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Cancer is a Scary Word by Lee Ann Brady, DMD

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Cancer is a scary word. Truth is, it’s even more frightening in reality than the word can convey. I was trained to complete a head and neck oral cancer screening 26 years ago in dental school and have been doing them routinely ever since. The problem is that head and neck cancer hasn’t stayed the same in those 26 years, so why should our detection and screening not advance to meet the challenge?

Approximately 42,000 people in the U.S. were diagnosed with oral cancer in 2013 and expectations are the number will rise to between 43,000 and 45,000 in 2014, according the Oral Cancer Foundation. Oral cancers include those cancers that occur in the mouth itself, those on the exterior lip of the mouth, and those in the oropharynx, oropharyngeal cancers. The number of oral cancer diagnoses has been on a steady rise for the past five years, and 2007 saw the greatest single increase in incidence rates of over 11 percent. To put these numbers into perspective, 100 people will be diagnosed with oral cancer everyday in the U.S., and once every hour someone dies from this disease.

So what do we know about cancer? There are two major etiologies in patients with cancer. Traditionally, tumors were caused by environmental factors (smoking and drinking), immunosuppression (congenital, HIV and transplantation), severe vitamin deficiencies, poor oral hygiene and nutrition, syphilis and radiation therapy. More recently human papilloma virus (HPV) has caused a paradigm shift in this disease. HPV, cervical cancer in women and is causing oropharyngeal cancers in both sexes. A small percentage of people (less than 7 percent) do get oral cancers from unidentified causes. It is currently believed these are likely related to some genetic predisposition.

The incidence of classic head and neck cancers is decreasing, but HPV-related head and neck cancers are increasing. Between 1988 and 2008 there has been more than a 200 percent increase. Consider that it is estimated about 80 percent of the adult male population has been exposed to HPV.Most people with healthy immune systems clear the virus within 24 months of exposure, however, in some people the virus can lie dormant for decades before progressing to cancer.

The survival rate for oral cancer is vastly different depending on when it is detected. When found at early stages (Stage I and II) of development, oral cancers have an 80 to 90 percent survival rate. Early stage detection also allows for less invasive, less life-devastating treatments. Unfortunately most oral cancer isn’t detected until in the late stages (Stage III and IV), and this accounts for the very high death rate of about 43 percent at five years from diagnosis. Late stage diagnosis also can necessitate traditional treatments like surgery and radiation therapy and high treatment-related morbidity in patients who survive the cancer. Late stage diagnosis is not occurring because most of these cancers are hard to discover; rather it is because of a lack of public awareness. Dentistry has the opportunity to change this and save lives.

About a year ago two events made me decide I needed to increase our ability to diagnose oropharyngeal cancer for our patients. The first was a patient with cancer. We did not find Dan’s cancer at a dental visit, it was found only once he had difficulty swallowing. I partnered with him before he began his treatment to help prepare him for the dental consequences and try to prevent massive damage to his teeth. Over the course of his medical treatment I watched as he couldn’t eat or even brush his teeth because his oral tissues were so painful. We worked together to think of ways he could keep his mouth clean, manage the burning tissues and improve his quality of life. Just when we thought we were on the other side, the next phase of challenges emerged. Radiographs had documented incredible external root resorption that would most likely cost him most of his posterior teeth on the side where he received his radiation therapy.

The second instrumental event was attending a lecture by Dr. Ted Teknos on oropharyngeal cancer. I learned much about the disease, its progression and treatment, but that is not what I left with. The message I took away was the need for awareness on the part of our patients about the risks, and the gift of early detection. The first change we made in our office was to be an advocate for our patients to understand what oral cancer is and that it can be found early and then treated successfully. This began by explaining to patients why we have always done such a thorough head and neck screening and what we are looking for. Patient information grew by adding pamphlets on oral cancer and information to the patient education slideshow that plays in our reception room. Helping our patients become aware was an important first step, but fulfilling on the promise of making a difference meant finding out how to get better at early detection.

My research ended with a decision to acquire a VELscope for our office and have every team member complete the training. I have a very basic paradigm when it comes to new technology or materials in my practice. First and foremost it has to effectively and efficiently provide the top quality of care for my patients. When it comes to efficiency, VELscope does not require the use of rinses, dyes or extended time to complete. The VELscope works by emitting a safe, visible blue light that causes the oral tissues to fluoresce.

Oral tissues contain “fluorophones” which are excited by a blue light of an appropriate wavelength and then emit their own light at a different wavelength, causing them to look predominantly green. Healthy tissue has its own particular pattern or appearance with fluorescence, which is strongly affected by abnormal processes that result from tissue injury or disease. The resulting abnormal fluorescence appearance (typically presenting as a marked and unusual loss of fluorescence) is often more dramatic and easily visible than the changes observed with conventional illumination. The VELscope helps me detect abnormal areas requiring follow-up that we might otherwise have missed had we performed only the traditional head and neck exam.

In just a few minutes during a hygiene exam we complete a VElscope exam in addition to our traditional head and neck screening. We put a pair of orange glasses on the patient and dim the lights in the room. With a clean shield on the VELscope we look through it and activate the light. Through the lens of the VELscope we examine all of the oral tissues, base of the tongue and as far back in the throat as we can visualize. With training and experience, we have a good sense of what type of fluorescence pattern is indicative of normal tissue or a normal variation. Tissue that has an unusual appearance through the VELscope, such as a pronounced loss of fluorescence in an area of the mouth that typically presents as a bright green, will get our attention. We are particularly concerned about abnormal areas for which we have no plausible explanation.

Inflammation associated with tissue injury or infection will almost always display a loss of fluorescence and so we can use a blanching technique to help us characterize these areas. When tissues blanch under diascopic pressure, it indicates that inflammation is present. In such cases, we try to ascertain the cause of the inflammation, deal with it if possible and have the patient return for a post op check in 14 days to make sure that the area has resolved. Abnormal areas with an unknown cause which persist despite our best efforts to deal with a possible cause are referred to a specialist for further evaluation.

Fortunately we have only had to refer about four patients, but more fortunately the three whose diagnosis was cancer were caught early enough that the prognosis is excellent. Every time we finish a head and neck exam and VELscope exam with no findings, we breathe a sigh of relief, and each time we find something I am glad that we may have helped spare a patient from the aggressive and debilitating treatment I watched Dan go through.

The death rates from oral cancer do not have to continue to rise, and we have the ability to help create awareness in this country, one patient at a time in our offices. As dental professionals, we are a key to both early detection of this disease and to aiding with the side effects (xerostomia, destruction of the dentition, etc.) for patients undergoing cancer treatment. Early detection is time well spent versus sitting with patients having difficult conversations about how we can support them through aggressive treatment. However you decide to make a difference, be an advocate for stopping this disease.

  Author's Bio
Dr. Lee Ann Brady earned her DMD degree from the University Of Florida College of Dentistry. She lives in Phoenix, Arizona, with her husband, Kelly, and three children Sarah, Jenna and Kyle. She maintains a private restorative practice in Glendale, Arizona. Outside of her private practice, Dr. Brady teaches her own courses at meetings around the country, as well as provides a resource for dental professionals on the Web. When not focused on dentistry she enjoys time with her family, being outdoors, gardening and reading.
Dentaltown Magazine
September 2025
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