Oral Cancer

Oral Cancer

by Dr. Sepi Fatahi DMD
What are signs and symptoms?

Signs and symptoms are both signals of injury, illness, disease – signals that something is not right in the body.

A sign is a signal that can be seen by someone else – maybe a loved one, or a doctor, nurse, or other health care professional. For example, fever, fast breathing, and abnormal lung sounds heard through a stethoscope may be signs of pneumonia.

A symptom is a signal that’s felt or noticed by the person who has it, but may not be easily seen by anyone else. For example, weakness, aching, and feeling short of breath may be symptoms of pneumonia.

Having one sign or symptom may not be enough to figure out what’s causing it. For example, a rash in a child could be a sign of a number of things, such as poison ivy, measles, a skin infection, or a food allergy. But if the child has the rash along with other signs and symptoms like a high fever, chills, achiness, and a sore throat, then a doctor can get a better picture of the illness. Sometimes, a patient’s signs and symptoms still don’t give the doctor enough clues to be sure what’s causing the illness. Then medical tests, such as x-rays, blood tests, or a biopsy may be needed.

How does cancer cause signs and symptoms?

Cancer is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.

As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure causes some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause symptoms.

But sometimes cancer starts in places where it won’t cause any signs or symptoms until it has grown quite large. Cancers of the pancreas, for example, usually don’t cause symptoms until they grow large enough to press on nearby nerves or organs (this causes back or belly pain). Others may grow around the bile duct and block the flow of bile. This causes the eyes and skin to look yellow (jaundice). By the time a pancreatic cancer causes signs or symptoms like these, it’s usually in an advanced stage. This means it has grown and spread beyond the place it started – the pancreas.

A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Cancer can also cause the immune system to react in ways that produce these signs and symptoms.

Sometimes, cancer cells release substances into the bloodstream that cause symptoms that are not usually linked to cancer. For example, some cancers of the pancreas can release substances that cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.
How are signs and symptoms helpful?

Treatment works best when cancer is found early – while it’s still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if the cancer can be removed with surgery.

A good example of the importance of finding cancer early is melanoma skin cancer. It can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people who live at least 5 years after diagnosis) at this early stage is around 98%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops to about 16%.

Sometimes people ignore symptoms. Maybe they don’t know that the symptoms could mean something is wrong. Or they might be frightened by what the symptoms could mean and don’t want to get medical help. Maybe they just can’t afford to get medical care.

Some symptoms, such as tiredness or coughing, are more likely caused by something other than cancer. Symptoms can seem unimportant, especially if there’s a clear cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has lasted a long time or is getting worse.

Most likely, symptoms are not caused by cancer, but it’s important to have them checked out, just in case. If cancer is not the cause, a doctor can help figure out what the cause is and treat it, if needed.

Sometimes, it’s possible to find cancer before having symptoms. The American Cancer Society and other health groups recommend cancer-related check-ups and certain tests for people even though they have no symptoms. This helps find certain cancers early, before symptoms start. For more information on early detection tests, see our document called American Cancer Society Guidelines for the Early Detection of Cancer. But keep in mind, even if you have these recommended tests, it’s still important to see a doctor if you have any symptoms.

What are some general signs and symptoms of cancer?

You should know some of the general signs and symptoms of cancer. But remember, having any of these does not mean that you have cancer – many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor to find out what’s going on.
Unexplained weight loss

Most people with cancer will lose weight at some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus (swallowing tube), or lung.

Fever

Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all people with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. (This can make it harder for the body to fight infection.) Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue

Fatigue is extreme tiredness that doesn’t get better with rest. It may be an important symptom as cancer grows. But it may happen early in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious. This is another way cancer can cause fatigue.

Pain

Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.

Skin changes

Along with skin cancers, some other cancers can cause skin changes that can be seen. These signs and symptoms include:

Darker looking skin (hyperpigmentation)
Yellowish skin and eyes (jaundice)
Reddened skin (erythema)
Itching (pruritis)
Excessive hair growth

Signs and symptoms of certain cancers

Along with the general symptoms, you should watch for certain other common signs and symptoms that could suggest cancer. Again, there may be other causes for each of these, but it’s important to see a doctor about them as soon as possible – especially if there’s no other cause you can identify, the problem lasts a long time, or it gets worse over time.

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor.

Sores that do not heal

Skin cancers may bleed and look like sores that don’t heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should be seen by a health professional.

White patches inside the mouth or white spots on the tongue

White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that’s caused by frequent irritation. It’s often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it’s not treated, leukoplakia can become mouth cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

Unusual bleeding or discharge

Unusual bleeding can happen in early or advanced cancer. Coughing up blood may be a sign of lung cancer. Blood in the stool (which can look like very dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

Thickening or lump in the breast or other parts of the body

Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size. Keep in mind that some breast cancers show up as red or thickened skin rather than a lump.

