Saving Teeth, Saving a Life in Stony Brook

 

I’ve saved many teeth in my years of practicing dentistry – after all, it’s my goal to help people keep their teeth.  But now I can say that I have saved a life.  It wasn’t a patient or a family member or a close friend but an acquaintance who has since become a friend.  I was at a dinner party when Lois approached me and said she wanted to ask my opinion.  She was having a crown made but the dentist couldn’t complete the work because she had sores in her mouth that hadn’t healed.  She wanted me to complete the dental work. She said that she was sucking her cheek and this caused the sores but she couldn’t stop the sucking habit.

 

I took her aside and asked her to pull aside her lip so I could see the area.  The entire cheek side of her lower right back teeth was covered with white pustules and much of the normal tissue had sloughed off. I had never seen a condition so serious.  I didn’t want to alarm her but I was emphatic that she needed to immediately see an oral surgeon for a biopsy.  She asked me if it was cancer. She said she didn’t want to know if it was.  My reply was that she needed to know so that it could be treated.  The next day I called her to be sure that she would follow through.  It took several phone calls on my part until she finally saw an oral surgeon for a biopsy.

 

Sadly the test was positive for well differentiated squamous cell carcinoma.  Lois will need surgery to remove the cancerous tissue and part of the jawbone, and then possibly undergo chemotherapy and radiation treatment.  Rehabilitation will take over six weeks, with limited speech and swallowing.  Lois is grateful to me for recognizing the pathology and for insisting that she have it diagnosed.  She has a long road ahead of her, but hopefully the cancer was caught in time.  I know I have saved a life.  Please don’t neglect yours. Don’t let fear keep you from the doctor – oral cancer that is caught early can be treated and cured.

 

 

 

 

Major League Baseball (MLB) teams will be playing ball this year with limits on the use of smokeless tobacco.  As part of the agreement between the MLB and the Players Association, team members will not be allowed to keep smokeless tobacco in their back pockets or anywhere else in their uniforms when on the field or whenever ball fans are in the park.  Likewise they will not be allowed to chew a wad of smokeless tobacco when meeting fans or being interviewed.

Smokeless tobacco impacts on oral health as it can cause oral cancer.  Its use has risen nearly 37% among high school boys since 2003.  Baseball player are often role models for these youngsters who emulate their heroes – chewing, spitting, and reloading a wad of tobacco under their lower lip (dipping) – and follow the path to addiction.  The former San Diego Padres hitter, Tony Gwynn, who now coaches baseball at San Diego State University, is a prominent former dipping addict.  He was unsuccessful in quitting the habit and now has salivary cancer.  He has had four oral surgeries to remove cancerous tumors.

What’s a hookah?  It’s an exotic water pipe, recently popular on American campuses.  The hookah glass and metal water pipes are used for smoking a blend of tobacco, molasses and fruit called shisha.  More than 40% of over 3,000 students at universities in North Carolina had smoked a hookah at least once, according to a 2008 study.

Young people believe that hookah smoke is not as harmful as cigarette smoke because the hookah smoke is filtered through water, resulting in fewer solid particles.  But hookahs are not safe.  The water does not filter all the harmful chemicals in the tobacco smoke and the water in hookahs filters out less than 5% of the nicotine.  Because a hookah session can last an hour with smokers taking long and deep breaths the smoke inhaled can equal 100 cigarettes according to a 2005 study by the World Health Organization.   Hookah smoke also contains heavy metals, tar, and other cancerous chemicals and exposes users to carbon monoxide.  Hookah smoking is linked to lung, bladder and oral cancer.  And the communally passed hookahs can spread herpes and other infections.

In California, Connecticut and Oregon state legislators have introduced bills to ban or limit hookah bars.  Other states, including New York, are also taking steps against the practice and some universities have banned hookahs in the dormitories.

With our awareness of oral cancer, the dental community needs to focus more attention on the rising popularity of the hookah and address the misconceptions about its safety.

I routinely examine my patients for signs of oral cancer.  In 2010 there were about 36,000 new cases of oral and pharyngeal cancer (OPC) in the U.S. and over 7,000 deaths.  Prevention includes early detection of premalignant changes in the oral mucosa.

