If you’re an adult, you probably know that smoking, chewing tobacco, and marijuana are all bad for your oral health. But did you also know that these habits can actually increase your risk of developing oral cancer? Fortunately, people are becoming more aware of the negative effects of these habits and their prevalence is declining as a result. It’s likely that in coming years the rate of new diagnoses for tobacco-related oral cancers will continue to drop. But until society stops stigmatising people who smoke or chew, there are some easy things you can do to reduce your risk of contracting. Let’s take a look at what we know about the causes and symptoms of mouth cancer.
Who Is This Article For?
This article is for adults with a persistent mouth ulcer or abnormal oral change, people who use tobacco or areca nut, cancer survivors and anyone concerned about mouth-cancer symptoms.
What is Oral Cancer?
Oral cancer is a disease that begins in the tissues of the mouth and throat. It can affect any part of the oral cavity and can also spread to the lymph nodes in your neck. If left untreated, oral cancer can be life-threatening because it can grow and spread very quickly. The most common types of oral cancer are:
- Squamous cell carcinoma
- Adenocarcinoma
- Burkitt’s lymphoma
- Other sarcomas
Diagnosis is often made only after the cancer has progressed to an advanced stage, when it’s more difficult to treat. Early detection and treatment increase the chance of a full recovery.
Warning Signs of Oral Cancer
These symptoms do not automatically mean cancer. Trauma, infection and inflammatory conditions can produce similar changes. However, a persistent or progressively worsening lesion should be professionally examined. NCI lists a non-healing sore, lump, red or white patch, bleeding, numbness and difficulty chewing or swallowing among the recognised warning signs.
- A mouth ulcer that does not heal
- A lump or thickened area
- A persistent red or white patch
- Unexplained oral bleeding
- Pain or numbness
- Difficulty chewing or swallowing
- Restricted movement of the tongue or jaw
- A loose tooth without an obvious dental cause
- Dentures that suddenly stop fitting
- A persistent neck lump
What Happens During an Oral-Cancer Examination?
A dentist, oral surgeon or medical practitioner examines the lips, gums, inner cheeks, palate, tongue and floor of the mouth under good lighting. The tongue may be gently moved so its sides and lower surface can be examined. The clinician may feel the tissues with a gloved finger and check the neck for enlarged lymph nodes. A routine oral examination is generally quick and does not require anaesthesia. NCI notes that dentists and doctors may inspect the mouth for abnormal lesions during routine examinations. The examination looks for:
- Ulcers
- Abnormal red or white areas
- Hard or fixed tissue
- Unexplained swelling
- Changes in texture
- Bleeding
- Reduced movement
- Enlarged lymph nodes
Why Is a Biopsy Needed?
- Visual examination can identify a suspicious area, but appearance alone cannot provide a definitive cancer diagnosis.
- A biopsy involves removing a representative sample of tissue so that it can be examined by a pathologist. It is usually performed under local anaesthesia. The type and location of the biopsy depend on the size and characteristics of the lesion.
- Imaging such as CT, MRI or PET scans may be recommended after clinical assessment or diagnosis to evaluate the extent of a lesion and nearby structures. Blood tests cannot independently confirm oral cancer.
- Special lights, dyes or brush-based methods may assist assessment in selected situations, but they should not replace a conventional clinical examination and tissue diagnosis when a lesion is suspicious. NCI identifies visual examination as the most common detection method and notes that adjunctive methods may be used to assess abnormal tissue.
Smoking and Oral Cancer
Oral cancers caused by tobacco products like smoking and chewing tobacco are the most common types of oral cancer in the United States. As many as 25% of all new mouth cancer cases are caused by these lifestyle habits. The connection between smoking and oral cancer is well-documented. As the American Dental Association points out,
“The human mouth is the only organ in the body that is exposed to the direct chemical action of tobacco smoke.”
Chewing Tobacco on Oral health
Chewing tobacco (also known as “dip” or “spit tobacco”) is uniquely dangerous because it contains many of the same toxins as cigarettes but without filters. Tobacco chewers are at higher risk for oral cancers than smokers, so if you or someone you love dips tobacco, this is something to be aware of.
