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Profile in Oral Health Trisha E. O'Hehir, RDH, BS Editorial Director, Hygienetown Magazine

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Lynda Young, RDH, MA, thought she had a simple, pesky ear ache; but further inspection eventually led to some grim news – she had oral cancer, and she had a 15 percent chance of survival. With treatment and a positive outlook, she beat the odds, and is now an advocate for stronger oral cancer screening.


by Trisha E. O'Hehir, RDH, BS
Editorial Director,
Hygienetown Magazine
Lynda Young, RDH, MA, holds a package of 3M Vanish Varnish

The problem with oral cancer is that it's easily overlooked. Early stages are painless and virtually undetectable. It's not until advanced stages that the tumor makes itself known. Lesions on the lips are easily noticeable and monitored by the patient, however the lips are no longer a common site for oral cancer. Cancers are more frequently found in the anterior part of the oral cavity like the tongue or the floor of the mouth. Recent trending data suggest that younger, nonsmokers are being diagnosed with lesions at the base of the tongue, the oropharynx (the back of the throat) on tonsils, and tonsillar pillars and crypts. Lesions at the base of the tongue and in the throat are not visible when performing a traditional oral cancer exam. Since the disease becomes increasingly more fatal as it progresses, other red flags would certainly be helpful in catching these cancers in earlier stages. It's up to the clinician to be a good detective, look carefully and ask questions. New cancer screening technology will help with visible lesions, but careful observations by the clinician are still the best tools we have for early detection.

Lynda Young had been experiencing a persistent ear ache for a while. Ear aches happen – but mostly to children because of the small size of their eustachian tubes – so she thought it odd that she couldn't get rid of hers, especially because she had no upper respiratory infection. Age wasn't an issue and she'd never smoked a single cigarette in her life. She went in for more tests and she was eventually diagnosed with oral cancer that was not visible during a routine oral cancer exam. Lynda's journey from an ear ache to diagnosis to radiation and chemotherapy was chock full of lucky breaks bolstered by her unwavering positivity. Lynda did what many oral cancer patients couldn't – she beat it.

Fortunately for us (and unfortunately for oral malignancies), Lynda is a dental hygienist, clinician, educator and director of continuing education at the University of Minnesota- School of Dentistry. She's organized many courses for dentists and hygienists on oral cancer and oral pathology and does oral cancer screening exams on all her patients. Never did she think she'd have to face this disease herself. I had the chance to interview her about her experience, what it taught her and how she's able to spread the message about more and better oral cancer detection.

Lynda, I never knew an ear ache was a red flag for cancer. This is news that all clinicians should know.
Young: I didn't know it either, but when I visited an urgent care center on July 3, I was lucky to connect with a physician who didn't automatically prescribe antibiotics. She told me that in the absence of an upper respiratory infection, an ear ache is a red flag and might indicate a malignancy. She ordered immediate blood tests and a CAT scan for July 5. This was my first lucky break - being seen by an astute physician who didn't automatically prescribe antibiotics, which would have delayed the correct diagnosis allowing further aggressive growth of the cancer.

Looking back, were there any obvious signs of cancer?
Young: There were two things related to the cancer that didn't seem important at the time. I was singing in a church choir for the first time in many years, and while I sang, I felt like I was spitting. This was most likely due to the floor of my mouth being shallower as the tumor pushed up on it. The second was noticed by an acupuncturist I was seeing for typical dental hygiene neck and upper back pain. Upon the full exam, the acupuncturist noticed that my uvula was deviated to the right, the direction of the tumor. The pressure of the tumor probably caused the uvula to tip to the right.

Where exactly was your tumor?
Young: The tumor was at the base of my tongue and front of my throat. It measured five-to-seven centimeters and could not be seen in my mouth. After the CAT scan, the physician used a nasal scope to enter through my nose to look at the tumor. This is not a common screening exam, so finding the tumor earlier would not have happened with routine examinations, even with the latest technologies.

