I practised in the UK as a Senior House Officer (SHO) in the Maxillofacial Department of Glan Clwyd Hospital. It was the first time I came face to face with cancer cases. Glan Clwyd was the main cancer unit in the whole of North Wales and referrals we received were among the most severe and rare cases.
My First Cancer Case
The first oral cancer surgery case that I assisted with was on a middle aged gentleman (X) who was a ex-heavy smoker. He had a partial tongue resection with a partial mandible resection, meaning that half of the tongue and half of the lower jaw had to be removed, together with affected lymph nodes on the same side. Jaw was reconstructed with a fibula graft and tongue with a muscle graft. The surgery took 11 hours. Patient recovered fully from surgery and started chemotherapy and radiotherapy right after surgery.
X would have remained under the care of the oncologist, maxillofacial surgeon, dietician, cancer nurse, psychologist and possibly psychiatrist for years to come. We saw these cancer cases on a daily basis. Most patients survived, while some passed away whilst recovering in the ward. We also saw skin cancer cases in the outpatient department.
Reflecting back, being an SHO in Maxfac possibly changed the way I practised dentistry. I became more aware of the warning signs to look out for, risk factors, symptoms that we can not ignore, urgent vs non-urgent referrals and treatment priority.
Since 2018, I practise in Mauritius. In my practice only, I have come across 4 confirmed cancer cases which were referred for biopsy. In this blog post, I will cover a few of the most important risk factors in oral cancer and warning signs that you should be looking at. The earlier the diagnosis, the better the prognosis.
Risk Factors for Oral Cancer
SMOKING
Cigarette smoke contains more than 60 toxic chemicals including carcinogens that can alter the genetic composition of cells that line our mouths. They reduce our immune response and at the same time potentiate the action of viruses such as HPV and EBV that are closely linked to oral squamous cell carcinoma (OSCC). See link attached https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752112/
ALCOHOL
Alcohol is linked to genetic mutations and reduction in absorption of nutrients such as folic acid. In conjunction with smoking, it increases your risk of oral cancer risk by multiple fold.
GENETICS
Whilst smoking and alcohol constitute the preventable risk factors, genetics is unfortunately a non preventable risk factor. A family history of cancer can predispose you to cancer as well. Cancer genetic testing is now available in multiple laboratories to help you estimate your chance of developing cancer in your lifetime. In Mauritius C-lab provides this service (please note that we bear no association with C-lab)
Warning Signs for you
We encourage everyone to have a 6 monthly check up at your dentist so warning signs can be identified by a professional. However, there are a few examinations that can be carried out solo at home in good lighting. Check your palate, sides of tongue, underneath your tongue, cheeks, inner lips.
White / Red or Speckled (white & red patches)
Non healing ulcer
Widening of jaw bone
Unexplained persistent severe pain in the jaw
Swollen hard lymph nodes in your neck or clavicle together with jaw pain
Out of interest, I found out the following information from the Global Cancer observatory.
Most frequent cancer in Mauritius remains breast cancer.
Oral cancer in Mauritius is the 12th most frequent cancer. In 2023 , 64 cases were diagnosed 31 deaths recorded.
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