I woke up in a hurry like most mornings to get ready for work, kissed my husband goodbye, and headed out the door. About two hours later, I got an SOS call from him. “Babe, I woke up with a huge knot on the side of my neck. It hurts to swallow. I’m scared.”

That was the phone call that changed another aspect of my life. You see, my husband was critically injured in the line of duty several years ago, which resulted in a kidney-pancreas organ transplant. He ended up having to have the transplant kidney removed 7 years later. Before that incident, he had been a smokeless tobacco user for about 20 years. As a current dialysis patient along with past immunosuppression medication use from the transplant, his physician assumed he had a systemic infection but knew lymphoma was a possibility. As a dental hygienist, I thought maybe he might have a nasty abscess. So, while his physician started antibiotics, I had him come into the office for radiographs and an oral cancer screening. No abnormalities were seen that day. Not even a week later, he was diagnosed with Squamous Cell Carcinoma of the Left tonsil confirmed via biopsy. The cause was immunosuppression, HPV 16+, and prior smokeless tobacco use. As a hygienist, I felt like I failed. However, instead of focusing on the negative, I threw myself into learning all I could to help my husband through this diagnosis. I had to be a better advocate for not only him but for my patients, to make sure I was doing my due diligence in educating them on the risks, symptoms, and treatments of oral cancer. In addition, I had to make both the extra and intraoral cancer screenings a priority at every appointment with my patients as well as educate them about the human papillomavirus.

Risk factors and symptoms

As an organ transplant recipient, you are made abundantly aware of the statement, “It is not a matter of if you get cancer, but when”. Taking immunosuppressive medications is known to increase your chances of getting cancer. Most often it is a skin cancer, so imagine our surprise to learn he had oral cancer. As a hygienist, I have been taught the risk factors and pathology but I still had much to learn. Such as, did you know that one does not have to have any known risk factors to have oral cancer? Cancer is non-biased, but when one thinks of oral cancer they often relate it to tobacco. It turns out, tobacco and heavy alcohol use, immunosuppression, family history, and the human papillomavirus (HPV) are all risk factors. The high-risk strains HPV16 and HPV18 are the main strains which contribute to oral cancer and it is more common in men vs women over the age of 40 ^[1].

When oral cancer is caught early, there are successful outcomes. Hence, it’s essential to know the symptoms could include ulcers and persistent sores that do not heal within two weeks, an enlarged lymph node of the cervical chain of the neck, pain, unexplained weight loss, fatigue, and difficulty swallowing or speaking. As oral cancer progresses symptoms could also include bleeding, pain, or numbness in the mouth and loose teeth ^[2]. The rule of thumb is if you see or feel something suspicious and it does not heal or go away in two weeks let your medical provider know. In my husband’s case, we let his physician know right away due to the size of the enlarged lymph node and pain.

Oral Cancer screening

At every comprehensive exam, it is required to conduct an oral cancer screening, but what about conducting a screening at your follow-up or future dental cleaning appointments? Your dental hygienist and dentist should be providing a thorough extraoral and intraoral examination at least twice a year. During the screening, one should expect both an extraoral and intraoral examination. During the intraoral exam, all areas of the tongue, tissue, salivary glands, tonsils, and back of the throat are viewed. We are looking for a white or red patch of the gums, tongue, tonsil, or lining of the mouth, a hard-painless lump in the cheek, near the retromolar pads or the front teeth, irregular color or growth of tissue, or an open sore that does not go away ^[2]. The extraoral exam should include palpation of your jaw, throat, neck, and back of your head to evaluate any enlarged lymph nodes or cysts.

Did you know you could screen yourself for oral cancer at home? As a woman, we are told to self-examine ourselves for breast cancer. All individuals are told to look out for abnormal moles, and skin tags for skin cancer. So why are we not looking in our mouths for signs, or abnormalities that could be cancer? The best way to evaluate yourself at home is to look in the mirror for any changes to the skin and palpate the throat, the sides of your neck and the back of your head, including behind the ears. Then take a small flashlight and look in your mouth at both sides of the tongue, and the back of the throat. Keep in mind there are abnormal structures in the mouth that are harmless, such as tori and geographic tongue.

You have oral cancer, what now?

Talk to your medical and dental provider. Your radiation oncologist should inquire about your last dental exam, which is necessary before starting treatment should one’s oral cancer treatment plan include chemotherapy and radiation. Do you have any infections, decay, or gum disease? All crucial questions are due to the damaging effects radiation will have on the oral cavity. The truth is radiation burns! It damages the tissue to eradicate the cancer leaving painful sores, mucositis, and severe xerostomia which may lead to the patient having a feeding tube placed due to the pain experienced when eating. In worst-case scenarios, symptoms can result in future gross caries and osteonecrosis. Your dental provider can prepare you by providing any necessary restorative treatment, extractions, prescription fluoride toothpaste, and magic mouthwash. In addition, your dental hygienist can go over your home care plan which may include the fabrication of fluoride trays, and recommending xerostomia products in the form of gums, rinses, sprays, and gels to alleviate your symptoms.

