Causes
- Tobacco and alcohol use: Tobacco use of any kind, including cigarette smoking, puts you at risk for developing oral cancers. Heavy alcohol use also increases the risk. Using both tobacco and alcohol increases the risk even further.
- HPV: Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to oral cancers.
- Age: Risk increases with age. Oral cancers most often occur in people over the age of 40.
- Sun Exposure: Cancer of the lip can be caused by sun exposure.
Symptoms
If you have any of these symptoms for more than two weeks, see a dentist or a doctor.
- A sore, irritation, lump or thick patch in your mouth, lip, or throat.
- A white or red patch in your mouth.
- A sore throat or a feeling that something is caught in your throat.
- Difficulty chewing, swallowing, or speaking.
- Difficulty moving your jaw or tongue.
- Swelling of your jaw that causes dentures to fit poorly or become uncomfortable.
- Numbness in your tongue or other areas of your mouth.
- Ear pain.
Diagnosis
Because oral cancer can spread quickly, early detection is important. An oral cancer examination can detect early signs of cancer. The exam is painless and takes only a few minutes. Many dentists will perform the test during your regular dental check-up. During the exam, your dentist or dental hygienist will check your face, neck, lips, and entire mouth for possible signs of cancer.
Treatment
When oral cancer is detected early, it is treated with surgery or radiation therapy. Oral cancer that is further along when it is diagnosed may use a combination of treatments.
For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy, which is a newer type of cancer treatment that uses drugs or other substances to precisely identify and attack cancer cells. The choice of treatment depends on your general health, where in your mouth or throat the cancer began, the size and type of the tumor, and whether the cancer has spread.
Your doctor may refer you to a specialist. Specialists who treat oral cancer include:
- Head and neck surgeons.
- Dentists who specialize in surgery of the mouth, face, and jaw (oral and maxillofacial surgeons).
- Ear, nose, and throat doctors (otolaryngologists).
- Doctors who specifically treat cancer (medical and radiation oncologists).
- Other health care professionals who may be part of a treatment team include dentists, plastic surgeons, reconstructive surgeons, speech pathologists, oncology nurses, registered dietitians, and mental health counselors.
Side effects of radiation treatment
- Dry mouth
- Severe tooth decay
- Loss of taste or changes in the way food tastes
- Sore mouth and gums
- Infections
- Jaw stiffness
- Jaw bone changes called osteoradionecrosis
- Neck pain
- Swallowing difficulties ( dysphagia)
- Tissue swelling (lmphadema)
Patients who are receiving cancer therapy often have changes in the mouth. This information can help you understand possible side effects of cancer treatment, including tips for mouth care that may help prevent or minimize these changes.
Introduction to mouth care
Chemotherapy affects rapidly dividing cells. Cancer cells and some normal cells, such as those lining the mouth, the gastrointestinal tract, bone marrow cells, and hair cells, divide rapidly.
Chemotherapy cannot tell the difference between normal cells and malignant cells and sometimes injures both. Chemotherapy may lower your white blood cell count, platelet count, and red blood cell count. This is known as bone marrow suppression (another name is myelosuppression). This makes you more at risk for infection and/or bleeding.
If there is pre-existing dental infection such as cavities, abscesses, or gum (periodontal) disease, the infection may become worse. In addition, your gums may bleed easily if they are irritated or swollen.
Chemotherapy may also cause mouth sores (mucositis). These sores usually heal in one to two weeks; however, more serious ulcers may become infected with bacteria or yeast that are commonly found in the mouth. Irritation from sharp teeth or fillings may worsen the condition. Medications to prevent sores and help with discomfort are available and can be prescribed for you.
As a comfort, ask for ice chips or sugar free popsicles to suck on while you are receiving chemotherapy. Research has shown this may decrease mouth sores by 60 percent.
Bleeding
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call the dental department for further instructions.
Swelling
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery.
Sit up at a 45° incline when you sleep at night. Just as you would care for a twisted ankle with elevation, similarly elevate your head and face. Swelling can also indicate infection. If the swelling is accompanied by a fever call the dental Department for further direction.
Diet
Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. You may eat and drink after your surgery avoiding hot foods that can stimulate bleeding and hard foods that can traumatize the mouth. Return to a normal diet as soon as possible unless otherwise directed.
Pain
You should begin taking pain medication before you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
Antibiotics
If given antibiotics, be sure to take the prescribed antibiotics as directed to help prevent infection. Most often antibiotics are not required for a tooth infection if the tooth is being extracted. If you develop a fever after your dental procedure contact the dental Department or your oncology team if you are on active cancer treatments.
Oral Hygiene
Good oral hygiene is essential to good healing. The day after surgery, the warm salt water rinses twice daily , after breakfast and before bed. Be sure to rinse gently for at least 30 seconds then spit it out. Brushing your teeth is no problem. Be gentle initially with brushing around the surgical areas. Keeping the mouth moist and clean will allow the surgery site to heal.
Activity
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.
Smoking
Smoking before any surgical procedure can place you at a higher risk for infection and pain. Smoking after dental surgery can place you at higher risk for infection, pain and surgical failure. Smoking impairs healing and can make your pain worse. You will be asked to refrain from smoking after your surgery for a reason. Nicotine patches can help you with your cravings during this time. Avoid any oral NRT products until the mouth has healed. If you have to smoke make sure gauze covers the area of surgery while you are smoking.
- Fact sheets on CT, before during and after RT
- Videos to complement
- Fact sheets on why quitting before cancer treatments is important
- Video to complement
- After tooth extractions ( insert)
- After biopsy (insert)
- After implant placement ( insert)
Organizations
Support Groups and Specific Organizations