Marijuana and Oral Cancer
There is little evidence that smoking marijuana causes mouth cancer. It’s possible that chemical compounds present in the marijuana plant could be carcinogenic, but the THC levels in marijuana cigarettes are very low, and risk is further reduced if you use a vaporizer.\
Detecting Oral Cancer Early
Early detection is key to treating oral cancer and increasing your chances of a full recovery. Fortunately, there are a few signs to watch out for that could signify. If you notice any changes in your mouth, it’s important to see your oral surgeon.
- A persistent, abnormal bleeding in your mouth (other than when you brush your teeth) .
- Any persistent soreness inside your mouth that doesn’t heal.
- A lump in your mouth or on your neck.
- Change in the shape of your teeth or in size of a patch (gingivitis) on your tongue
- A change in your jaw line or overall oral health.
Oral Care During Recovery
For patients who are in the middle of recovering from their oral cancer treatment, regular brushing and flossing may not be an option. If you’ve had surgery on your tongue or jaw, you may not be able to brush or floss during your recovery period. The type of surgery you’ve had will determine which oral hygiene practices you can and can’t do:
If you’ve had surgery on the tongue, you probably won’t be able to brush or floss during your recovery period. This is because if you try to brush or floss during this time, it could lead to bleeding and swelling. If you’ve had surgery on the jaw, you may not be able to brush or floss during your recovery period since it could lead to the dislodging of your stitches.
Dental Care is Important for General Health
Good dental care reduces the risk of other diseases, and overall poor dental hygiene can cause other health issues. Some of the key problems that can occur if you do not take care of your teeth and gums are tooth decay and gum disease. Both of these problems can lead to tooth loss and other complications. Gum disease can also cause infections in your body.
A growing body of evidence has linked oral health, particularly periodontal (gum) disease, to several chronic diseases, including diabetes, heart disease, and stroke. In pregnant women, poor oral health has also been associated with premature births and low birth weight.
Conclusion
This is treatable when caught early, but it is also preventable. If you are adult smoker, chewing tobacco, or marijuana smoker, you can reduce your risk of developing oral cancer. Be sure to limit your tobacco and marijuana use, and brush your teeth regularly. And remember: early detection is key to treating and increasing your chances of a full recovery.
Frequently Asked Questions
Can a dentist detect oral cancer?
A dentist can identify suspicious changes during an oral examination and arrange a biopsy, specialist referral or additional investigation. Final diagnosis usually requires pathological examination of tissue.
Does every mouth ulcer mean oral cancer?
No. Many ulcers are caused by biting, sharp teeth, dental appliances or infection. An ulcer that does not heal, repeatedly returns in the same place or has hard or irregular margins should be examined.
Is an oral-cancer examination painful?
A routine visual and tactile examination is generally painless. The clinician inspects and gently feels the oral tissues and neck.
Is an oral biopsy painful?
A biopsy is normally performed under local anaesthesia. The patient may feel pressure during the procedure and temporary soreness afterwards.
What are the major risk factors for oral cancer?
Important risk factors include smoked and smokeless tobacco, areca nut or betel quid and heavy alcohol consumption. Certain cancers in nearby throat regions are also associated with high-risk HPV.
Can oral cancer occur in someone who does not use tobacco?
Yes. Tobacco substantially increases risk, but oral cancer can also develop in people without an obvious risk factor. A persistent oral change should therefore be examined regardless of tobacco history.
Does oral-cancer screening confirm that a patient has cancer?
No. Screening or visual examination identifies an area that may need investigation. A diagnosis generally requires biopsy and pathology.
Who should examine a suspicious mouth lesion?
A dentist, oral and maxillofacial surgeon, oral-medicine specialist, ENT surgeon or other suitably trained clinician can assess the lesion and arrange the appropriate investigation.
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Medical Disclaimer
This article is for patient education only. Dental treatment should be planned after clinical examination, medical history review, and X-rays or scans where required. Treatment suitability, cost, timeline, healing, and results vary from patient to patient.
