Introduction

How you care for your dental and oral health may impact your risk of oral cancer. Any illness affecting your oral health may affect your ability to smile, speak, taste or eat. Oral cancer is one such illness. 

Cancer is the harmful, uncontrollable growth of cells in any part of your body. It comes with pain, sadness, worry and sometimes disfigurement for you. Read on to learn about oral cancer, its connection to your dental and oral health and how to prevent it.

Understanding oral cancer

Oral cancer is a cancer that develops on any part of your mouth and the back of your throat.^1,2 

Oral cancer is the 13th most common cancer in the world. Globally, oral cancer is estimated to have affected 377,713 people and caused 757 deaths in 2020.²

In 2019, in the UK, 3,108 people had mouth cancer, 2,324 people had oropharyngeal cancer, and 116 people had lip cancer. Oral cancer affects more men than women in the UK and globally. It is also more common in older adults.^1,2

Oral cancer is deadly because it can spread quickly, but early detection and treatment improves outcomes.^1,3

Types of oral cancer

Oral cancer is categorised into three groups:^1,2

1. Mouth or oral cavity cancer: This is a cancer that develops on
   • your inner lip
   • parts of your tongue aside from the back of your tongue
   • your gum
   • the floor of your mouth (under your tongue)
   • your palate (the roof of your mouth) or
   • other unspecified parts of your mouth

2. Oropharyngeal cancer: This is when cancer develops on
   • the back of your tongue
   • your lingual tonsils
   • your tonsils
   • the back of your throat or
   • other unspecified parts of your upper throat 

3. Lip cancer: This is cancer that develops on your outer lip

Warning signs and symptoms of oral cancer

The key to early detection of oral cancer is recognising its signs and symptoms. They include:^1,3,4

• Mouth ulcers lasting for longer than three weeks 
• Swelling or hardening of any part of your mouth lasting for more than three weeks 
• A persistent lump on your head, neck, lip or inside your mouth
• Erythroplakia — red patches inside your mouth
• Leukoplakia — thick white patches inside your mouth
• Erythroleukoplakia — a miss of red and white patches inside your mouth
• Feeling a constant pain in your mouth, throat or when swallowing for more than three weeks 
• Persistent hoarseness occurring for more than three weeks 
• Bad breath 
• Consistent weight loss
• Shaking tooth
• Delayed healing of a tooth extraction site
• Difficulty chewing, speaking or moving your jaw or tongue
• Bleeding in the mouth 
• Ear pain

Erythroplakia, leukoplakia and erythroleukoplakia are not always cancer-related.¹ 

Additionally, some people with oral cancer may not experience any symptoms.¹ 

Causes and risk factors of oral cancer

You're at risk of oral cancer if you:^1,2,3,5

• smoke, chew, sniff or take tobacco in any form
• drink alcohol, especially in excess 
• chew areca nut (betel nut) or its leaves
• have a human papillomavirus (HPV) infection
• expose your skin — a risk factor for skin cancers including lip cancer — to too much sunlight or ultraviolet (UV) light
• don't practice good oral hygiene
• don't have a healthy diet rich in fruits and vegetables
• are older than 40 years
• have a weakened immune system (e.g. people with HIV/AIDS)
• have untreated oral health conditions like erythroplakia, leukoplakia and erythroleukoplakia
• had oral cancer before or other head and neck cancers, particularly cancer of the cervix, food pipe (oesophagus) and lung
• have a close relative who has had a head and neck cancer
• use the hypertension drug called hydrochlorothiazide
• live a sedentary lifestyle 

Your risk of oral cancer may be even higher if you have multiple risk factors. For example, evidence shows the chance of having oral cancer is higher for people who smoke and also drink.¹

Diagnosing oral cancer

You should visit your dentist if you notice unusual or uncomfortable changes in your mouth. To diagnose oral cancer, your dentist or healthcare provider will:¹

• Ask you about your symptoms
• Examine your medical, dental and family medical history 
• Ask you questions about your lifestyle habits, such as smoking and drinking
• Examine your mouth (inside and outside), neck and throat

Your dentist or doctor will request you do more tests if they find anything suspicious or refer you to a specialist such as a head and neck doctor, an ear, nose and throat doctor (ENT) or an oncologist.^3,6,7

Further tests the specialist might carry out include:⁷

• Nasoendoscopy — a test to look inside your nose, mouth and throat
• A biopsy
• A CT scan of your head, neck, chest and abdomen 
• An MRI scan of your head and neck 
• An x-ray of your mouth and jaw

The link between oral or dental health and oral cancer

Oral cancer affects your dental and oral health, so they are connected.

