Why Is Early Detection of Oral Cancer Important?

The global impact of the COVID-19 pandemic has been significant, leading to the suspension of routine dental care in March 2020. Many dental offices limited their services to phone consultations and remote triaging, resulting in longer waiting times for patients.

This reduced capacity in dental clinics due to new operating procedures highlights the importance of oral cancer screening and early detection, as discussed in this article.

Risk Factors Associated with Oral Cancer

While oral cancer is a significant health concern, many cases are preventable. Smoking and alcohol use are the primary risk factors associated with oral cancer and are present in 90% of cases. The first step in assessing a patient’s risk of oral cancer should involve identifying their specific risk factors. 

This information, combined with considerations such as caries, periodontal health, and tooth wear risk, can help determine an appropriate recall interval for follow-up.

Importance of Oral Cancer Screening

Ninety percent of oral cancer cases are squamous cell carcinomas, with the tongue being the most commonly affected site, followed by the tonsils, floor of the mouth, lower lip, and lateral borders of the tongue. Routine dental examinations should include a thorough screening for oral cancer, as potentially malignant changes in the oral cavity often precede the development of oral cancer. 

In addition to a visual and tactile examination of the oral mucosa, a comprehensive risk assessment should be conducted, including questions about the patient’s alcohol and tobacco use.

A systematic approach is crucial during oral cancer screenings to ensure that all relevant areas are examined accurately. Dentists can create their own screening protocol as long as it covers all essential regions.

Key areas to examine during oral cancer screenings include:

• Buccal mucosa
• Lateral borders of the tongue
• Dorsal and ventral surfaces of the tongue
• Lips and vestibule
• Hard and soft palate
• Lymph nodes
• Gingivae
• Oropharynx

Signs and Symptoms

Leukoplakia and erythroplakia are the first clinically noticeable abnormalities that may indicate a potentially malignant condition. Leukoplakia appears as a white plaque with variable risk, and other potential causes should be ruled out before treatment. 

Erythroplakia is a red lesion with a high propensity for malignancy, and it cannot be clinically or pathologically associated with another condition.

Signs that warrant an immediate referral for further evaluation (two-week wait) include:

• Ulceration or unexplained swelling in the oral cavity lasting more than three weeks
• Red, white, or mixed red and white patches in the oral mucosa indicative of erythroplakia or erythroleukoplakia lasting more than three weeks
• Pain or difficulty swallowing lasting more than three weeks
• Sore throat lasting more than three weeks
• Hoarseness persisting for more than three weeks
• Unexplained tooth movement not related to periodontal disease
• Numbness or nerve injury of unknown origin

Conclusion

Early detection of oral cancer is crucial to improving treatment outcomes. Given that alcohol and smoking account for 90% of cases, dental professionals should assess each patient’s risk during routine examinations. 

A systematic approach, along with comprehensive screenings covering essential regions such as the tongue, lips, and oral mucosa, is essential for detecting potentially malignant conditions. Clinically noticeable abnormalities like leukoplakia and erythroplakia warrant immediate referral for further evaluation. 

Dental practitioners play a crucial role in raising awareness, educating patients about associated risks, and participating in awareness campaigns. Prioritizing oral cancer screenings can enhance early intervention and preventive efforts, ultimately safeguarding oral health.