What happened next?
Young: A biopsy was the next step, and my HMO wanted me to wait three weeks. Looking back, with such an aggressive tumor, waiting three weeks would have delayed treatment and allowed the tumor to grow. I was lucky to have friends at the University of Minnesota School of Dentistry who knew people who could get the biopsy scheduled within a week. When it comes to cancer care, you have to be your own advocate to be sure you get the care you need in a timely way.

Was the diagnosis clear cut from the start?
Young: The biopsy was read by a physician from the HMO and I was told it was a Stage 1-2 squamous cell carcinoma. With the urging of several friends, I requested a second opinion with Dr. Kerry Olson at the Mayo Clinic in Rochester, Minnesota. Everyone I spoke with recommended Dr. Olson for this type of cancer treatment. When he looked at the biopsy specimen, his diagnosis was Stage IV, basaloid squamous cell carcinoma, a much more aggressive type of cancer. This type of cancer can grow within weeks, which is what happened in my case. It's essential the physician nail the diagnosis, if they expect to nail the treatment. That is when I decided to seek treatment at the Mayo Clinic.

I elected not to have surgery, as that would have meant removal of my tongue, leaving me unable to eat or speak. Instead, the team of doctors recommended the maximum dose of radiation and the maximum chemotherapy to be done simultaneously, since it was already Stage IV and was such an aggressive form of cancer.

Lynda, how did you maintain a positive outlook in the face of such a grim diagnosis and prognosis?
Young: The news was bad. I was given a 15-19 percent chance of survival. When faced with such bad news, I knew I had to be hopeful and positive. To do that I asked each of the three physicians involved in my treatment the same question, "Can you tell me the most positive thing you can about my condition?"

The answers were encouraging. First I was told, "You are young and healthy and have no compromising conditions." The radiologist told me, "The type of cancer you have is very responsive to radiation therapy." The best news came from Dr. Olson, who said, "We are going for the cure."

I left with those positive thoughts in mind and kept repeating them to myself. Remember, all cancers are curable, someone has been cured from every type of cancer known, so why couldn't I?

The mind is an amazing tool. Placebo drugs work, because the mind believes they will work. Stress is in the mind and it can negatively affect health. A positive attitude will also affect health, but in a good way. I used it to my advantage. Faith, prayer and belief in the possibility of healing gives us all hope.

My advice to others facing cancer is: Coach your doctors in the direction you want your treatment to go. You want them to aim for a cure, not just remission. Also, support from family and friends is critical.

Tell me about your simultaneous radiation and chemotherapy.
Young: The radiation therapy was Monday to Friday for seven weeks. Specific coordinates are used to be sure the radiation targets the exact spot each time. As the tumor reduces in size, the coordinates are changed. Using impression techniques, the radiologists created a mask of my face and neck, much like a fencing mask, on which they marked the coordinates. They also put a tiny tattoo on my chest, as a stable coordinate. For the treatments, my head was placed on a stabilizing form, the prosthesis was placed over my face and the radiation was focused on the exact location of the tumor. The coordinates were determined with the use of the CAT scan and an MRI and a PET scan. Re-imaging was done weekly during the radiation therapy to adjust coordinates as the size of the tumor reduced.

Chemotherapy began with a loading dose of Erbatux, a reasonably new drug that helps direct the radiation to the tumor. I was also treated with Cisplatin. As expected, I became very sick. Morning sickness with vomiting happened nearly every day.

As clinicians, we deal with the side effects of radiation and chemotherapy in our patients. Now, you have direct experience as to what they feel like. What side effects did you experience?
Young: By the third week, the radiation burns in my mouth were significant. Eating was impossible and vomiting each morning added to the pain in my mouth. None of the drugs the doctors prescribed helped with the vomiting. A feeding machine dripped a liquid formula into a portal surgically placed next to my belly button. Just like eating, this had to be done several times a day for three months and I couldn't do it alone. Normally, the constant attention needed to control the titration of the feeding machine would be easy, but I was unable to handle what came so naturally when healthy.

