David F Pascoe DDS MSD
(631) 765-1919

It is time for an honest, frank and disquieting conversation:

One of the most important components of your continuing care visit to your dentist is an oral cancer examination. Many of us have done this routinely and discretely as part of our routine examinations throughout our careers. A significant number of patients will tell you that they have been referred for follow up consultations sometimes involving biopsies. In my own career I have observed at least four confirmed positive findings.

 It used to be that this was characterized as a finding in older individuals with self-abusive habits using various recreational drugs. This is certainly no longer the case. The known risk factors of other dental disease, age, drug use ( including alcohol and tobacco ) diet and sun exposure are now joined by high risk sexual behavior. This bluntly involves the high incidence of oral sex in young adults. There has been much discussion about the role of human papilloma virus ( HPV ) as an etiologic factor in cancer. The oral cavity is a large exposure of vulnerable mucosa.

 There are two components of an oral cancer screen, the social and medical history, and then a physical examination. It is ironic that the small symptom free lesions are usually of more concern than the uncomfortable ones.

 On occasion initial screening tools are used to evaluate areas of concern, typically brush biopsies or fluoresence imaging. Persistent lesions are of primary concern and initial photographs enable changes to be evaluated at short follow up times for early diagnosis.

 There are a large number of abnormal tissues and lesions in the mouth that appear remarkably similar to oral cancer ( ie. Herpetic and aphthous ulcers ). When present for more than 14 days these become of real concern and need follow up.

 According to the Centers for Disease Control 36,000 individuals in the United States will be diagnosed with oral cancer this year. The 5 year survival rate has been estimated at 52%. Since it is anticipated that the number of individuals developing oral cancer will continue to increase so will the importance of making sure that at least annual examinations are done by a dental team and that follow up referrals for areas of concern are not ignored.

Remember when diving was dangerous and sex was safe?