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Jason Wong: Mouth Cancer

Jason Wong is a dentist and Partner at the Maltings Dental Practice. He is the Deputy Chief Dental Officer for England, and gained an MBE for services to Oral health and Dentistry in 2020. Here he talks to Dental Review in his role as Clinical Ambassador on behalf of the Mouth Cancer Foundation.

It is essential to understand that cancer can happen in the mouth and throat. Mouth cancer is the 6th most common cancer in the world, but thankfully it’s much less common in the UK. Even so, around 8,700 people are diagnosed with mouth cancer each year in the UK, which is about one in every 50 cancers diagnosed.

More than two in three cases of mouth cancer develop in adults over the age of 55. Only one in eight (12.5%) happen in people younger than 50. Men are more likely to get mouth cancer than women. This may be because, on average, men tend to drink more alcohol than women.

Despite this trend for sufferers to be over 55, mouth cancer can develop in younger adults. We believe these cancers result from the human papilloma virus (HPV) infections which are thought to be linked with oral sex activities. Yet, however the cancer is caused, there is no blame attached, just the advice that the best outcome results from early diagnosis and treatment.

We suggest regular examinations in the dental surgery and self-examinations once a month at home, which takes as little as two minutes and might save your life. You’ll need a mirror and a good light source.
1. Look at your whole face. Can you see any new swellings? Has anything about your skin changed recently? Have your moles got larger or started to itch or bleed?
2. Run your fingers under your jaw and feel along the large muscle either side of your neck using the balls of your fingers. Are there any swellings? Does everything feel the same on both sides?
3. Use your index, middle finger and thumb to feel the inside of your mouth. Pull your upper lip upwards and lower lip downwards. Look for any sores or changes in colour.
4. Use your thumb and forefinger to examine your gums while feeling for anything unusual.
5. Open your mouth and use your finger to pull your cheeks away one side at a time, looking for any red or white patches. Check for ulcers or lumps, feel for any unexpected tenderness. Your tongue can also prove useful in this examination process for probing soft tissues.
6. Gently pull out your tongue to look for any swellings, ulcers, or unexpected changes in colour. Examine the underside of your tongue by lifting it up towards the roof of your mouth.
7. And finally, tilt back your head and open your mouth to examine the roof of your mouth. You are still looking for changes to colour or texture, or ulcers that don’t heal. Then lift your tongue to look underneath. After your visual examination gently press your finger along the floor of your mouth and under your tongue, feeling for lumps, swellings or ulcers.

Is this examination worthwhile? Let’s look at the numbers. Someone is lost to mouth cancer every three hours. As I said earlier, over 8,700 people are diagnosed with this terrible disease every year in the UK alone, and more than 2,700 die from it. If you see something that concerns you during your oral examination, report it to your dentist or GP. Early diagnosis could be the difference between life, severe facial disfiguration, and death.

40% of cancers in general are caused by lifestyle and environmental issues, but with mouth cancers this rises to between 80-91%, especially for smokers. If someone is smoking and also drinking alcohol this makes it 30% more likely they will contract the disease. I cannot urge people enough to be alert to the risks and to get checked out.

We have recently concluded an audit in our dental practice. Out of 83 soft tissue lesions, 33 were what we call two week waits, which means alarm bells were ringing and they had to be seen by a specialist within two weeks. 70% of these had biopsies and three malignancies were found. The patients didn’t even know they had an issue, just slight red patches.

If the disease is picked up early enough the 5-year survival rate is 80%. If the cancer is allowed to reach stage 4, that drops to just 15%. This is not just about the mouth, the cancer might have metastasised from elsewhere, but it pays to be aware of the symptoms and alert to them.

As with so much else in the health system there is a massive correlation between the incidence of mouth cancer and areas of health care deprivation, including poor oral hygiene regimes in the home. To a degree, mouth cancer is preventable through effective oral health practices and sensible lifestyle choices, but the cancer is more prevalent where caries and gum disease are rife.

The general trend towards mouth cancer is on the rise. This might be due to HPV or people choosing to have multiple sexual partners. It might be due to environmental factors, or we might just be getting better at spotting it. The blame could be put at the door of more people drinking alcohol at home rather than in social situations, or the rise in the popularity of alcopops.

We know more women are choosing to smoke, and some vapes are actively toxic; so, add that to the difficulty in finding an NHS dentist and you can see why self-examination is becoming essential. This is one of the reasons I am talking to the general public and my peers through Dental Review.

Yes, the dental profession must continue to monitor for mouth cancer symptoms during regular check-ups and routine examinations, but even during COVID lockdowns dental professionals were still spotting and referring cancer patients, meaning there is a very real and positive story to share. Not all is gloom and negative results. But there is a caveat to this.

The NHS is very much an indicator of health inequalities. We can almost use NHS health services to map deprivations in the UK, especially dental health. As long as its cheaper to fill an empty stomach with biscuits and sugary foods – and effective oral hygiene practices are ignored – these health inequalities will continue.

If the choice is between cigarettes and toothpaste, I can only urge people to choose toothpaste. The alternatives are potentially life-changing, and not in a good way.

The Mouth Cancer Foundation’s 18th Mouth Cancer 10 KM Awareness Walk is taking place in London’s Hyde Park on Saturday 23rd September 2023. The ‘Walk from Home’ series starts on Sunday 1st October until Thursday 30th November. It is easy to register for all our walks.

To discover all the information you need about joining the walk and sponsorship, visit the official walk website.

Go to https://register.mouthcancerwalk.org/?mc_cid=4381a5f767&mc_eid=c64e5ce919.

See the original article here: Dental Industry Review