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Dentistry and Disease Detection Carlos Ugalde, DDS, MS and Ashifa Nurani, DDS

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A visit to the dentist can be the difference between life and death. The authors present a case using dental screening to detect oral cancer.

by Carlos Ugalde, DDS, MS and Ashifa Nurani, DDS


In today’s busy world, getting a regular dental cleaning is often thought of as just another errand to run. But routine checkups are often a way to detect serious diseases. For most of our patients, their concerns are focused primarily on maintaining good oral health, which is extremely important. But many people do not realize that a regular dental cleaning can be the only way to learn of a severe medical condition. With the improvements in screening technology, the dental community is often a first line of defense in detecting many life-threatening diseases. From oral cancer to diabetes to kidney failure, dentists, dental hygienists and oral surgeons all play an important role in identifying signs of disease and, ultimately, saving lives.

According to the American Cancer Society, oral cancer kills approximately 7,880 people annually in the United States – that’s nearly one person every hour, 24 hours a day. In 2010, an estimated 36,540 people were diagnosed with new cases of oral cancer in the U.S. alone.¹ As the sixth most common cancer, oral cancer occurs nearly as frequently as leukemia and is more deadly than melanoma or cervical cancer.²

This disease, though serious, can be effectively combated if diagnosed and treated quickly. While recent statistics are grim, 90 percent of oral cancer cases are in fact curable if found in their earliest stages.³ Unfortunately, early detection accounts for only 35 percent of all oral cancer cases.4 Recent advances in screening technology put dental professionals in a unique position to significantly improve these statistics and potentially save thousands of lives each year.

Other serious health conditions that dental professionals might be able to identify are diabetes and kidney failure. Diabetes and pre-diabetes are often linked to periodontal disease, which can be easily detected during a simple dental cleaning.5 Clues left in the mouths of diabetics include inflammation, infections, dry mouth, burning tongue, persistent gingivitis and multiple lesions.6 Dental professionals can help patients with periodontal disease understand the link to diabetes and act on it, preparing the patient with the tools to ward off full-fledged diabetes later in life. Dentists can also find evidence of kidney failure, as indicated by delayed tooth development in children, dry mouth, odor, metallic taste and ulcers on the tongue and gums.7 If left untreated, kidney failure can cause complications such as anemia, high blood pressure, congestive heart failure and eventually, death.8

The oral health community is an important line of defense in the early detection of many diseases. During a recent visit to a Bright Now! Dental office in Bellevue, Washington, the patient’s dental team detected tongue cancer, an often-overlooked form of the disease, and encouraged him to seek immediate treatment. Thanks to this early detection, the cancer was far less life threatening and easier to treat than it could have been. Here, we explore the important link between dentists and disease detection in the case study presented below.

Case Study

Thomas Guffey, 56, is employed at a shipyard in a stressful job due to the hazards his work involves. He developed the habit of smoking in his 20s, consuming approximately two packs of cigarettes per day. Thomas drinks two to three cups of coffee per day but rarely drinks alcohol. Good oral hygiene has never been important in his life and consequently he has lost many of his teeth. During the last two years he has been developing pain in his lower jaw due to caries (cavities) on tooth #32 (a wisdom tooth). Thomas continued to ignore the problem and did not seek dental care because of financial and time issues. In recent months, his pain worsened with difficulty swallowing, and a rightsided otalgia. Ultimately his wife urged him to visit his dentist to determine the source of his pain and discomfort.

The general dentist referred Thomas to Dr. Ugalde, an oral surgeon, for extraction of some root tips in his maxilla and tooth #32. During his visit, Thomas showed no interest in the extraction of the upper teeth, for financial reasons, and only asked for the removal of his wisdom tooth, so he could get back to work as soon as possible. The exam showed poor oral hygiene with severely decayed teeth and ulceration on his tongue adjacent tooth #32. His neck exam showed no evidence of any lymphadenopathy. This ulceration could have been caused by the broken third molar, and Dr. Ugalde decided to monitor it for the next two weeks for spontaneous healing before doing a biopsy.

