ODA FEATURE
Oral Cancer:
THE CAUSE OF DEATH OF A YOUNG DENTIST By: Parul Dua Makkar, DDS
Oral cancer is a preventable form of cancer. We as dentists are on the forefront of its detection and diagnosis. My aim today is to revisit this cancer and bring awareness of being diligent in our screening process during examinations - talking to our patients, educating them about risk factors, discussing the need for Human Papilloma Virus (HPV) vaccinations, helping them do self-examinations, and opting for biopsies for persistent symptomatic or nonsymptomatic lesions. After the loss of my younger and only brother, Dr. Manu Dua, due to squamous cell carcinoma (SSC) of the tongue, this cause has become dear to me on a professional and personal level. Manu himself was also a dentist. He was only 33 years old at the time of his diagnosis, and 34 at the time of his death. In his own words he felt like “the shoemaker whose own shoe was broken.”1 My hope is that cancer screenings are conducted more frequently, and we dental professionals pay closer attention to the signs and symptoms of oral cancer. When we treat our patients, a high-quality comprehensive exam is a minimum requirement. Oral surgeon, Dr. Cathy Hung, advises that we must examine the buccal mucosa, palate, tongue, floor of mouth, and oropharynx. We should also check the neck for asymmetry or induration of lymph nodes2. We must revisit the health history, family history, and ask about social habits. Ask questions regarding alcohol use, smoking, vaping, and use of chewing tobacco. Vaping is especially important to discuss with our younger patients. A recent study in Minnesota found that vaping causes an increased level of DNA-damaging chemicals such as formaldehyde, acrolein, and methylglyoxal in the saliva3 and with continued use over long periods of time increases risk factors substantially. Devices like a VELscope can also be used to help screen for any mucosal abnormalities and 38 journal | March/April 2022
then sent for biopsies if a lesion seems suspicious of cancer. Head and neck cancers are the 6th most common cancers and of those, oral cancer cases are 48% of head and neck cancer cases8. Ninety percent of all head and neck cancers are caused by SSC. Even with recent advancements, the 5-year survival rate is only 50% in most countries8. The etiology of oral cancer is multifactorial and certain factors put patients at higher risk. Some risk factors for oral cancer include:9 • Tobacco use • Alcohol use • Betel quid/ nut use • Gender (males are more at risk) • Sunlight exposure (for lip cancer) • Increased age • Previous cancer • Family history of oral cancer • Poor nutrition (diet low in fruits and vegetables) • Human papillomavirus (HPV) • Weakened immune system • Genetic syndromes: Fanconi anemia and dyskeratosis congenita • Poor oral health • Lichen planus • Graft-versus-host disease HPV is the cause of a host of carcinomas such as cervical, oropharyngeal, vulvar, penile, and anal cancers4. It is the most common sexually transmitted virus and infection in the United States6. There are over 200 strains of HPV but only nine are
Dr. Manu Dua in his clinic
carcinogenic. HPV strains 16 and 18 are the leading causes of oropharyngeal cancers8. These cancers are usually found in the tonsils, the base of the tongue, throat, and a very small number are found in the front of the mouth6. Thus, we must also discuss the need for HPV vaccinations for our young people when it is the most beneficial. According to the Centers of Disease Control and Prevention (CDC) guidelines, the ideal age for HPV vaccination is between 11-12 years old, but can be administered as early as nine. It is not recommended over the age of 265. Most HPV is cleared by our bodies, but for unknown reasons, some are more inclined to progress to oral cancer. According to the Oral Cancer Foundation, some of the signs and symptoms of oral cancer may include:6 • An ulcer or sore that does not heal within 2-3 weeks • A red, white, or black discoloration on the soft tissues in the mouth