Staying alert to oral cancer symptoms

Staying alert to oral cancer symptoms

You are a dental technician. A person visits your laboratory with a broken lower bi-lateral partial denture. Evidently, the fracture is a result of the patient trimming it themselves to make it more comfortable. Do you simply repair it or does it light a concern at the back of your mind?

Have they been trimming it because it was pressing on a lesion? If so, they need to be strongly encouraged to visit a dentist immediately. That lesion could be an oral cancer and potentially deadly.

Such awareness of oral cancer should apply not just to dental technicians and clinical dental technicians, but all DCPs – this was brought up at an All-Party Parliamentary Group (APPG) for Dentistry meeting some weeks ago.

It seems that while many countries across the world are seeing a decline in the incidence of oral cancers, the reverse is true in the UK (and Japan).

Professor Saman Warnakulasuriya, Professor of Oral Medicine and Experimental Oral Pathology at King’s College London Dental Institute, is researching the development of chairside and genetic markers for diagnosis of pre-cancer and oral cancer and examining lifestyle risks for oral cancer in different populations. He was the principal investigator of an epidemiological study on oral cancer in young people, the largest reported so far from Europe. He presented his findings to the APPG.

The general risk factors are:

• Men more than women, although women are catching up in the numbers of cases being diagnosed.

• The over 40s, although the younger generations are not exempt.

• Those smoking 20 to 30 cigarettes a day.

• Those who consume excessive amounts of alcohol. The high incidence of cancer related also to the habit of chewing tobacco or substances like betel nut were noted to be related to specific communities.

Professor Warnakulasuriya said that the majority of individuals believe that a soft tissue lesion is actually some form of simple ulcer or never notice the deterioration of an area of soft tissue, unless it becomes painful. Even when pain is noticed, the individual may often put up with the pain until, out of necessity, they finally visit a dentist. Such a delay in seeking appropriate advice allows the lesion to develop beyond the more easily treatable pre-cancerous stage. The result may be radical surgical intervention and a noticeably reduced chance of survival. 

Professor Warnakulasuriya requested that the GDC should require all dentists to do mandatory CPD on recognition of the symptoms of oral cancers. But should such a requirement relate only to dentists? The DTA representative at the meeting, Tony Griffin, made the point that all DCPs need to have access to NHS learning resources to assist in their support to patients in the early recognition of pre-cancerous symptoms. Dental hygienists and therapists see many patients and have the opportunity to identify potentially cancerous lesions. Likewise, dental technicians and clinical dental technicians need to be constantly aware of the possible link between a patient’s denture wearing problem and a potential oral cancer symptom.

However, it’s not just a question of knowledge. Returning to the scenario I outlined at the beginning, do you as a dental technician have the necessary communication skills to encourage a patient to visit a dentist urgently without alarming them? A similar question could be asked of all DCPs.

 You may find patient information leaflets about mouth cancer – Dental Health Information Leaflets – from the British Dental Health Foundation useful. You can also download (for printing) official Mouth Cancer Foundation leaflets from www.rdoc.org.uk. There’s also more information on the NHS Choices website: www.nhs.uk/conditions/cancer-of-the-mouth/Pages/Introduction.aspx).