But you can also assist in prevention.  An article in the February, 2011 Journal of the American Dental Association reported on “Diet and Prevention of Oral Cancer.”  A diet high in fruits and vegetables is protective against OPC.  Vitamin C and E have antioxidant properties and may prevent DNA damage because they reduce exposure to the free radicals of oxygen.    Fruits and vegetables also contain phytonutrients which may act synergistically to prevent OPC and other cancers.  In contrast, nitrites in processed meats form nitrosamines which are carcinogenic and increase the risk of developing cancer.  The protective dietary factors of antioxidant vitamins, carotenoids, lycopene and fiber occur in plant foods: whole grains, nuts, legume, vegetables and fruits.  A plant food diet also minimizes pathogenic dietary factors including saturated fat and animal protein and nitrates.  Salted meat, processed meat and animal fat all increase the risk of oral cancer.  Dietary supplements are not a substitute for a diet rich in fruits and vegetables.

For more information about diet and prevention of oral cancer see: http://jada.ada.org/cgi/content/short/142/2/166

The Great American Smokeout which encourages people to stop smoking for 24 hours will take place this year on November 18.  The goal is that the decision to stop smoking will last much longer than the one day.  This annual event is sponsored by the American Cancer Society.

Quitting smoking is not easy because tobacco contains nicotine which is addictive.  As Mark Twain once said, “Quitting smoking is easy. I’ve done it a thousand times.”  I have made it a goal in my Long Island dental office to help my patients who smoke to break the habit once and for all.

Smokers are at risk for oral cancer and periodontal disease.   Cigarette smoking has also been linked to increased risk of heart disease, stroke, diabetes, and respiratory disease.

In 1890, at the start of his second term of office, President Grover Cleveland noticed a rough spot on his palate.A biopsy confirmed a diagnosis of cancer, and surgery was indicated.The Government wanted to keep the President’s health a secret because there was a financial crisis at the time, and they did not want the public to be alarmed.

So the surgery was done in secret while the President was aboard his friend’s yacht traveling up the East River in New York.The surgical team, including a dentist, was sworn to secrecy.Dr. Hasbrouck, a New York dentist, administered the anesthesia. Two teeth were extracted and part of the maxilla was removed.Dr Hasbrouck also constructed an appliance to close the defect caused by the surgery, and the President was able to make a planned address to Congress shortly thereafter.

The President lived for many more years without a recurrence of the oral cancer, and he died in 1908 of a heart attack.The government did not officially acknowledge Cleveland’s oral cancer until 1917.Dentists today, as in Cleveland’s day, play a crucial role in the diagnosis and treatment of oral cancer and post-surgical reconstruction.In my dental office I routinely check my patients for oral cancer.Early treatment of cancerous lesions saves countless lives each year.For more on oral cancer, visit my blog post on oral cancer.

Oral Cancer Self-Examination

We do an oral cancer examination and screening for our Long Island dental patients at every dental examination visit. But you can also perform an oral cancer self-examination between your dental visits to check for any early signs of oral cancer. If you are concerned about any of your findings, call us immediately for an evaluation.

Oral Cancer Self-Examination Steps:

1. Press along the sides and front of your neck and feel for any tenderness or lumps. Do the same on your face. Your face and neck are symmetrical, so notice any bumps or swelling.

2. Pull your upper lip up and look for any sores and/or color changes on your lips and gums. Repeat this on your lower lip.

3. Use your fingers to pull out your cheek and look for any color changes such as red, white, or dark patches. Put your index finger on the inside and your thumb on the outside of your cheeks to feel for any lumps. Repeat on the other cheek.

4. Tilt your head back and open your mouth wide to see if there are any lumps or color changes.

5. Grab your tongue with a cotton gauze and examine for any swellings or color changes. Look at the top, back, and each side of your tongue.

6. Look at the underside of your tongue and the floor of your mouth (Touching the roof of your mouth with your tongue during this portion of the exam will allow you to see these areas better). See if there are any color changes or lumps. Using one finger inside your mouth and one finger on the outside (corresponding to the same place), feel for any unusual bumps, swelling, or tenderness.

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Ever since I started practicing dentistry I have included a visual oral cancer examination for my patients. This includes examining the soft tissues, the tongue and the back of the mouth for suspicious lesions. Last year over 35,000 Americans were diagnosed with oral cancer and over 7,000 died from the disease. But survival rates are very high for cases that are detected early. In recent years several screening devices have become available. Two popular systems are VELscope and ViziLite Plus. I did use each of these systems for a time but returned to the visual exam after reading several studies that showed these adjuncts to be of no value in detecting oral cancer. The patients of my Long Island dental office know that I keep abreast of medical and dental literature and do what I think is best for them!cook the thief his wife her lover the divx download