Dental Hygiene

Most people have heard of cancer affecting parts of the body such as the lungs or breasts. However, cancer can appear in the mouth, where it can affect the lips, tongue, cheeks, and throat.

Yes. Nearly 2,000 people in the UK die from mouth cancer every year. Many of these deaths could be prevented if the cancer was diagnosed early enough. As it is, people with mouth cancer are more likely to die than those having cervical cancer or melanoma skin cancer.

Most cases of mouth cancer are linked to tobacco and alcohol. Cigarette, cigar, and pipe smoking are the main forms of tobacco use in many parts of the world. However, the traditional habits in some cultures of chewing tobacco, betel quid, gutkha and paan are particularly dangerous. Alcohol increases the risk of mouth cancer, and if tobacco and alcohol are taken together the risk is even greater. Over-exposure to sunlight can also increase the risk of cancer of the lips. Many recent reports have linked mouth cancer to the human papillomavirus (HPV). HPV is the main cause of cervical cancer and affects the skin that lines the moist areas of the body. HPV can be spread through oral sex, and research now suggests that HPV could soon rival smoking and drinking as one of the main causes of mouth cancer. Practising safe sex and limiting the number of partners you have may help reduce your chances of getting HPV. Many people get HPV during their lives and for many, this does not cause a problem.  There are now HPV vaccines for both girls and boys. They were developed to fight cervical cancer, but it is likely that they will also help to reduce the rates of mouth cancer. These vaccines are given at ages 12 to 13 before sexual activity starts.

Mouth cancer can appear in different forms and can affect all parts of the mouth, tongue, and lips. Mouth cancer can appear as a painless mouth ulcer that does not heal normally. A white or red patch in the mouth can also develop into a cancer. Be aware of any unusual lumps in your mouth or jaw area and any persistent hoarseness. It is important to visit your dental team or doctor if these areas do not heal within three weeks. If you aren't sure, go for a check-up anyway.

Mouth cancer can often be spotted in its early stages by your dental team during a thorough mouth examination. If mouth cancer is diagnosed early, then the chances of a cure are good. Many people with mouth cancer go to their dentist or doctor too late.

Be aware of what is going on in your mouth. Examine yourself regularly. Ulcers that do not heal within three weeks, any unusual red or white patches, lumps in your neck or jaw area, or persistent hoarseness are all reasons for asking your dental team or doctor to examine you. There is probably nothing seriously wrong, but an early diagnosis could save your life.

The inside of your mouth and your tongue will be examined with the help of a small mirror. The examination will also look at your neck and underneath your jaw. Dentists will carry out this examination as part of a routine dental check-up. Remember, your dental team can see parts of your mouth that you cannot easily see yourself.

If they find something unusual, they will refer you to a consultant at the hospital, who will carry out a thorough examination of your mouth and throat. A small sample of the cells may be gathered from the area (a biopsy), and these cells will be examined under the microscope to see what is wrong. What happens next? If the cells are cancerous, more tests will be carried out. These may include overall health checks, blood tests, x-rays, or scans. These tests will decide what course of treatment is needed.

If mouth cancer is spotted early, the chances of a complete cure are good, and the smaller the area or ulcer the better the chance of a cure. However, too many people come forward too late because they do not have regular mouth examinations.

Stop smoking and cut down on the amount of alcohol you drink. Eat a balanced, healthy diet with at least five portions of fruit and vegetables a day. This can also help protect against many other cancers. Visit your dental team regularly, as often as they recommend.

Ulcers are painful sores that appear inside the mouth. They are usually red or yellow. They are different from cold sores, which appear on the outer lips and are caused by a virus.

Usually, a single mouth ulcer is due to damage caused by biting the cheek or tongue, or by sharp teeth, brushing or poorly fitting dentures. These ulcers are called ‘traumatic' ulcers. If you have a number of mouth ulcers, and they keep coming back, this is called ‘recurrent aphthous stomatitis'.

Traumatic ulcers are usually on their own, are next to the cause of the damage and go away once the source of the problem is removed.

Recurrent aphthous stomatitis is a common problem and is the repeated appearance of mouth ulcers in otherwise healthy children and young people. The cause is not known, but it is not infectious and is unlikely to be inherited.

Different types of mouth ulcers: -

• Minor ulcers are the most common. They can appear inside the cheeks, on the lips, tongue, and gums, and, more rarely, on the roof of the mouth. Most of these ulcers are the size of the top of a pencil and can sometimes come in clusters. You can get four to six at any one time.

• Large ulcers are more severe and can take longer to heal. Any ulcer that lasts longer than 3 weeks should be checked by your dentist. Large ulcers may appear near the tonsils and can be very painful, especially when you swallow. You usually only get one at a time.

• It is also possible to have up to 100 very small, painful ulcers which last for one to two weeks. However, these last two varieties are very rare. You may get ulcers in other parts of the body such as your eyes or genital area. It is important to tell your dental team about this.

Infections can cause mouth ulcers. Herpes simplex often causes mouth ulcers in children and some adults. Other less common viral and bacterial infections may cause mouth ulcers, but this is rare. Mouth ulcers can be caused by anaemia and occasionally by other blood disorders, and some skin or gastrointestinal diseases. Sometimes the mouth ulcers are the only sign of an underlying disease.

Cancer of the mouth can first appear as a mouth ulcer. The ulcers caused by mouth cancer are usually single and last a long time without any obvious nearby cause (for example a sharp tooth). Any ulcer that lasts longer than three weeks should be looked at by your dentist. Ulcers caused by cancer usually appear on or under the tongue, but may occasionally appear somewhere else in the mouth. Cancer of the mouth is usually linked to heavy smoking and drinking. Doing both together greatly increases the risk.

Mouth ulcers cannot be caught by kissing, or by sharing drinks and utensils.

The treatment depends on the cause of the ulcers. Sometimes all that is needed is for a sharp tooth to be smoothed down or a denture adjusted, although some patients may need mouthwashes or tablets.

If an ulcer lasts more than 3 weeks, you should always ask your dental team or doctor for advice. They may be able to tell you the cause and provide treatment, or they may arrange more tests or refer you to a specialist if needed.

You may be able to reduce the risk of mouth ulcers by keeping your mouth as clean and healthy as possible, using high-quality toothbrushes (to reduce the risk of damage to your mouth), eating a good diet which is rich in vitamins A, C and E, and includes foods such as fresh fruit and vegetables (to lessen the risk of mouth cancer) and regularly visiting your dentist.

Most ulcers heal on their own. However, if they don't heal within three weeks you should visit your dentist. Your dental team will be able to examine your mouth to check that the problem is an ulcer and not something more serious such as mouth cancer. If you suffer from ulcers that come and go often, you should visit your dental team to check that there is not an underlying medical cause.

Always see your dental team or doctor if the ulcer lasts for more than 3 weeks, you are unwell, or the ulcers keep coming back.