Every cancer experience is different and may require less or more support. My husband is an oral cancer survivor with residual effects from radiation exposure including short episodes of paralysis to the left side of his tongue. There were plenty of times when he wanted to end treatment due to the pain. Fluoride trays had been made but the types of gel attempted for use were irritating to his tissues and due to his severe xerostomia, he could not take the pain. Therefore, other products were given to attempt to alleviate those symptoms. I say this because it will take some trial and error to get your overall care plan right but following the steps below were taken for his case. His care plan included brushing more frequently, rinsing his mouth every 4 to 6 hours with a non-hydrogen or non alcohol mouth rinse, using magic mouth rinse when necessary, and moisturizing lips with Aquaphor or Vaseline. It is important to note there is a waiting period before applying a chap-stick before radiation therapy^[3]. Avoiding spicy foods, citrus, tobacco, and alcohol is also necessary to avoid additional discomfort with radiation therapy.
Catching oral cancer early has a high cure rate. Knowing what to look for and knowing how to care for your symptoms is imperative to one’s success in completing treatment. If diagnosed with oral cancer there will be help along the way. You got this!

Chassidy Cassady

I have been in the dental industry for over a decade now and I still the love the profession! I love patient education and advocacy . Therefore, I will always continue to learn and grow. Not only is it a joy to change someones life, it is so rewarding to see the confidence it can give someone. Besides being a RDH, I enjoy time at home with my husband and fur-babies as well as writing, reading and traveling when able.

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1. www.ncbi.nlm.nih.gov/pmc/articles/PMC4107541/
2. www.nidcr.nih.giv/health-info/oral-cancer
3. www.mskcc.org/cancer-care/patient-education/mouth-care-during-your-treatment

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While dental cleanings make your teeth whiter and brighter, there is more that goes into a dental cleaning than you might expect. Before you arrive, your dental hygienist reviews your dental chart and medical history. Once you arrive to your appointment, they may check your blood pressure and other vitals. They may also perform a head and neck exam, which helps to detect many types of conditions that can affect your whole body, such as cancer or thyroid disease. Your hygienist takes measurements of your gums that help them to determine if you have periodontal disease, and if so, to what extent. All of this happens before any of the cleaning actually begins!

Dental cleanings treat disease or help to prevent it

Dental professionals commonly use the phrase “dental cleaning” with their patients, but there are actually different types of dental cleanings. Some types are preventive in nature, such as a dental prophylaxis. Others even treat disease, such as non-surgical periodontal therapy. There are also types that help to maintain stability in oral condition, such as periodontal maintenance. So, when your dental healthcare provider says something about a dental cleaning, they are actually referring to a procedure that is specialized to your needs, not just a one-size-fits-all appointment.

Dental cleanings are more than just polishing

Many people think that polishing is the dental cleaning. Polishing removes plaque buildup and stains. Most of what can be accomplished by polishing can actually be done with a regular toothbrush and toothpaste. However, the most important part of the actual removal of build up on the teeth is scaling. During scaling, dental hygienists use hand instruments or an ultrasonic scaler (or most commonly, a combination of the two) to remove calculus from the teeth. You may be more familiar with the term tartar, which is the older terminology for calculus. Removal of calculus is very important for maintenance of health and prevention of disease because it harbors toxins and microbes, including disease-causing bacteria ^[2].

Dental cleanings are essential to whole-body health

Periodontal disease, also known as gum disease, has been scientifically linked to serious systemic diseases, including heart disease, diabetes, and rheumatoid arthritis ^[3]. The bad bacteria that cause periodontal disease have been found in the arterial plaques in people with heart disease, as well as in the brains of people with Alzheimer’s ^[1][3]! Also, increased inflammation in the mouth leads to more inflammation throughout the body ^[3]. The mouth is connected to the rest of the body, and any illness that impacts the mouth can have an effect on overall health. Just as your hands, eyes, and heart are part of your body, so is your mouth!

Different people need dental cleanings at different time intervals

Your dental hygienist will make a specific recommendation for how often you should receive dental care. They will consider how much inflammation you have, how quickly you accumulate calculus, your homecare habits, your systemic risk factors, and many other elements. Common recommendations are three, four, and six months. Many people need care more often than dental insurance will cover. Keep in mind that your hygienist is making their recommendations based on your individual needs, whereas your insurance benefits are pre-set, regardless of your oral health. If you are having a hard time affording the dental care you need, talk with your dental team to explore solutions. They may offer a discount plan, or may be able to refer you to lower cost clinics, such as a dental or dental hygiene school.

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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1. American Academy of Periodontology. (2019, January 28). Periodontal Disease Bacteria Linked to Alzheimer’s Disease https://www.perio.org/press-release/periodontal-disease-bacteria-linked-to-alzheimers-disease/
2. Kamath, D. G., & Umesh Nayak, S. (2014). Detection, removal and prevention of calculus: Literature review. The Saudi Dental Journal, 26(1), 7–13. https://doi.org/10.1016/j.sdentj.2013.12.003
3. Lim, G., Janu, U., Chiou, L.-L., Gandhi, K. K., Palomo, L., & John, V. (2020). Periodontal health and systemic conditions. Dentistry Journal, 8(4), 130. http://dx.doi.org/10.3390/dj8040130

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