Thomas recovered well from the extractions, but his ulceration remained. While he had refused a biopsy in the past, Dr. Ugalde convinced Thomas to move forward with the procedure because of the ulceration’s persistence. Dr. Ugalde worked with Thomas to ease his financial concerns and was able to make the procedure affordable to him.

The diagnosis of his biopsy was squamous cell carcinoma – a type of oral cancer that accounts for 90 percent of diagnoses.9 Dr. Ugalde explained the diagnosis when Thomas and his wife came back to his office for a follow-up visit. He was scheduled for an evaluation with a head and neck oncologic surgeon immediately.

The following month, Thomas had a resection of his tongue cancer, radical neck dissection and reconstruction with a radial forearm free flap. Fortunately, his diagnosis was not too late and the cancer was removed completely.

Early diagnosis is of vital importance for the prognosis of the patients with oral squamous cell carcinomas. For this reason, dentists play a crucial role in the early detection and prevention of oral cancers. A few months after his recovery, Thomas and his wife came back to Dr. Ugalde’s office for a surprise visit. As he walked into the reception room full of patients, he happily shouted to staff members across the office, “Thank you all! You saved my life!”

This particular case underscores that a visit to the dentist can be the difference between life and death. It is critical that both patients and dental professionals understand the importance of dental screenings as they apply to disease detection. The dental community has an incredible opportunity to change the face of oral health as it applies to overall health.

References
  1. American Cancer Society (2010). Oral Cancer. Retrieved September 19, 2011 from: http://www.cancer.org/acs/groups/content/@nho/documents/document/oralcancerpdf.pdf
  2. Kademani, D. (2007). Division of oral diagnosis and oral and maxillofacial surgery. Mayo Clinic Proc, 82 (878-887). Retrieved September 20, 2011 from: http://www.ncbi.nlm.nih.gov/pubmed/17605971
  3. National Cancer Institute (2011). General information about lip and oral cavity cancer. Retrieved September 17, 2011 from: http://www.cancer.gov/cancertopics/pdq/treatment/lip-and-oral-cavity/HealthProfessional/page1
  4. Alfano, M. C., Horowitz, A. M. (2001). Performing a death-defying act. Journal of the American Dental Association, 132. Retrieved September 18, 2011 from: http://jada.ada.org/content/132/suppl_1/5S.full
  5. Burkett, S., Cheng, B., Kunzel, C., Lalla, E., Lamster, I.B. (2011). Identification of unrecognized diabetes and pre-diabetes in a dental setting. Journal of Dental Research, 90, (855-860). Retrieved September 23, 2011 from: http://jdr.sagepub.com/content/90/7/855.full
  6. Diabetes Research & Wellness Foundation (2011). Periodontal disease and diabetes. Retrieved September 18, 2011 from: http://www.diabeteswellness.net/Portals/0/files/DRWFUSteeth.pdf
  7. Delta Dental (2011). Part dentist, part detective: Importance of dental visits increases with understanding of greater connections. Retrieved September 20, 2011 from: http://www.deltadentalil.com/Disease_Detection_0906
  8. Patel, P. (2009). Chronic kidney disease. Retrieved September 19, 2011 from: http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm
  9. American Dental Association (2011): Oral Cancer: The Importance of Early Detection. Retrieved September 19, 2011 from: http://www.ada.org/2607.aspx#earlydetection


Author’s Bio
Dr. Carlos M. Ugalde is a graduate of Doctor of Dental Surgery in 2003 from the Latin American University of Science and Technology in San Jose, Costa Rica. He completed residency training in oral and maxillofacial surgery and Master of Science at The Ohio State University in 2008, and cleft and craniofacial surgery fellowship at the University of Oklahoma in 2009. Ugalde is a diplomate of the American Board of Oral and Maxillofacial Surgery and affiliate faculty at the Department of Oral and Maxillofacial Surgery at the University of Washington. He runs a private practice in Lacey, Washington.

Dr. Ashifa Nurani is market dental director for the affiliated offices of Smile Brands, Inc., in Washington state. She oversees more than 60 providers and 16 of Smile Brands’ 337 affiliated dental offices.
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