Mouth cancers going undiagnosed during Covid-19 crisis, dentists warn

A high number of mouth cancers could be missed, or found late because people are unable, or less likely to go to their dentist during the Covid-19 crisis, dentists now warn.

Dentists are attempting to catch up with cases, but Professor Leo Stassen, an oral surgeon who specialises in treating cancers, warns that late-diagnosis will become a nationwide issue as the State emerges from lockdown.

“I think it’s going to be a big problem,” he said, noting that dentists were helping to discover between 150 and 180 cancers each year before the Covid-19 pandemic struck.

Prof Stassen, president of the Irish Dental Association (IDA), identified two cases of mouth cancer during the lockdown when he was sent photographs of two concerned patients, but many patients are ignoring symptoms.

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Rather than seek medical treatment, some people are wrongly concerned about the risks of coronavirus when they go to the dentist, or unaware emergency dental services have continued to operate throughout.

Mouth cancers are relatively common. Cases caught early have about a 90 per cent survival rate and may only require surgery, while cases caught at a later stage of development have a survival rate of between 5 and 10 per cent.

Prof Stassen also noted that his and other clinics are now facing “drastically reduced” patient capacity due to social distancing measures and patients will have to be prioritised based on their case files.

As well as those with unchecked symptoms, patients who have recovered from the disease must be checked to ensure they do not develop a second case.

In the past 10-15 years, the management of oral cancer has greatly improved but, he said, “Covid-19 has knocked us off our perch”.

Limerick dentist Dr Robert Bowe was alarmed to discover two mouth cancers in the first three weeks after he returned to regular practice; before that he had seen just one case in eight years.

“People had to put things off although we were open for emergencies and people could travel out of their areas and come to the dentist, but generally people were avoiding interactions,” he said of recent months.

“My point is, if I am seeing this as a dentist, what other things are being put off?”

One of his patients had a mouth ulcer underneath a denture which went unchecked. Another had swelling around a tooth. On later inspection he was concerned by the pattern and took a scan which he sent on to a doctor. The patient was booked in for medical treatment the following day and had a biopsy which later confirmed B-cell lymphoma.

“The message would be that if you have an ulcer that hasn’t gone away after two weeks you should get it [checked],” he said.

“The vast majority that are investigated aren’t anything to worry about but if it needs treatment, if it’s picked up early it’s much easier to treat.”

The association recently warned that Ireland was facing an "unprecedented crisis", following a survey of 329 practitioners on the fallout from Covid-19.

As well as addressing the financial difficulties experienced by practices, it noted the pandemic was impacting on people’s ability to seek treatment.

Fintan Hourihan, the group's chief executive, noted in May that besides the impossibility of routine dentistry at the time, many practitioners were unable to provide emergency care because of a lack of personal protective equipment (PPE). Since then, dental services have resumed and some dentists have sourced their own PPE.

“Oral health is a key part of a person’s overall health, and the effects of this outbreak will have repercussions that will last long after the virus has disappeared,” he said.

“The bleak reality is that, unless supports are put in place for dentists, dental practices will close and patients will have to travel further for dental care and hospitals will be overwhelmed with emergency dental appointments.”