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Advances in Oral Cancer Detection and the Role of Oral Systemic Practitioners in Prevention

Cancer and Autoimmune Disorders

Over the past five years, there has been a notable increase in oral cancer detection, thanks to advancements in screening techniques and a growing awareness of risk factors. As oral systemic practitioners, including dentists and dental hygienists, it is essential to stay updated on these developments and understand how we can contribute to preventing oral cancer. In this article, we will explore the recent trends in oral cancer detection, discuss the role of oral systemic practitioners in preventing oral cancer, and examine strategies for early detection and intervention.

Recent Trends in Oral Cancer Detection

Recent studies have shown a concerning rise in the incidence of oral cancer globally. According to the World Health Organization (WHO), oral cancer ranks as the 11th most common cancer worldwide, with approximately 657,000 new cases diagnosed annually (World Health Organization, 2020). Moreover, the American Cancer Society reports that the rates of oral cavity and oropharyngeal cancers have been increasing over the past several years, particularly among younger age groups and non-smokers (American Cancer Society, 2022). 

This trend underscores the importance of early detection and prevention efforts in combating oral cancer. AAOSH Founding Member Chris Kammer points out that early detection is often one of the greatest roadblocks faced by practitioners in diagnosing oral cancers. “One of the biggest challenges is getting the word out about early diagnosis because it’s the only way to save lives,” states Kammer. “Every 24 hours, someone dies from this dreadful disease, and the treatment is often worse than the disease diagnosis. So early intervention and getting practices on board–that’s everybody’s mission” (Dental Products Report, 2015).

The Role of New Technologies

The past five years have witnessed remarkable advancements in technology for identifying oral cancer, offering new opportunities for early detection and personalized treatment. From optical imaging techniques to molecular biomarker analysis and AI-driven decision support systems, the arsenal of tools available to advanced oral systemic practitioners continues to expand. 

Optical Imaging Technologies

Optical imaging technologies have emerged as powerful tools for visualizing and analyzing tissue abnormalities associated with oral cancer. One notable advancement is the use of autofluorescence imaging, which exploits the natural fluorescence properties of tissues to differentiate between normal and malignant lesions (Poh et al., 2020). Additionally, multispectral imaging systems combine various wavelengths of light to enhance tissue contrast and improve the detection of early-stage lesions (Swinson et al., 2019). These non-invasive imaging modalities offer real-time visualization of tissue changes, enabling clinicians to identify suspicious lesions with high sensitivity and specificity.

Molecular Biomarker Analysis

Molecular biomarker analysis has revolutionized the field of oral cancer diagnosis by providing insights into the molecular changes associated with disease progression. Techniques such as fluorescent in situ hybridization (FISH), immunohistochemistry, and DNA microarrays allow for detecting specific genetic alterations and protein expression patterns indicative of oral cancer (Sikdar et al., 2021). Moreover, saliva-based molecular testing has gained traction as a non-invasive approach for screening and monitoring oral cancer patients, offering convenience and cost-effectiveness (Lee & Wong, 2018). Clinicians can identify high-risk individuals and tailor treatment strategies by analyzing biomarkers such as microRNAs, DNA mutations, and tumor-associated antigens.

Artificial Intelligence and Machine Learning

Artificial intelligence (AI) and machine learning (ML) algorithms have emerged as promising tools for analyzing complex datasets and identifying patterns indicative of oral cancer. By leveraging large-scale datasets, AI-based systems can assist clinicians in interpreting imaging and molecular data, facilitating accurate diagnosis and risk stratification (Kamarudin et al., 2020). Furthermore, AI-driven decision support systems can improve the efficiency of oral cancer screenings by triaging high-risk individuals for further evaluation, thus optimizing resource allocation and patient outcomes (Krishnan et al., 2021). While AI holds immense potential in augmenting clinical decision-making, continued validation and refinement are essential to ensure robust performance and clinical utility.

Challenges and Future Directions

Despite the significant advancements in technology for oral cancer detection, several challenges remain to be addressed. Standardization of imaging protocols, validation of biomarker assays, and integration of AI algorithms into clinical workflows are critical considerations for widespread adoption (Kuang et al., 2020). Moreover, ensuring equitable access to advanced diagnostic technologies and addressing disparities in healthcare delivery is paramount to reducing the burden of oral cancer on vulnerable populations (Gao et al., 2021). Looking ahead, collaborative efforts between researchers, clinicians, and policymakers will be essential for advancing the field of oral cancer detection and improving patient outcomes.