How poor oral hygiene can increase cancer risk

Poor oral or dental hygiene involves:⁸

• Not brushing your teeth at least twice daily
• Not brushing your teeth thoroughly
• Not flossing your teeth
• Missing teeth
• Not visiting your dentist regularly
• Not promptly taking care of any oral health condition

Poor oral hygiene, especially in addition to tobacco use (smoking or otherwise), areca nut chewing and alcohol use, increases your risk of oral cancer.^8,9

Early detection of oral cancer through regular dental visits

Part of practising good oral hygiene is doing regular dental checkups. Your dentist would likely be the first to detect oral cancer, especially if you have no symptoms. So, regularly going for dental visits gives you a higher chance of noticing oral cancer early. Early detection of oral cancer increases the success of your treatment and survival rate.^10,11

A healthy diet and its role in oral health

A healthy diet is rich in fruits and vegetables and low in saturated fat, added sugars, processed foods and alcohol. Eating healthy benefits your general health. A healthy diet nourishes your body with essential nutrients. It ensures your body is strong enough to fight against infections like HPV and diseases such as oral and dental health conditions.

Prevention and early detection of oral cancer

You can implement strategies to prevent oral cancers and ensure you find out early if you happen to develop one. Consider the actions explained below.

Maintaining a healthy lifestyle

Maintaining a healthy lifestyle is an important strategy to prevent oral cancer and other chronic diseases. It also guarantees a higher chance of detecting oral cancer early. 

Limiting your alcohol and tobacco use

Alcohol consumption and tobacco use are major causes or risk factors of oral pre-cancers and cancers. Drinking less alcohol and stopping tobacco use will help you prevent oral cancer effectively.^11,12

At least to maintain a low risk of oral cancer and other alcohol-related diseases, the UK Chief Medical Officers (CMOs) advise you to¹¹

• keep your alcohol intake to less than 14 units a week and spread your drinking evenly over three or more days 
• go several days a week without drinking any alcohol 

Maintaining good oral hygiene

Taking proper care of your mouth will reduce your risk of precancerous oral conditions, such as erythroplakia, leukoplakia and erythroleukoplakia, and oral cancer.

Ways you can maintain good oral hygiene include:

• Proper brushing¹³: Thoroughly brushing your teeth regularly prevents plaque (bacteria) build up on your teeth, which causes gum disease and tooth decay. Follow these steps:
  • Brush your teeth for about two minutes at least twice daily — preferably before you go to bed and any other time of the day — with a toothbrush and fluoride toothpaste
  • Ensure you brush the inner, outer and chewing surfaces of your teeth
  • Brush your tongue to prevent bacterial buildup
  • Don't rinse your mouth with water or use mouthwash immediately after brushing, as this will reduce the effect of the fluoride
  • Instead, spit out excess toothpaste and rinse your mouth much later

• Proper flossing: Regularly flossing or using an interdental brush before brushing your teeth removes food particles wedged between your teeth and plaque. Flossing helps prevent gum disease and bad breath¹³
• Using mouthwash: Using a fluoride mouthwash can help you prevent tooth decay. But don't use it immediately after brushing. For example, you may use it after lunch if you brush mornings and nights. Wait 30 minutes after using a fluoride mouthwash before you eat or drink anything¹³
• Addressing dental problems promptly: You should immediately go to your dentist if you experience unusual changes in your mouth. This will ensure you get prompt diagnosis and treatment for any oral or dental health problems
• Regular dental checkups and cleanings: You should get your mouth checked and cleaned regularly by your dentist. Regular dental visits will ensure your mouth stays healthy or you gain early awareness of any health problems and get early treatment. Your dentist may determine the frequency of your visits based on your oral and dental health and risks of problems, but ensure you attend every appointment¹⁴

Eating a balanced diet rich in fruits and vegetables

A healthy, balanced diet rich in vegetables and fruits is essential for overall health and well-being. Besides the vital vitamins and minerals fruits and veggies will provide you, they also give you a healthy dose of antioxidant substances that reduce your risk of cancer, cardiovascular diseases, diabetes, neurological disorders, inflammatory diseases and other health problems.¹¹

