Oral Cancer

The mouth and throat:

This is about cancers that occur in the mouth and the part of the throat at the back of the mouth. The oral cavity and oropharynx have many parts:

• Lips
• Lining of your cheeks
• Salivary glands
• Roof of your mouth
  
• Back of your mouth
• Floor of your mouth
• Gums and teeth
• Tongue
• Tonsils

Understanding cancer

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.
Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

• Benign tumors (not cancer):
• Benign tumors are rarely life-threatening.
• Generally, benign tumors can be removed, and they usually do not grow back.
• Cells from benign tumors do not invade the tissues around them.
• Cells from benign tumors do not spread to other parts of the body.
• Malignant tumors are cancer:
• Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
• Malignant tumors often can be removed, but sometimes they grow back.
• Cells from malignant tumors can invade and damage nearby tissues and organs.
• Cells from malignant tumors can spread to other parts of the body. The cells spread by breaking away from the original cancer and entering the bloodstream or lymphatic system. They invade other organs, forming new tumors and damaging these organs.

Oral cancers:

Oral cancer is part of a group of cancers called head and neck cancers. Oral cancer can develop in any part of the oral cavity or oropharynx. Most oral cancers begin in the tongue and in the floor of the mouth. Almost all oral cancers begin in the flat cells that cover the surfaces of the mouth, tongue, and lips. These cancers are called squamous cell carcinomas.
When oral cancer spreads, it usually travels through the lymphatic system. Cancer cells that enter the lymphatic system are carried along by lymph, a clear, watery fluid. The cancer cells often appear first in nearby lymph nodes in the neck.
Cancer cells can also spread to other parts of the neck, the lungs, and other parts of the body. When this happens, the new tumor has the same kind of abnormal cells as the primary tumor. For example, if oral cancer spreads to the lungs, the cancer cells in the lungs are actually oral cancer cells. The disease is metastatic oral cancer, not lung cancer. It is treated as oral cancer.

HIV/AIDS and the Role of the Dentist

Good news is that transmission of HIV from a dentist to patient is very unlikely. Patient-to-patient infection didn’t seem to occur in one dentist’s practice in spite of the fact that the dentist didn’t follow proper infection control practices – dental tools were not autoclaved after use and were treated with a disinfectant not recommended for disinfecting dental instruments. Also, dental lines were not flushed between patients, which can result in one patient’s tissue being expelled in the next patient’s mouth. Transmission from dentist-to-patient is known to have only occurred once - a Florida dentist infecting 6 patients. Patient-to-patient transmission is known to have occurred only once too. Almost all AIDS patients will develop oral manifestations of the disease, so the dentist definitely has a role in the management of HIV/AIDS patients. The frequency and type of oral lesion depends on the stage of the disease and degree of immunosuppression of the patient. During late stage infection more than 20% of patients experience at least one of the following oral conditions: aphthous ulcers, oral thrush, Kaposi’s sarcoma, oral hairy leukoplakia and linear gingival erythema. Left untreated these conditions can lead to the patient having difficulty talking, chewing and swallowing. Periodontal disease is also common.

HIV is infrequently transmitted orally because there are low numbers of CD4 cell targets and the presence of anti-HIV antibodies and anti-viral factors in the saliva as well as there being thick epithelial wall in the oral cavity. HIV recovery from the saliva is very poor.

Dental infection protocols are designed to reduce transmission of infection from any body fluid. In other words treat all patients as if all their body fluids are infectious. Dentists need to be able to recognise the oral features of HIV infection, manage their oral symptoms and understand the systemic effects of HIV, including their mental health and behavior.

HIV/AIDS patients are likely to not disclose their HIV status to the dentist. One of the reasons for not disclosing is the attitude of the dentist. Some dentists stigmatice HIV/AIDS patients. This means that dentists should always use Universal precautions and to display an empathetic attitude towards all patients. 46% of AIDS patients admit to not telling the dentist of their status at least once. Yet over 80% of HIV/AIDS patients would prefer their dentist did know their status. The situation where it is most important to know a patient’s HIV status is perhaps after the dentist sustains a needle stick injury and the decision of whether to take antiviral prophylaxis needs to be made based on that patient’s HIV status.