We all (I assume) get at least semi-regular dental cleanings and try to keep up on our oral health. A dental visit typically includes a history, these days usually done via a form by the patient, an examination and cleaning by the hygienist, and then the dentist performs an examination. You may talk about not flossing enough, or age related tips to maintain dental and oral health. One of the subtle components of the examination that the dentist should be performing is an oral cancer screening. They will ask about and look for unexpected lesions in the mouth that may be early indications of oral or tongue cancer. These pre-cancer lesions provide warning signs to reasonably prudent dentists. With tongue cancer, the abnormal cells will often look like an ulcer, or canker sore, that does not go away.
Your dentist should be able to identify these abnormalities and evaluate them for further work up. He or she may perform a brush biopsy, which simply scrapes cells from the lesion to be examined for malignancy, or, better yet, refer you to an oral surgeon to perform a more substantial punch or incisional biopsy. The problem with a brush biopsy is that it may scrape enough for a pathologist to be able to make an accurate diagnosis. And it does not get cells deep below the surface for the pathologist to read, either. A biopsy performed by an oral surgeon will remove a piece of tissue large enough to – hopefully – make a definitive diagnosis.
Too often, dentists overlook or ignore a long-standing lesion until it is far too late. Sometimes the lesion may be mistakenly identified as hyperkeratosis, which is thickening of the skin, sort of like a callous. This may send the patient down a course of treatment that further delays treating cancer.
If enough time is allowed to lapse, the pre-cancerous lesion may have advanced to cancer, and begun spreading through the tongue and beyond. At this point the first course of treatment may be to remove a large portion of the tongue and adjacent lymph nodes, hoping that the margins are clear and the cancer did not spread to other parts of the body. Tragically, this all too often starts as a lesion in the patient’s mouth that should be identified at the dentists office.