Indigestion or trouble swallowing

Indigestion or swallowing problems that don’t go away may be signs of cancer of the esophagus(the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

Recent change in a wart or mole or any new skin change

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully. See pictures of skin cancers and other skin conditions in our Skin Cancer Image Gallery.

Nagging cough or hoarseness

A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the larynx (voice box) or thyroid gland.

Other symptoms

The signs and symptoms listed above are the more common ones seen with cancer, but there are many others that are not listed here. If you notice any major changes in the way your body works or the way you feel – especially if it lasts for a long time or gets worse – let a doctor know. If it has nothing to do with cancer, the doctor can find out more about what’s going on and, if needed, treat it. If it is cancer, you’ll give yourself the chance to have it treated early, when treatment works best.

Effects of taking medications

Effects of taking medications for different diseases that cause xerostomia
By Dr. H. Kopel
We all need saliva to moisten and cleanse our mouths and digest food. Saliva also prevents infection by controlling bacteria and fungi in the mouth. If saliva flow is reduced or non existent then a condition called xerostomia results. Xerostomia or dry mouth may be caused by medications.

Dry mouth is a common side effect of many prescription and nonprescription drugs, including drugs used to treat depression, anxiety, pain, allergies, colds (antihistamines and decongestants), obesity, acne, epilepsy, hypertension (diuretics), diarrhea, nausea, psychotic disorders, urinary incontinence, asthma. Xerostomia can also result from certain muscle relaxants and sedatives.

When prescription medications are suspected of causing dry mouth symptoms the patient should return to their medical doctor for substitute medications or adjustment of dosage to current medication.

Here is a list of the top 15 prescribed drugs that are associated with xerostomia:
1. Hydrocodone and Acetaminaphen, narcotic
2. Lisinopril (Prinivil /Zestril), antihypertensive
3. Simvastin (Zocor), antiperlipidemic
4. Amlodipine (Norvasc), antihypertensive
5. Alprazolam (Xanax), anti-anxiety
6. Hydrochlorothiazide, diuretic
7. Omeprazole (Prilosec), anti-ulcer agent
8. Lipitor, antihyperlipidemic
9. Furosemide (Lasix), diuretic
10. Metoprolol (Lopressor), antihypertensive
11. Sertaline (Zoloft), antidepressant
12. Metoprolol (Toprol), antihypertensive
13. Zolpidem (Ambien), seadtive/hypnotic
14. Oxycodone and Acetaminophen, narcotic
15. Citalopram (Celexa), antidepressant

Blood Thinners

By Dr. O. Karnakova

One of the most common types of drugs that can cause abnormal bleeding are blood thinners.
These classification of drugs are used for treating patients who have a type of heart or blood vessel disease, poor blood flow to the brain, atrial fibrillation, heart valve surgery, or other congenital heart defects. Blood thinners decrease the risk of a stroke or heart attack by reducing the formation of blood.

There are two main types of blood thinners. Anticoagulants, such as warfarin (Coumadin) or heparin, work by increasing the length of time your body takes to form a blood clot. Antiplatelet drugs such as Aspirin or Plavix prevent platelets in your blood from clumping together to form a harmful clot.

Patients who are taking blood thinners need to fully understand the effects of these drugs. The medication interferes with the body's normal clotting mechanism to stop bleeding. This comes as a particular concern for dentists who need to perform procedures that cause bleeding. Some of the common dental procedures associated with bleeding include: tooth extractions, implants, scaling and root planing, periodontal gum surgery, and biopsies.

It is important for patient's to correctly fill out their medical history along with a list of all medications. Please inform your dentist if you are taking any blood thinners so any precautions can be made between you, the dentist, and physician. Depending on the type of procedure, INR level, or clotting risks, your physician may inform you to do the following: continue taking the medication; change the dosage or type of medication; discontinue the medication prior to treatment. Do not under any circumstances alter or discontinue your medication without consulting your physician and dentist.

Nutrition and Oral Health

Nutrition and Oral Health
by Dr. H. Kopel

Along with regular dental check ups and good oral hygiene, nutrition plays a very important role in the health of your teeth and gums. Below is a list of common vitamins and mineral found in a well balanced diet and the role they play in oral health. If a well balanced diet is not possible then consideration should be given to a daily vitamin supplement.

