Down in the mouth

Mouth cancer awareness month is not until 1st November.  However, a recent article in the newspaper reporting a story of a women with oral cancer inspired me to write something a little sooner.

The story involves a 34 year old mother of three boys, who would have been put into a low risk category by her GP and dentist because of her general health, low alcohol intake and non-smoking status.  But this shows that although very rare, especially in those under 50 and even more so in women, mouth cancer is on the increase and so it is becoming vitally important to be aware of any changes that may have occurred in your mouth.

The mouth is the gateway to the inside of your body and can show a whole host of systemic problems that may be occurring elsewhere inside you.  The Chinese have mastered the art of diagnoses from looking at your tongue as changes to the colour and surface can reveal a lot about your general health.  For example, other systemic issues that can present themselves orally are Crohn disease, chronic liver disease, vitamin deficiencies, diabetes, HIV, leukaemia and sarcoidosis, just to name a few. Or it could just be plain old ulcers and a bit of stress which in the vast majority of cases, is exactly what it will be.

A great web page I have found for what oral cancer looks like, is the oral cancer foundation website with its large gallery of photos – some of oral cancer, some not. What is quintessentially important from looking at these images is the realisation that the appearance of oral cancer is hugely varied and can occur anywhere in the mouth.

The reason why it is SO important not to ignore ANY lesion that has not healed within two weeks is because that is how long it generally takes for the mouth to completely recover from a trauma – i.e. complete cell turnover takes 10-14 days.  Just like on the outside of our body when we lose skin cells and the body makes new ones, the skin on the inside of our mouths regenerates very quickly.  This works as a protective mechanism against harmful agents that might be trying to invade us.  The soft skin in our mouths can also build up hard skin like the soles of our feet through constant trauma like cheek biting or from continual exposure to heat and chemicals from smoking.  So when a cell does start to mutate and not grow as it should, things can get out of hand very quickly.  Hence, the two week window of review.

Dentists diagnose more cases of oral cancer than doctors.  If you have a good dentist/hygienist/therapist, they should be carrying out a least an 8-point examination for oral cancer screening.

If you have an excellent dentist/hygienist/therapist, they will also carry out checks around your jaw and neckline for any enlargements of your lymph nodes just as a routine check, before even looking at the teeth.

You can also check your own mouths once a month, looking and feeling for lumps with your fingers.

Although this will all sound very scary, we have to keep this in perspective.  I have practised for nearly ten years and although have referred a large number of patients to the dentist, that have ended up having lesions biopsied, none have turned out to be cancerous.  When I trained, I was told that If I was to practice for thirty years, the chances of me seeing a patient developing any malignancies in their mouth is incredibly low.

At the moment, treatment for oral cancer is pretty brutal, life changing and intensive.  But there is hope for the future and it comes in the form of HAMLET.  A protein found in, yes you’ve guessed it, human milk.

HAMLET stands for Human Alpha-lactalbumin Made Lethal to Tumor cells.  What they discovered is this human milk protein on it’s own, did not have much effect on bacterial or tumour cells, but added to fatty acids found in human milk, it became activated into a tumour killing machine by climbing inside the tumour cell and setting off a time bomb for the cell to slowly deactivate, giving the immune clean up cells a chance to mop up the dying tumour cell without its hazardous innards spilling out and causing damage to healthy cells around it.  Beyond clever.  But what is even cleverer is they have found that HAMLET has shown the ability to kill 60 different type of tumour cells, including those that cause mouth cancer.  It seems they work especially well on tumours of the mucous membranes which can be anything from mouth to bowel.  Entrance to exit.

So, what can we learn from the story about Natasha, the 34 year old Mum? Well it has taught me not to be complacent – not to just presume that a young, fit and healthy patient is low risk and therefore won’t need to be checked as thoroughly or to dismiss a lesion because it is unlikely in their case.  Despite it’s rarity, If I can do anything to wage the war on oral cancer, it will be to do my job properly, for every patient.  And that is what I will be doing from now on regardless of their ‘risk’.

What can you do? Make sure your dentist is checking your mouth properly.  Don’t be afraid to call them out if you don’t think they have. Check your own mouths once a month and don’t hesitate to get it looked at if you’re unsure.  Be aware that risk factors do include high alcohol intake and smoking.  Avoid mouthwashes with alcohol – there are plenty of alcohol-free ones on the market. But what ever you do, if you do find an ulcer, don’t be tempted to do this….unless you have permission of course.

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