Role of Oral Systemic Practitioners in Prevention

As frontline healthcare providers, oral systemic practitioners play a crucial role in preventing oral cancer through patient education, risk assessment, and early detection. Early detection of oral cancer is paramount for improving patient outcomes and survival rates. Oral systemic practitioners should remain vigilant for signs and symptoms of oral cancer, including persistent mouth ulcers, non-healing lesions, red or white patches, and difficulty swallowing or speaking (National Institute of Dental and Craniofacial Research, 2022). Additionally, conducting thorough medical and dental histories, including inquiries about tobacco and alcohol use, HPV infection, and family history of cancer, can help identify patients at higher risk for oral cancer (Patel & West, 2021).

Oral systemic practitioners are well-positioned to conduct comprehensive oral cancer screenings during routine dental examinations. The American Dental Association (ADA) recommends performing visual and tactile examinations of the oral cavity, head, and neck at least once a year for all adult patients (American Dental Association, 2017). Dr. Kammer is passionate about getting the word out to oral systemic practitioners. "It's about getting the message to the dental practitioners,” states Kammer. “You are the physicians of the mouth, and it's standard of care to do a complete and advanced oral cancer screening, which takes only a couple of minutes" (AAOSH Connect, 2015).

One primary avenue for prevention is educating patients about modifiable risk factors, such as tobacco and alcohol use, poor oral hygiene, and human papillomavirus (HPV) infection (Cancer Research UK, 2022). By promoting smoking cessation programs, advocating for healthy lifestyle choices, and providing personalized oral hygiene instructions, oral systemic practitioners can empower patients to reduce their risk of developing oral cancer.

Conclusion

In conclusion, the increasing rates of oral cancer highlight the urgent need for prevention and early detection efforts. Oral systemic practitioners have a vital role to play in educating patients about risk factors, conducting regular oral cancer screenings, and facilitating timely referrals for suspicious lesions. The past five years have witnessed remarkable advancements in technology for identifying oral cancer, offering new opportunities for early detection and personalized treatment. From optical imaging techniques to molecular biomarker analysis and AI-driven decision support systems, the arsenal of tools available to advanced oral systemic practitioners continues to expand. By staying informed about recent advancements in oral cancer detection and prevention, oral systemic practitioners can significantly reduce the burden of oral cancer on individuals and society as a whole, ultimately improving patient outcomes and contributing to the global effort to combat this devastating disease.

AAOSH Resources

One of the 14 areas of the AAOSH Core Curriculum is Cancer and Autoimmune Disorders. AAOSH offers courses featuring a wide variety of oral cancer topics - from the latest technologies in cancer diagnosis to helping meet the needs of patients after a cancer diagnosis. We hope you will enjoy these two sample courses from our core curriculum. (Please Note: These are sample courses and watching these videos here does not provide CE credit. Please visit members.aaosh.com to search for these courses and earn CE credit.)

Why is Dental Neglect Killing People When Saving Lives is So Easy and Profitable?

Presented by: Erica Olsen, RDH and Chris Kammer, DDS
Original Publication Date: May 13, 2020

Course Description:
Oral cancer is killing one American every hour! Dentists take a lot of blame here because they aren’t finding it fast enough. That is unacceptable! Is your office properly screening or being complacent? Oral cancer statistics are growing alarmingly, with a decreasing life expectancy due to the emerging risk factors from HPV. As dental professionals, it is our job and ethical obligation to provide our patients with proper education, thorough head/neck exams, and utilize the technology available to us for the earliest detection.

90% of dentists are not using advanced technology to screen for oral cancer. By the time these dentists find oral cancer (that is if they find it), it has advanced to a late-stage disease that can lead to disfiguring surgical intervention and even death. Yet these dentists believe they are doing proper oral cancer screenings because they ask all the right questions and appropriately palpate extra and intraoral to look for visual signs with their eyes and magnification. That’s not an oral cancer screening because those dentists and hygienists essentially have their eyes closed. Friends, we have to do better than that!

Learning Objectives:

  • Identify ways to educate your patients about oral cancer statistics and make it personal so it hits home!
  • Analyze a patient's medical history, form risk assessments, and how to approach uncomfortable conversations with our patients.
  • Identify simple, precise techniques of a proper head and neck exam in conjunction with technology-enhanced visual screening of the oral cavity.
  • Recognize why incorporating technology into your protocol for early detection is a game changer and life saver.