At five weeks, I became very sick and needed to be hospitalized. I was hospitalized again two to three weeks after the treatment and also spent a few weeks in a nursing home to recover. I was thankful that I would be leaving the nursing home, as the other residents would not.

The treatment sounds horrible. Did you begin to feel better after the treatment?
Young: No, as a matter of fact, the worst part came after the radiation therapy and lasted a couple of months. The mucositis was extremely painful and the pain medications didn't help. The tissue sloughed away and a yellow goo seeped down onto my teeth. The sloughing of the tissue was likely very acidic and is what accounts for decay for many people since eating and drinking anything but water are completely intolerable. I was still on the feeding machine and slept 90 percent of the time during my recovery. Of the whole process, care during the two months of recovery was the weakest link. This was the worst time and care during this period isn't as well defined as it should be. It takes a couple of months after the treatment to begin to see beyond simply surviving each day and actually looking ahead.

What did you do to protect your oral health during treatment and afterwards?
Young: Before beginning radiation therapy, patients are sent for an oral exam and the dental "OK" to begin treatment. This is when I had fluoride varnish applied to my teeth and repeated every month or two. The radiologists at Mayo Clinic recommended fluoride gel in trays, which was the worst thing for burned and sloughing tissue. Fluoride varnish was magic for me! It doesn't touch the tissue and daily compliance by the patient is eliminated. I survived the entire treatment and recovery with no decay, thanks to the fluoride varnish and excellent dental and dental hygiene care.

What effects did the radiation have on your tongue?
Young: The tongue is a muscle, and mine was damaged, so after the radiation therapy, swallowing wasn't normal. I can swallow about 80 percent of a mouthful the first time, but the rest stays in my throat and I need to swallow more to get it all down. There is nerve damage on my right side due to the treatment, which accounts in part for the swallowing disorder. The speech therapist suggested turning my head to the right when I swallow, which does help.

What is your message to dentists and hygienists doing oral cancer exams?
Young: Be vigilant, ask questions, look further back in the mouth, look for even slight changes from normal. If a patient came to me with an ear ache, a change in the uvula or a feeling of excess saliva, I would put the pieces of information together differently than I did in my own case.

What advice do you have for clinicians treating oral cancer patients?
Young: The oncologist can save a person's life, but it's the dentist and the hygienist who are responsible for the quality of that life; for the ability to eat and speak. Be sure the radiation oncologists know your practice/team is available to do preradiation screenings and help people going through radiation therapy with oral mucositis. The time to intervene is before radiation treatment begins.

This is also the time to begin fluoride varnish applications. This is extremely valuable for preventing tooth decay. Dentists, please write prescriptions for salivary enhancing drugs before the salivary glands are destroyed. These drugs work with existing saliva and take a month to kick in, so start patients at the time radiation treatment begins, not after. Don't wait until there is no saliva to prescribe the drugs.

Ask patients if they are on a feeding tube. When they begin eating again, see them more often as the risk for caries goes up with eating.

Check for mucositis. The pain is significant and the patch and oral pain medications don't alleviate it. Prescribe the Magic Mouthwash made of Benadryl, Milk of Magnesia, liquid anesthetic and an antifungal if necessary. This really works and I counted the minutes until I could use it again.

Check jaw opening and teach patients to stretch their jaws daily to regain optimal opening using tongue blades or fingers. This stretching is important to continue for an entire year after treatment in order to maintain maximum opening capacity.

What was the most important thing you realized going through this experience?
Young: I wasn't an average patient. I was extremely lucky to be working with some of the finest experts in oral cancer and xerostomia right here at the University of Minnesota. They made sure I was treated by the best at the Mayo Clinic and they shared their expertise with me. I'm fortunate in many ways as now, two-and-a-half years later, the oncologists have declared the cancer cured, not in remission. However, I believe that the most important thing about my experience was to maintain a positive outlook, to have hope and faith.
Dentaltown Magazine
September 2025
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