Sometimes a routine visual and clinical exam, done in a dentist’s chair, can save a life.
Dr. Naida Henriquez, director of dentistry at Open Door Family Medical Center, and her team routinely perform a comprehensive oral exam and tobacco screening with patients as young as 12 years old. The exam itself, done as part of a routine dental checkup, typically takes no more than several minutes.
It was not too long ago that a patient came to see her after noticing a spot on the side of his tongue.
“He told us that he had a history of heavy smoking and drinking, both risk factors for oral cancer,” said Dr. Henriquez. “Based on our observations, combined with his history, we immediately sent him to the Westchester Medical Center for a biopsy. A biopsy gives a lesion a proper name. A lot of times, it’s benign.”
But, in this case, it wasn’t. The biopsy revealed that the lesion was cancerous and within two weeks the patient had surgery for its removal. Additional treatment began soon after.
“I think it’s fair to say that in finding the suspicious tissue, we literally saved his life,” she said.
Oral cancer – cancer forming in the mouth, lips, cheeks, gums, tongue, hard palate, tonsils and throat – accounts for about three percent of all cancers diagnosed annually in the U.S., or about 53,000 new cases. As with most cancer, early intervention is key. When discovered early, the five-year relative survival rate is over 85 percent. This drops to about 40 percent when it is discovered in its later stages. An estimated 11,000 Americans die annually and others, found to have later stages of the disease, may require more radical surgery and treatment.
“We are the gatekeepers in terms of finding what looks normal and what doesn’t,” said Dr. Ben Geisler, Open Door’s Ossining dental site director. Using their eyes and their hands, Dr. Geisler and his team do a comprehensive oral exam that includes a complete head and neck exam. They palpate the lymph nodes and exam the borders of the tongue, the floor of the mouth and the throat.
The dental team also gives dental clearance prior to any cancer treatment. This involves cleaning up any oral issues – such as periodontal disease, tooth decay or extractions – to reduce the risk of any future infection. Tobacco screenings include asking patients if they are current or former smokers, whether they smoke pipes or cigarettes, chew tobacco, or use e-cigarettes or vape. Patients are educated on the dangers of tobacco use and supported in helping them quit.
Other risk factors for oral cancer include heavy alcohol use, excessive exposure to the sun, HPV (human papillomavirus), and a weakened immune system. Oral cancer is more prevalent among those older than 50, but can affect those much younger. Statistically, males are at higher risk than females.
Common signs of oral cancer include a lip or mouth sore that doesn’t heal, a white or reddish patch on the inside of the mouth, loose teeth, a growth or lump inside the mouth, difficult or painful swallowing, and mouth or ear pain.
According to Dr. Henriquez, while the visual and clinical exams pick up most suspicious lesions, she and her team have been exploring new technologies – digital intraoral cameras, oral brush biopsies, natural tissue fluorescence lighting, and saliva precursors – that help find abnormal tissue that may go unnoticed by the naked eye.
“We see a lot of 5, 10 and 15-year oral cancer survivors who are doing fine,” said Dr. Henriquez. “For the exam, which is part of the routine checkup, we do everything in the chair so the patient never has to go anywhere else. It only takes a few minutes and it can save your life.”