Oral diseases, which affect about 3.5 billion people every year according to estimates by the World Health Organization, they are one of the big public health problems. We are talking about caries, gingivitis, periodontids, oral manifestations of HIV, oral-dental trauma, noma, cleft lip, fissured palate, oral cavity cancer.
Oral cancer, for example, is among the top ten most common cancers. In the countries of Asia-Pacific, explains the World Health Organization, due to the heavy consumption of alcohol, tobacco, areca nut, it is among the first three causes of cancer, while in North America and Europe papillomavirus infections human beings are responsible for an increasing percentage of oral cancers among young people. Nor does it spare Italy, where every year between 8,000 and 9,000 cases are recorded on average, with a mortality of around 39%, while, thanks to early diagnosis, the survival rate fluctuates between 80 and 90%.
Smoking and mouth health © iStock
SYMPTOMS
Oral cancer can affect the mucous membranes of the cheeks and gums, the hard palate, the tongue, the lips, the retromolar trine, and the salivary glands. Symptoms are often overlooked or confused with other pathologies, such as, for example, dental abscesses, jaw cysts, simple inflammations, hence the importance of a timely diagnosis. The symptoms to be monitored, as mentioned on the occasion of the 2021 edition of Oral Cancer Day, are a swelling that does not heal, white or red patches on the surface of the mouth, constant sore throat, sudden loss of one or more teeth, pain and stiff jaw, pain and difficulty when swallowing and chewing, sensation of something in the throat, changes in tone of voice and difficulty speaking, unusual bleeding from the mouth, pain in holding dentures, weight loss.
In fact, the Ministry of Health explains that it is important to search for suspicious lesions throughout the oral cavity, even in hidden areas, especially the tongue, lesions, therefore, such as spots or plaques, nodules or erosions-ulcer, verrucosity. Injuries that do not heal in 14 days should be considered, he explains, as a doubtful case, while in the case of suspicious lesions, “never delay the diagnosis with therapies based on vitamins, mouthwashes, antibiotics or other for a period of time exceeding 14 days “. In case of “strong diagnostic suspicion” it is necessary to perform a biopsy, using, explains the Ministry of Health, an excisional biopsy technique for all “lesions of reduced size and localized in accessible and non-debilitating areas for the patient” and, on the other hand, an incisional one to be performed on the edges of the lesion, including the ” more suspicious clinics “, avoiding, however, the” necrotic areas “.
Mouth exam © Dental magik
Homogeneous, non-homogeneous, multifocal leukoplakias, Lichen planus, entoplakias, erytoplakias, which of these lesions can turn into malignant? “Homogeneous leukoplakias” explains the Ministry of Health “have a risk of malignant transformation of about 1%, while non-homogeneous ones have a much higher percentage of transformation (about 40%). Furthermore, there is another type of leukoplakia, that with multifocal localization, called proliferative verrucous oral, which presents a very high risk of malignant transformation (over 70%); it is more frequent in women (4: 1 female to male ratio) with an age peak at around 50 years. Lichen planus is a mucocutaneous disease affecting the skin and mucous membranes with an increased potential for malignant transformation. It most frequently involves subjects between the fifth and sixth decade of life, and it is twice as frequent in women than in men. The malignant transformation potential of Lichen planus has been the subject of intense research with studies showing a transformation rate between 0 and 12.5%. Erythroplakia has the highest risk of malignant transformation compared to all other precancerous diseases of the oral cavity (14% -52%) “.
SELF-EXAMINATION OF THE MOUTH
If in the mouth, explains ANDI, the national association of Italian dentists, you see white and / or red spots or plaques, which could be precancerous lesions, lichen, inflammatory eruption with the presence of papules, wounds that do not heal, rotten teeth, swollen or sick gums, in this case it is necessary to consult a doctor or a specialist, even if in the absence of pain, to have a more precise diagnosis. If a precancerous or chronic lesion is diagnosed, its removal should not be opposed. White and / or red spots or plaques, small erosions or ulcers inside the mouth, was mentioned on the occasion of Oral Cancer Day, are, in fact, often underestimated by patients who label them as simple inflammations. It is important, then explains ANDI, to periodically self-examine the mouth, checking it under and above the tongue and also lateral to the tongue, thus checking the cheeks and palate up to the uvula.
