Medical Edge Newspaper Column

Screening for Oral Cancer Should Be Done With Regular Dental Visits

May 1, 2009
Dear Mayo Clinic:
My periodontist recommends an annual screening for oral cancer using a rinse that one keeps in the mouth for a few minutes. It is supposed to reveal any abnormalities of the mouth and tongue. Unfortunately, the screening is quite costly. What can you tell me about this? It is worthwhile?

Answer:
Your dental care provider is correct that oral cancer screening is important. A screening should be done every time you see a dentist or periodontist.

The standard oral cancer screen is a visual inspection of all areas inside the mouth: the floor, back and roof of the mouth, inside of the cheeks, the gums, the tongue and the tonsils. Your dentist or hygienist will do this inspection, looking for abnormal white or red patches that could become cancerous. Other oral cancer symptoms include:

• Bleeding in the mouth or a sore that doesn't heal
• A lump or thickening of the skin or lining of your mouth
• Loose teeth
• Problems wearing dentures
• Tongue pain
• Jaw pain or stiffness
• Difficult or painful chewing
• Difficult or painful swallowing
• Sore throat

The rinse you mention supplements the unaided visual inspection. The patient swishes a fluorescent, vinegar-like rinse in the mouth. Then, the dentist uses a specialized light to look in the mouth. The rinse and the light make it easier to see abnormalities in the mouth.

Studies on this technique published in major dental journals in 2006 and 2007 found that the rinse did make it easier to see lesions, which could be precancerous cells, small cuts or even canker sores. The results did not indicate that this screening improved patient care or outcomes. That is, the care providers using this approach didn't find precancerous or cancerous lesions that would have been missed with an unaided visual inspection. So far, the research indicates that an unaided visual exam done by an experienced dental care provider is still the most effective and cost-effective screening tool.

Nearly 23,000 Americans were diagnosed with oral cancer in 2008. While the incidence is smaller than many other cancers, it's often a deadly disease. The five-year survival rate is at best 50 percent.

Tobacco use and heavy alcohol use are risk factors for oral cancer. Age is a factor, too. Most oral cancers occur in people over age 45. Sun exposure is a risk factor for oral cancer that presents on the lips.

Increasingly, younger adults who aren't smokers or heavy drinkers are developing oral cancer. This demographic has a high incidence of the sexually transmitted human papillomavirus (HPV), which has been linked to an increased risk of oral cancer.

Every time you see your dental care provider, make sure he or she looks for signs of oral cancer. Like all cancers, oral cancer is most successfully treated when it is caught early.

— Phillip Sheridan, D.D.S., Department of Dental Specialties, Mayo Clinic, Rochester, Minn.