Babe Ruth

What do the following people all have in common:

• Larry Hagman (played J.R. Ewing on Dallas)
• Beatle George Harrison
• British author Aldous Huxley (he wrote Brave New World)
• Babe Ruth
• TV Producer Aaron Spelling
• Jack Klugmam (from the Odd Couple)

The answer is that all of these people – and hundreds of thousands of others – all were diagnosed with oral cancer that either directly or indirectly led to their deaths.

There is a perception amongst the public that dentists only deal with teeth. It is only natural to think that.  After all, the prefix “dent” means “tooth” in Latin.  So a dentist must only deal with teeth, right?

But that characterization could not be farther from the truth.  As a practicing dentist, I diagnose or aid in the identification of many pathologies and conditions beyond those which affect the teeth.  These include: obstructive sleep apnea, tonsillitis, acute maxillary sinusitis, Type II diabetes, Sjogrens Syndrome, AIDs, tonsilloliths, oral cancer, and numerous others.  So when your dentist is doing an exam at your six month cleaning, he/she is evaluating and analyzing areas that go way beyond your teeth and gums.

Many Americans see their dentist and hygienist more frequently than their primary care physician.  Where I practice in Orange, CT, the hygienists and I collectively spend close to an hour in rather intimate contact with a patient every six months. If there is going to be a pathology with an impact on the oral cavity, we will be the ones to catch it.

We all know who shot J.R. Ewing. We don’t all know that Larry Hagman died from a form of oral cancer that dentists frequently identify. Courtesy of Getty Images.

Oral cancer is actually a blanket term for multiple types of cancer that can affect strutures in oral cavity.  Oral cancer can affect the salivary glands, the tongue, the larynx, the floor of the mouth, the roof of the mouth, the inside of the cheek, the angle of the lower jaw, and other areas.  It can vary in its presentation from being visible on the soft tissue only to only being detectable with dental x-rays.  Some forms are benign and slow growing and will generally not produce a fatality; other forms are aggressive and can metastasize, leading to a poor long term prognosis.

Screening for oral cancer is a routine part of your six month recall exam.  Dental x-rays are taken at appropriate intervals based upon your risk for dental decay (cavities); if there is a suspiscious finding suggestive of oral cancer of the hard tissue then additional x-rays may be warranted.  Next, the entire oral cavity, including the tongue is inspected.  Our hygienists will typically have the patient stick out their tongue so that the right, left, top and bottom of the tongue can be analyzed.  The floor of the mouth underneath the tongue is also looked at.

Some vendors promote a screening device that purpotedly assists in the identification of soft tissue abnormalities.  An example is Velscope and another is Vizilite.   While it is beyond the scope of this blog post to comment on the efficacy of each technique, the acceptance and use of these techniques is not uniform across the United States.

As a practicing dentist who has identified two cases of oral cancer in my career, I can’t stress the importance of regular cleanings and exams. Remember, even though “dent” means tooth in Latin, your dentist and hygienist are looking at many other things besides your teeth!