Taking measures to prevent HPV infection

Human papillomavirus, or HPV, is a very common sexually transmitted infection (STI) that can cause some types of cancer, such as cervical cancer and increase your risk of others, such as oral cancer. HPV-positive oral cancer is mainly diagnosed in younger people who don't smoke or drink little or no alcohol. For most people (about 90%), HPV doesn't cause any health problems and goes away within a year or two without the person knowing it was even there. However, it is advisable to be cautious.^5,15,16

You can prevent HPV infection by:¹⁵

• Getting vaccinated: HPV vaccination protects you against infection. No HPV infection means prevention of diseases and cancers caused by HPV and reduced risk of cancers like oropharyngeal cancer. Consult your doctor for advice on getting the vaccine
• Practice safe sex: You can lower your risk of getting infected by using a condom or dental dam during sex and maintaining one sexual partner, preferably someone who you're sure has a sexual relationship with you alone

Self-examination for oral cancer

The Mouth Cancer Foundation recommends you check your mouth for cancer once a month. The oral self-check is easy, provided you have a good mirror and lighting. Ensure you thoroughly clean your teeth and wash your hands before starting. Ask a relative or friend to help you check if you're unsure about doing it yourself. Follow the steps outlined by the Mouth Cancer Foundation. 

See your dentist or healthcare provider if you see or feel anything unusual, including sores, lumps, red or white patches and changes in colour or texture.

Regular dental screenings

Although there is no national screening programme, your dentist or doctor will probably recommend regular dental screenings or checkups for oral pre-cancer and cancer screening if you're at a high risk, for example, if you smoke, drink or have an HPV infection. According to the UK National Health Service (NHS), most people diagnosed with oral cancer are between the ages of 66 and 70. So, it may benefit you to get regular oral cancer screening if you're around or in this age bracket.^14,17

Treatment and support for oral cancer

The current treatment options for oral cancer and support channels are discussed below.

Available treatment options

Treatment for oral cancer may depend on its severity, location of cancer, size and type of tumour, your overall health and the side effects of the available treatments.^3,18

Available treatments for oral cancer are:^3,18

• Surgery — to remove the tumour
• Radiotherapy — using radiation to kill the cancer cells
• Chemotherapy — using drugs to kill the cancer cells
• Targeted therapy — using certain drugs to pinpoint and eliminate cancer cells
• Immunotherapy — boosting your immune system to identify and kill cancer cells
• A combination of treatments

According to the US National Cancer Institute, surgery or radiotherapy cures oral cancer in its early stages — stages 1 and 2. Stage 3 and 4 oral cancer often requires a combination of treatments, including treatment and supportive care to manage symptoms.^18,19

Support for oral cancer

If diagnosed with oral cancer, your journey to recovery wouldn't need to be lonely. In addition to your healthcare team, you and your family can access support groups and organisations ready to help. You can find those supporting

• cancer patients in general
• head and neck cancer patients
• oral cancer patients
• mouth cancer patients
• and a host of other categories depending on the type or area affected.

In the UK, your healthcare team may recommend local support services available to you. You can check this NHS page for a list of cancer support organisations and more information on getting the support you need. 

Surviving oral cancer 

Survival from oral cancer depends on how serious it was when you got your diagnosis, the area affected and whether it is HPV positive or negative.^11,20

In England, statistics for people diagnosed with oral cancer from 2009 to 2013 who survived for five years or more are 56% of mouth cancer patients and 66% of oropharyngeal cancer patients. NHS England, the Department of Health & Social Care, and the Office for Health Improvement & Disparities say survival rates are improving.¹

HPV-positive (caused by HPV) oral cancer is often oropharyngeal cancer. In terms of survival, people with HPV-positive oropharyngeal cancer do better than HPV-negative patients.²⁰

Summary 

Oral cancer is a dangerous disease that you could prevent by taking proper care of your mouth, stopping tobacco use and limiting alcohol consumption. Just as your diet improves your dental health, it may also help reduce your risk of oral cancer. Proper oral hygiene won't only keep your mouth clean but also help detect oral cancer early. So, ensure you see your doctor or dentist immediately if you notice uncomfortable changes in your mouth because early detection of oral pre-cancers and cancers improves your treatment outcome.