In addition to proper intake of nutrients and good oral hygiene the following can provide additional protection against tooth decay:

  1. Flouride: consult with your dental professional on proper administration
  2. Xylitol: naturally organic substitute for sugar or as a supplement
  3. Remin Pro: topical application contains both flouride and xylitol plus hydroxyapatite (calcium and phosphate) to strengthen the enamel

Calcium—Your teeth and jaw are mostly made out of calcium so consuming calcium on a regular basis helps keep your teeth enamel and jaw strong and healthy. Consuming too little of calcium can put you at risk of gum disease and tooth decay.
Sources of Calcium: Milk, yogurt, cheese, beans and kale

Iron—Consuming too little of iron can cause tongue inflammation or mouth sores. The main role of iron is to transport oxygen throughout your body so a lack of iron can also contribute to infections and bacteria build up in the mouth due to lack of oxygen flow in your body.
Sources of Iron: Liver and red meat

Vitamin A—Vitamin A helps maintain a healthy saliva flow that washes away bacteria and other harmful substances from your mouth. It also helps to keep the tissues in your mouth healthy.
Sources of Vitamin A: Beef liver, sweet potatoes, melon and spinach

Vitamin B3—Vitamin B3 helps your body convert food into energy and helps your nervous system function. Consuming too little of Vitamin B3 can affect your oral health by causing bad breath and mouth sores.
Sources of Vitamin B3: Chicken and fish

Zinc—Zinc helps to prevent the growth of bacteria and the build-up of plaque along your gum line.
Sources of Zinc: Wheat, cereal, wild rice, cheese, and beef

Vitamin B12 & B2—Consuming Vitamin B12 and B2 can reduce your risk of developing canker sores, which is a painful open sore that develops in your mouth.
Sources of Vitamin B12: Pasta, bagels, spinach and almonds
Sources of Vitamin B2: Red meat, chicken, liver, pork, fish, milk, yogurt, and cheese

Vitamin C—Vitamin C plays an important role in maintaining health teeth and preventing gingivitis. A lack of Vitamin C can cause your gums to bleed and loose teeth.
Sources of Vitamin C: Sweet potatoes, raw red peppers and oranges

Vitamin D—Vitamin D helps your body to absorb calcium and should be taken alongside foods that are high in calcium. A lack of Vitamin D can lead to burning mouth syndrome, which includes a bitter, metallic taste and dryness in your mouth.
Sources of Vitamin D: Milk with egg yolk or fish to increase Vitamin D intake

Magnesium—Magnesium helps to build strong enamel for your teeth and helps prevent the formation of cavities.
Sources of Magnesium: Spinach, kale, dark chocolate

Dads’ dental fear may be passed on to their children

Dads’ dental fear may be passed on to their children

A father who is afraid to go to the dentist is likely to pass on his fear to his children, say Spanish researchers.
Although the researchers at Rey Juan Carolos University of Madrid say that previous studies have identified an association between fear levels of parents and children, no study has focused on the different roles of mothers and fathers in passing dental fear to children.
In a study published in the International Journal of Paediatric Dentistry, scientists surveyed 183 Madrid schoolchildren ranging in age from 7 to 12 years old, as well as their parents. Families received anonymous questionnaires that asked participants rated their level of fear on 15 items related to dentistry and other medical issues.
Read more on ADA News

What foods enhance people’s oral health

by Sepi Fatahi DMD

Generally, good nutrition is beneficial for oral health as well as total health. Fill your diet with fresh produce, nuts, seeds, legumes, lean meats and whole grains. These contribute to a more alkaline state in the body, which defends against bacteria and inflammation.

Avoid food with artificial preservatives, artificial sweeteners, food coloring, high fructose corn syrup, refined sugar, refined flour and partially hydrogenated oils. These contribute to a more acidic state in the body, which increases bacteria and creates inflammation.

This list of 10 superfoods for great oral health will benefit your mouth:

Kiwi. Most fruits contain Vitamin C, which is vital for the health of your gum tissue, but kiwis contain the highest amount. Without Vitamin C, the collagen in your gums breaks down, the gums become tender and more susceptible to the bacteria causing periodontal disease.

Cheese. High in phosphate and calcium, cheese helps balance the pH in the mouth, killing bacteria and preserving tooth enamel. This prevents cavities and gum disease.

Celery. As a crunchy vegetable made mainly of water, chewing celery produces saliva, neutralizing the bacteria Streptococcus mutans that causes cavities. It’s also a naturally abrasive food that massages gums and cleans between teeth.

Green Tea. Enjoyed for centuries in Asia, green tea contains catechins that kill the bacteria leading to plaque while preventing gum disease and cavities. It also inhibits the growth of bacteria leading to bad breath.

Sesame Seeds. High in calcium, sesame seeds preserve the bone around the teeth & gums. They also help slough off plaque while helping build tooth enamel.

Onions. Onions have powerful antibacterial sulfur compounds, making them terrific for oral health. They are strongest when eaten fresh and uncooked.

Shiitake Mushrooms. These mushrooms contain lentinan, a naturally occurring sugar that prevents mouth bacteria from forming plaque.

Raisins. Sweet and tasty, raisins contain phytochemicals like oleanolic acid that inhibit two species of oral bacteria to prevent cavities and gum disease.

Sweet Potatoes. Along with carrots, pumpkin and broccoli, sweet potatoes have high amounts of Vitamin A, which is essential for tooth enamel formation and promotes healing of gum tissue.

Water. Water is as effective as mouthwash at swishing away stuck particles and residue from teeth. It also keeps your gums hydrated while stimulating saliva – the best defense against bacteria.