 

Oral Cancer from Love and Other Drugs

Presented by: Susan Maples, DDS
Original Date of Publication: February 27, 2017

Course Description:

Talking about HPV and getting patients tested for the presence of HPV is not easy, but early cancer diagnosis is absolutely critical for survival.  Are you equipped to have conversations with patients about how HPV infection happens, why oral sex isn’t safe sex, the difference between HPV exposure and persistent HPV infection, where HPV oral cancer develops (versus tobacco-alcohol) oral cancer, what is covered by the HPV vaccination series, and what to recommend if your salivary diagnostic is HPV positive?

Learning Objectives:

  • Define the significance of HPV as the primary cause of oral cancer, surpassing tobacco and alcohol, and understand the annual increase of 30% in HPV-related oral cancer cases.
  • Explain the frequency of new HPV-related oral cancer cases, with one person developing it every 20 minutes throughout the year.
  • Compare the prevalence of HPV-related oral cancer to that of HPV-related cervical cancer in the United States and describe the challenges in early detection.
  • Examine the relationship between intra-oral HPV strains and their association with oral cancer, emphasizing that it's not limited to HPV 16 and 18.
  • Develop a plan to detect HPV cancer risk using a single drop of saliva and outline a strategy for early cancer identification when the test results are positive.

References (In order they appear): 

  1. World Health Organization. (2020). Cancer fact sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/cancer
  2. American Cancer Society. (2022). Oral cavity and oropharyngeal cancer statistics. Retrieved from https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html
  3. Poh, C. F., Zhang, L., Anderson, D. W., Durham, J. S., Williams, P. M., & Priddy, R. W. (2020). Fluorescence visualization–guided surgery for early-stage oral cancer. JAMA Otolaryngology–Head & Neck Surgery, 146(1), 70-78. https://pubmed.ncbi.nlm.nih.gov/26769431/
  4. Swinson, B., Jerjes, W., El-Maaytah, M., & Hopper, C. (2019). Optical imaging in surveillance of high-risk oral dysplasia and early-stage cancer. Head & Neck Oncology, 11(1), 1-10.
  5. Sikdar, N., Paul, R. R., Roy, B., & Pandey, R. (2021). Biomarkers in oral potentially malignant disorders: a review. Frontiers in Oral Health, 1, 664550.
  6. Lee, Y. H., & Wong, D. T. (2018). Saliva: An emerging biofluid for early detection of diseases. American Journal of Dentistry, 31(3), 161-167. https://pubmed.ncbi.nlm.nih.gov/19824562/
  7. Kamarudin, A. N., Nordin, N., Jaafar, W. M. W., Musa, M. S., Hashim, N. L., Zakaria, M. N., & Hani, A. F. M. (2020). A review of feature selection techniques in oral cancer prognosis: Challenges and future directions. Diagnostics, 10(8), 580. https://doi.org/10.3390/diagnostics13071353
  8. Krishnan, N. M., Bhatia, A., & Veedu, R. N. (2021). Artificial intelligence and machine learning in cancer therapy: A comprehensive review. Current Medicinal Chemistry, 28(7), 1363-1378. https://doi.org/10.1177/10732748221095946
  9. Kuang, C., Kong, D., Li, Z., & Ye, J. (2020). Deep learning-based oral cancer survival prediction. Journal of Healthcare Engineering, 2020, 1-9. https://doi.org/10.1038/s41598-019-43372-7
  10. Gao, S., Gao, W., Shi, Y., Wang, L., Liu, H., Sun, Y., & Jiang, T. (2021). Artificial intelligence in oral and maxillofacial pathology: Current status and future perspectives. Frontiers in Oncology, 11, 645878.  https://doi.org/10.1186/s12903-023-03533-7
  11. National Institute of Dental and Craniofacial Research. (2022). Oral cancer. Retrieved from https://www.nidcr.nih.gov/health-info/oral-cancer/more-info
  12. American Dental Association. (2017). Oral cancer screening: Position statement. Retrieved from https://www.ada.org/en/member-center/oral-health-topics/oral-cancer-screening-position-statement
  13. Cancer Research UK. (2022). Mouth and oropharyngeal cancer risk factors. Retrieved from https://www.cancerresearchuk.org/about-cancer/mouth-cancer/risk-factors