WORD OF MOUTH:'I'VE JUST come in for a check-up." As I tip back the chair, ask about that troublesome tooth, the ancient denture and perhaps the latest match, I begin the routine oral examination. Most dentists have a system of examining patients' mouths. It may surprise you that examination begins the moment you walk through the door.
Oral health can be judged not just by looking in the mouth, but by a patient’s countenance and appearance. See those nicotine-stained fingers? Smoker – heavy staining on the teeth, increased risk of dental and oral health problems. Chewed fingernails? Stressed patient – probably grinds teeth. Thirsty patient looking for water? Nervous, perhaps, or taking medication that causes a dry mouth. These and other telltale signs prepare the dentist for later findings.
As the chair buzzes back, and I take a look inside, the familiar chorus of letters and numbers are recited. You know how it goes. “Upper left six. MOD. Lower right five MO.” All of this sounds like some Cold War spy language. It is, of course, that “dentalese” language dental staff speak fluently.
As the examination continues, there is usually a pause – sometimes lengthy. The dentist may ask you to raise your tongue or open wider. The next piece of dentalese usually goes something like “I/O : NAD”. I/O is shorthand for intra-oral (examination) and the letters NAD stand for “no abnormality detected”. Three simple words. No abnormality detected. These words are (thankfully) chorused throughout dental surgeries in Ireland every day. However, this may not always be the case, as I can personally testify.
We are all sadly familiar with cancer, particularly the common ones: lung, breast, cervical, prostate and skin. Recent campaigns to combat cancer are proving effective.
Cervical cancer provides a good example. Women are generally better at health issues than men. Their attendance for screening is turning the tide with this cancer, thanks to a successful Cervical Check national campaign. The Irish Cancer Society records that in 2009 there were 304 cases of cervical cancer in Ireland.
National campaigns prove successful in other areas too. The Road Safety Authority has shown this. The number of road fatalities in Ireland in 2009 was 238. In 2010 it was 212.
Why are we talking about cervical cancer and road fatalities in a dental column? Well, in 2009 there were also 300 cases of oral/mouth cancer.
Awareness of this cancer is low, yet the figures suggest that its prevalence is high. Mouth cancer can occur in different sites within the oral cavity, for example the lip, tongue, floor of mouth and so on. These cancers are more common in men than in women. Worryingly, though, this is changing. There has been a 3 per cent per annum increase in oral cancer incidence in women since 1994.
Early detection of oral cancer greatly improves treatment options and ultimately survival rates.
The predisposing factors to oral cancer include smoking and high alcohol consumption. Recent research suggests that individually these can promote cancer, but together they work almost in unison. Sun exposure too can be a component, with excessive sunlight playing a significant role in lip cancer.
Last September, survivors of mouth, head and neck cancers along with Dublin Dental Hospital, Cork Dental Hospital and the Irish Cancer Society organised an oral-cancer screening day.
The response was phenomenal. Some 1,800 attended in Dublin, 1,393 in Cork. The results were startling. In Dublin, 29 suspicious lesions were detected, along with three early cancers and two established cancers.
In Cork, 49 pre-malignant lesions were detected and one established cancer.
Following on from this initiative last year and in conjunction with the Irish Dental Association, a National Mouth Cancer Awareness Day will take place on Wednesday, September 21st.
Dentists are often the first line of defence in detection of mouth cancer. They are trained in oral health and disease and are usually the health professional most likely to be consulted with a mouth lesion.
In my own personal experience with 10 years’ general dental practice in north Tipperary, I have detected three cases of oral cancer. Each of these was thankfully treated in time and enjoyed successful outcomes.
The National Mouth Cancer Awareness Day will see dentists throughout the State provide free oral soft-tissue examinations and offer advice on mouth-cancer prevention.
On this day, patients are encouraged to attend participating dentists to get screened for this disease. The examination is quick and painless and could help save a life.
Advice and details of your nearest participating dentist can be found at mouthcancerawareness.ie. Advice on mouth cancer is also provided by the Irish Cancer Society’s helpline on free phone 1800-200700. Let’s hope that this nationwide initiative will yield the same tide-turning results as have been demonstrated by the Road Safety Authority and Cervical Check.
Paul O’Dwyer is a dental surgeon
In 2009 there were 300 cases of oral/mouth cancer There has been a 3% per annum increase in oral cancer incidence in women since 1994