RISK FACTORS
Risk factors for oral cancer are considered smoking, alcohol abuse, malnutrition, diet low in fresh fruit and vegetables, poor oral hygiene, exposure to chemical carcinogens – for example polycyclic aromatic hydrocarbons, aromatic amines, residues from combustion of the tobacco – fungal or viral agents, poorly made dentures, broken or chipped teeth, genetic or systemic causes, unprotected oral sex.
PREVENTION
Prevention therefore begins with lifestyle. If we are what we eat, what can we do to counteract the possible appearance of the disease? With the paradox that the richest and most advanced societies, while being able to opt for a healthy eating style, often take refuge in regimes that, conversely, can favor the onset of the disease. “A diet low in fruit and vegetables” was explained on the occasion of Oral Cancer Day “which causes important vitamin deficiencies, can also be an enemy for the health of the oral cavity. Nutrition is undoubtedly one of the most important factors able to control the onset and development of oral cancer. Fundamental is the role of antioxidant vitamins A, C and E, contained in red, yellow and green vegetables and fruits, capable of eliminating free radicals from damaged cells. An adequate support of varied nutrients, belonging to the so-called Mediterranean diet, as well as a correct absorption of iron, vitamin B12 and folic acid are extremely important factors in the prevention of this form of cancer “. However, fruit and vegetables, explains the Ministry of Health, must, however, be non-starchy.
There is, therefore, oral hygiene. Healthy daily rules, in addition to protecting the health of the mouth, can, in fact, help avert the risk of developing oral cancer. Rules well illustrated in a decalogue of the Italian Academy of Conservative and Restorative Dentistry: “Clean your teeth every day with a toothbrush and toothpaste. Use floss or brush to clean the spaces between the teeth for better protection from tooth decay and gum inflammation. Repeated gingival bleeding is a symptom of gingivitis or periodontitis. Don’t overlook it and let your dentist see you! Smoking greatly damages the health of your mouth. It is scientifically proven that it aggravates gum disease and slows the healing of surgical wounds in the mouth. Dental hypersensitivity can be caused by diet (acidic foods or drinks) or by incorrect use of a toothbrush (too hard) or toothpaste (too abrasive). Dentist and hygienist can gladly advise you. Caries is linked to incorrect dental hygiene, to residues of sugary foods that have remained between the teeth for a long time, to poor resistance of the organism to the action of microbe of caries. Clean your teeth well several times a day, avoid sweets between meals, strengthen your teeth with fluoride toothpastes! To prevent cavities in children, groove sealing on the chewing face of children is useful molars starting with the first permanent molars that emerge after the age of six. Root caries, which affects the roots of the elongated teeth of the elderly, develops very rapidly and is destructive. It is prevented with thorough cleaning and frequent rinsing with fluoride mouthwashes. Annual or semi-annual check-ups are highly recommended especially for young people. Small cavities discovered in time can be treated today with very little invasive techniques and with invisible fillings. Even titanium implants can get sick! THE battery they can affect the gum and bone tissues near the implant and cause its loss. Maintain scrupulous hygiene of these prostheses and have them checked often by the dentist to extend their life. We take care of the mouth and teeth daily as we care of eyes, hair, skin of the face and hands. A beautiful smile and a fragrant breath are a fantastic business card “.
To prevent oral cancer, in addition to following a healthy diet rich in fruit and vegetables and low in fat, and not neglecting hygiene and cleanliness of the mouth, ANDI reminds you not to smoke; not to drink hard alcohol on a regular basis; not to consume wine between meals; from do not associate smoking with the daily consumption of spirits; to regularly consult a dentist; to remake old and / or inadequate prostheses; to undergo an annual mouth check-up; from do not engage in unprotected oral sex. Finally, in case of oncological therapies with radio or chemotherapy, it is necessary to talk to your dentist because, in these cases, there are dental protocols to follow.
WE TALKED ABOUT
World Health Organization Website | Twitter | Facebook | Instagram | Pinterest | YouTube | LinkedIn
Oral Cancer Day Website
Ministry of Health Website | Twitter | Facebook | Instagram | YouTube | LinkedIn
ANDI – National Association of Italian Dentists Website | Facebook | Vimeo
Italian Academy of Conservative and Restorative Dentistry Website | Facebook | Vimeo