the stick…

How long will it be before someone sues their dentist for not detecting an oral cancer? And what do we think the settlement amount will be? A few thousand dollars?…or several million!

Some oral cancer facts

According to the Oral Cancer Foundation (US-based), one out of four oral, head and neck cancers, particularly in patients over the age of 50, are detected in patients who do not smoke or drink alcohol; obviously all patients, regardless of their history, need to be screened at least once a year by their physician or dentist.

Current research indicates that HPV-positive disease is rapidly changing these ratios and age groups. Younger, non-smoking patients under the age of 50 are the fastest growing segment of the oral cancer population.

Unfortunately, this increase in the number or oral, head and neck cancers found in men and women in their 20s and 30s is rapidly replacing those caused by tobacco, since the use of tobacco products has declined in the US every year for more than a decade.

During this same period of time, the incidence rate of OSCC has actually increased. Opportunistic screening of ALL patients must become the norm if the death rate is to be reduced. As in many cancers, symptoms and history will often lead the dentist/physician to not only the presence of a cancer, but also the likely site of the lesion. Tobacco/alcohol lesions tend to favor the anterior tongue and mouth, and HPV positive lesions tend to favor the posterior oral cavity.

Dr Phillip Palmer ran a successful dental practice in the Sydney CBD for 34 years.

He is the founder and director of Prime Practice P/L, which is the industry-leading practice management company in Australia and New Zealand, helping dentists manage and grow their businesses at any stage of their career. He is also a director of Practice sales Search P/L, Australia’s leading dental practice brokerage firm.

Phillip has a deep understanding of all the different management, financial and professional issues that face dentists and is regarded as Australasia’s leading expert on the business of dentistry.

Watch Dr Phillip Palmer show you how easy it is to do an oral cancer health check here.