Introduction:
As the first to recognize and treat early indications of oral pre-cancer and oral cancer, dentists are vital to the prevention of these diseases. Dentists can identify abnormal changes in the mouth, including leukoplakia or erythroplakia, which can be a sign of cancer, during routine dental check-ups. Dentists contribute to the decrease in the prevalence of oral malignancies by doing comprehensive examinations, teaching patients about risk factors such as alcohol and tobacco use, and encouraging excellent oral hygiene practices. Since early detection and prompt intervention greatly enhance treatment outcomes and survival rates, they are essential. Therefore, dentist's proactive participation is crucial to the ongoing fight against oral cancer and pre-cancerous lesions.
Why Are Oral Cancers on the Rise?
Despite significant advances in diagnostics and detection of oral cancers over the past decade, modern dental research indicates that a concerning number of individuals predisposed to developing oral cancers still fall victim to this condition, primarily due to a lack of awareness about dental and oral hygiene. The last decade has seen tremendous growth in therapeutic advancements and technologies for treating oral cancer patients in oral pathology. However, the widespread lack of awareness, particularly in rural and lower socioeconomic populations in developing countries, has kept survival rates low in these groups despite improved biopsy and exfoliative cytology methods for diagnosing oral cancer.
The combined use of smokeless tobacco and alcohol significantly increases the risk of developing oral precancers in these countries, with untreated lesions often progressing to malignant tumors or oral cancers. Tobacco smoking releases several carcinogens, such as tobacco-specific N-nitrosamines formed from nicotine. Regular alcohol consumption further compounds this risk. By eliciting habit histories from suspected patients and raising awareness about the detrimental effects, dentists can motivate individuals to undergo dental screenings and encourage cessation of these harmful, cancer-causing habits.
What Are the Pre Operative Evaluations for Preventing Pre-Cancers and Oral Cancer?
The dental surgeon should thoroughly assess suspected cancer patients by obtaining detailed medical and dental histories. When the dental or maxillofacial surgeon detects premalignant lesions, it is crucial to document the clinical features of the lesion, its duration, and potential progression. Clinically, any premalignant oral lesion that shows changes in texture, shape, or size, as well as symptoms such as pain, history of dental trauma, bleeding sites from the oral mucous membranes or gingival tissues, dysphagia, odynophagia, limited mouth opening or trismus, and sudden weight loss, are important diagnostic indicators of the lesion's severity and scope. By evaluating the patient's habit history, particularly tobacco use and chronic alcoholism, both major risk factors for oral cancers, along with a detailed assessment of the local lesion, dentists and oral surgeons can intervene early with appropriate treatment modalities. This early intervention can prevent the malignant transformation or metastasis of the lesion.
Regardless of the stage of cancer, the maxillofacial surgeon or dentist should focus on getting the patient's medical history, prior drug history (since some patients may have autoimmune disorders that can interact with certain medications), and whether the patient has ever had an organ transplant, among other information, to detect both pre-cancerous lesions and oral cancers. To successfully eradicate the malignancy, the dentist or oral surgeon must do a comprehensive preoperative and diagnostic evaluation, taking into account all relevant medical risks and circumstances.
What Is the Importance of Differential Diagnosis?
The most crucial thing a dentist or surgeon can do to stop oral malignancies from getting worse or from progressing further is to get a differential diagnosis. Because there is a significant danger of malignant transformation from existing oral lesions that are non-healing and chronic, exhibiting clinical symptoms in the patient's oral cavity, dentists must create a differential diagnosis as well as a confirmative diagnosis. Current research in dental and oral pathology indicates that non-healing lesions have a 14 to 50 percent approximate chance of being cancerous lesions or that the lesion in question may develop into something malignant. However, since many lesions have benign causes, and some would also be oral cavity infections by bacteria, fungi, or viruses, making a differential diagnosis would be necessary.
Based on clinical and histopathologic examinations, the dentist or surgeon can differentiate precancerous or cancerous lesions from a list of common oral infections or lesions that often resemble cancers clinically, including:
- Tuberculosis of the oral cavity.
- Oral lichen planus (OLP).
- Lupus erythematosus.
- Pemphigus.
- Hemangiomas.
- Drug-associated mucositis.
- Median rhomboid glossitis.
- Lingual varices.
- Oral candidiasis.
- Histoplasmosis.
- Early-stage squamous cell carcinomas.
- Oral purpura.
- Kaposi's sarcoma.
What Is the Focus of Dental Communities in the Primary Prevention of Oral Cancers?
According to the World Health Organization Framework Convention on Tobacco Control, this evidence-based international treaty aims to reduce global tobacco demand through measures such as pricing, taxation, and non-price interventions, thereby decreasing the incidence of oral precancers and cancers. Raising awareness among dental patients about the major risk factors of tobacco use and alcoholism and their role in the development and progression of oral cancers is crucial for preventing these conditions.
The current focus of the dental community and maxillofacial surgeons is to prevent tobacco and alcohol use and to promote awareness about the importance of a nutritious diet, emphasizing increased consumption of fresh fruits and vegetables. This approach is particularly important in lower and middle socioeconomic countries to prevent a significant number of oral cancers. When primary prevention campaigns fall short, early detection through dental or oral evaluations and screenings remains the most effective strategy for reducing the globally increasing mortality rates associated with oral cancers.
Conclusion:
The key to preventing the rising global mortality rates from oral precancers and cancers is early detection of oral lesions before they progress to advanced stages or metastasize to distant organs. Raising awareness about the necessity of regular dental checkups and educating the public about major risk factors for oral cancer, such as tobacco smoking and chronic alcoholism, is essential worldwide. Dental communities must actively promote this knowledge. Additionally, since dietary deficiencies have been linked to over 90 percent of oral cancers observed globally, dentists must emphasize the importance of proper nutrition and diet in individuals presenting with early precancerous or cancerous lesions.
