Page 20 - GP Spring 2018

Oral Cancer Screening

By Philip A. Gentry, DDS, FAGD

Introduction era and showed it to the
As dentists it is important for us to screen every patient for oral patient (Figure 2). I told
cancer. This year, it is estimated that approximately 49,750 Amer- him that clinically it
icans will be diagnosed with oral or pharyngeal cancer with over looks like a Human Pap-
80% being squamous cell carcinomas, causing almost 10,000 illoma Virus (HPV) and
deaths. Approximately 70% of these cancers are discovered late, recommended removal
1
after spreading deep and metastasizing; resulting in a 5-year sur- and biopsy. The patient
vival rate of only 57%.² returned two weeks later
and I removed the lesion
The oral cancer screening only takes about 20 seconds and you do with a #15 blade and sent
not need any fancy equipment, just your eyes and hands.³ After the specimen to the Figure 2. Close-up photo of the soft palate.
completing the dental hard and soft tissue examinations, look over University of Mary-
all the tissues. Have the patient stick out their tongue, check the land oral pathology lab
floor of the mouth and under and sides of the tongue. Have them (Figure 3). The biop-
say “ahh” and check the hard and soft palates as well as the back sy results confirmed
of the throat and tonsils. Have the patient close down and check the clinical diagnosis
the insides of the cheeks and buccal mucosa. Use the mirror as a of a papilloma (HPV)
tongue blade. At the same time you can check the airway to look with mild to moderate
for signs of sleep apnea, such as: constricted airway, large tongue, dysplasia (Figure 4).
uvula, large neck, and tonsils blocking the airway. Check and feel I also had the sample
the face and neck while doing your TMJ exam. Listen for a hoarse stained for the tumor
voice. suppressor gene p16.
In addition to the physical exam, also ask about risk factors for oral A positive brown stain
cancer. Men are twice as likely to have oral cancer. Being over age means the papilloma
55, tobacco and alcohol use, human papilloma virus (HPV), poor virus is the HPV 16
diet, and excessive exposure to sunlight (lips and skin) are risk type and high risk for
factors. Over the past 20 years, oral HPV infection has increased developing squamous
2,3
due to the increase in oral sex, and is now causing 75% of all oral cell carcinoma, (Fig-
and oropharynx squamous cell carcinomas. There are over 100 ure 5). Fortunately, this
types of HPV, but type 16 causes most oral and pharyngeal cancer patient’s lesion did not
cases. Most HPV lesions occur in the back of the mouth, so we stain brown. I would
need to look back there. recommend any HPV
Figure 3. Biopsy specimen, clinical photos, positive microscopic
It is thought that males develop oral cancers more often than fe- and paperwork ready to send to the oral finding that has dyspla-
males because females acquire the HPV infection easier and earlier pathology laboratory. sia be further stained
in life. Acquiring the infection earlier allows females to serocon- and tested for type 16.
vert the infection into a protective antibody. Males take many more
sexual partners, and, thus, more time and exposure, before forming
a protective antibody to the virus. Therefore, males get exposed
to more sexual partners before having any protective antibodies.¹

Case Report
A 44-year-old male patient presented for a routine initial examina-
tion. His blood pressure was 117/75 and was in good health. He
was free of caries and periodontal disease. All appeared normal.
He had a large tongue
blocking the back of his
throat. When I held his
tongue down to check
his airway and back of Figure 4. Microscopic slide Figure 5. Brown stain indicating
his mouth, I noticed a showing dysplastic changes, dangerous HPV p16 type.
lesion on his soft palate hyperchromatism, and
(Figure 1). The patient basilar hyperplasia.
had no idea that it was
present and the hygien- I called the patient and told him the clinical diagnosis of HPV was
ist had not noticed it. confirmed, and that it is not the dangerous 16 type. I felt that I
Figure 1. Lesion on soft palate. I took close-up photos removed the entire lesion and asked him to return in one month
with the intra-oral cam- to check, and we will continue to monitor and check him every

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