Thursday April 5, 2007 

Dear Dr. Mady: My cousin in Nebraska went to see her dentist and during a routine oral cancer screening, he found that she was in the beginning stages of cancer in the mouth. She said that he used a scope-type light and that it was something new. Do dentists in Canada use this scope because I have been smoking for twenty years and would like to have my mouth checked—Bernice in Colchester


Dear Bernice: Dentists and hygienists today do generally screen for oral cancer when you go for your dental examinations. This is almost always done even though your dentist may not talk about it if there are no abnormal findings. This type of examination is completed via visual exam by your dentist and by palpation using the fingers. Most practitioners today can tell just from this if there are any lumps, bumps, or tissue textures and colors that don’t belong in your mouth. Dentists are considered the first line of defense in detection of oral carcinomas.

If they find something that does not appear normal, they will create a differential diagnosis of all the potential things that could be occurring and then most likely refer you to an oral surgeon for a biopsy if they don’t do it themselves. The Biopsy is sent to a center where it is examined under microscope and through other various tests including histological dye tests. Subsequently, your dental health care professional receives the results of the biopsy and contacts you.

You will then be advised that either everything came back normal, or further treatment may be required. The key, as always, is early detection. This is in stone and will never change. I have been a long –time advocate of early detection of oral cancers, but sometimes individuals will not seek treatment or advice until it is too late or until the cancer is extremely obvious.

I feel that it is important to routinely examine all patients for diseases of the mouth, especially those at risk of oral cancer. When I say “at risk”, I mean those individuals with a family history of the disease, those who smoke and/or drink regularly or who use chewing tobacco. Unfortunately these are not the only causes of cancer in the mouth and surrounding areas, but they come to mind immediately when the topic is opened for discussion.

Ignorance is the most common cause of cancers going undetected, but by educating yourself through discussions with your physician, dentist and local health unit, one can learn about a healthy lifestyle that will help limit the chances of becoming sick. If you are telling me that you have smoked for twenty years it is simple. I am going to tell you that you have to quit NOW and yes, you should be evaluated by your dentist for oral cancer by whatever technique it is that they use.

In addition to the normal methods for examination that I spoke of above, there is a new instrument available now that dentists can use as an aid to determine if biopsy of oral tissues is indicated or not. It has been available in the United States for some time and has been available for health practitioners in Canada since June, 2006. A device of this type eliminates the “wait and see” predicament and helps answer the question, biopsy or no biopsy?

The process involves what is known as autofluorescence. In detecting oral cancer, fluorescence deals with the shining of a certain wavelength of visible light onto suspected tissues in the mouth as an aid in determining if any of the tissues are in fact abnormal. It is designed to bridge the gap between visible clinical exam and actual biopsy because examining alone can only tell the differences between color and surface texture of an abnormal area versus a normal one.

On the contrary, when a light of specific wavelength induces autofluorescence, the difference between normal and diseased tissues can be seen by changes in its fluorescent pattern, as the light hits the tissues. The pattern changes if the biological makeup of the area has changed. So, basically unhealthy tissues look different under this light than healthy, and the look under the light is known as the tissue’s optical signature. This type of test provides a clear indication of whether or not an invasive biopsy is warranted.            

Many dentists today are beginning to learn about and use this technology and I personally feel that it will promote a great advantage with respect to the detection, diagnosis and treatment of oral cancers. Current studies estimate that approximately twenty-five percent of all diagnosed cases of oral cancers result in death. This is a serious problem and the worst thing about it is that diagnosis is often made when the cancer has progressed too far.

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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