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The Oral Cancer Foundation estimates that close to 42,000 Americans will be diagnosed with oral or pharyngeal cancer this year. Oral cancer’s mortality is particularly high, not because it is hard to detect or diagnose, but because the cancer is often discovered late in its development.
Factors That May Cause Cancer
Research has identified a number of factors that may contribute to the development of oral cancer. In the past, those at an especially high risk of developing oral cancer were over 40 years of age, heavy drinkers and smokers.
While smoking and heavy drinking are still major risk factors, the fastest growing segment of oral cancer patients is young, healthy, nonsmoking individuals under the age of 40. Recent research has identified the human papillomavirus version 16 as being sexually transmitted between partners and related to the increasing incidence of oral cancer in young non-smoking patients. There are also links to young men and women who use conventional “smokeless” chewing or spit tobacco.
Perform a Self-Exam Monthly
Everyone should perform an oral cancer self-exam each month. The oral exam should be performed using a bright light and a mirror:
- Remove any dentures
- Look and feel inside the lips and the front of gums
- Tilt head back to inspect and feel the roof of your mouth
- Pull the check out to see its inside surface as well as the back of the gums
- Pull out your tongue and look at all of its surfaces
- Feel for lumps or enlarged lymph nodes (glands) on both sides of the neck including under the lower jaw
When performing a self-examination, look for the following:
- White patches of the oral tissue – leukoplakia
- Red patches – erythroplakia
- Red and white patches – erythroleukoplakia
- A sore that fails to heal and bleeds easily
- An abnormal lump or thickening o the tissues of the mouth
- Chronic sore throat or hoarseness
- Difficulty in chewing or swallowing
- A mass or lump in the neck
Your mouth is one of your body’s most important early warning systems. Don’t ignore any suspicious lumps or sores. Should you discover something, call our office for an appointment. If we determine that something looks suspicious, a biopsy may be recommended. A biopsy involves the removal of a piece of the suspicious tissue, which is then sent to a pathology laboratory for a microscopic examination that will accurately diagnose the problem. The biopsy report not only helps establish a diagnosis, but also enables us to develop a specific plan of treatment.
Early treatment may well be the key to complete recovery.
Oral and Maxillofacial Surgeons are beginning to see a growing number of patients with symptoms of osteonecrosis of the jaws, an often painful condition characterized by exposed dead or dying bone in their jaws. Further investigation revealed a link between these cases and the use of bisphosphonate and other antiresorptive drugs.
What are Bisphosphonate Drugs?
Bisphosphonates are a class of drugs that prevent the loss of bone mass. High-potency intravenous bisphosphonates have been shown to modify the progression of malignant bone disease in several forms of cancer, especially breast and frequently prostate cancer. Oral bisphosphonates are used to treat osteoporosis, osteitis deformans (Pagent’s disease of the bone) and other conditions that lead to bone fragility.
What is MRONJ?
Medication Related Osteonecrosis of the Jaw (MRONJ) can be described as an area of bone in the jaw that has died and been exposed in the mouth for more than 8 weeks in a person taking any bisphosphonate or other antiresorptive medication. Although the exact cause is unknown, MRONJ is considered to be a side effect of bisphosphonate and antiresorptive medication therapy.
Symptoms of MRONJ include:
- Exposed bone
- Localized pain
- Swelling of the gum tissues and inflammation
- Loosening of previously stable teeth.
MRONJ is usually identified by the appearance of exposed bone in the oral cavity.
Risk Factors for MRONJ
While the majority of patients on intravenous (IV) and oral bisphosphonates will not develop MRONJ, it is important to understand the risk factors for the disease. Three categories of risk factors have been identified for the disease.
- Use of bisphosphonates or other antiresorptive medications such as Prolia. Although this is a common reason for the development of MRONJ, it is the dosage and length of therapy that are the determining factors.
- Duration or number of treatments with bisphosphonates appears to increase in relation to the number of treatments with an IV bisphosphonate.
- Dental procedures. Patients undergoing routine dental surgical procedures, including tooth extraction, periodontal surgery or dental implant placement, while being treated with bisphosphonates comprise about 60% of MRONJ cases.
Oral hygiene is particularly important if you are being treated with bisphosphonates. It is also crucial that you schedule regular examinations with your family dentist and/or Associates in Oral and Maxillofacial Surgery so that any infections or problems can be identified and addressed early.
Perform a regular self-examination or your mouth for signs and symptoms of MRONJ, such as pain, swelling, and exposed bone. Early detection allows Associates in Oral and Maxillofacial Surgery to diagnosis and treats the condition as quickly as possible.
How is MRONJ Treated?
If you are diagnosed with MRONJ, it is very important that your treatment plan includes regular and thorough communications between your physician, family dentist and oral and maxillofacial surgeon. There is a number of treatment options available to the oral surgeon, who will select the one most appropriate for you. Treatment may include:
- Daily irrigation and antimicrobial rinses.
- Antibiotics to control infection.
- Surgical treatment to remove the necrotic bone may be advisable in more advanced cases.
Well-fitting dentures can be worn if appropriate care is taken to minimize irritation to soft-tissues. This is particularly important for patients who are receiving IV bisphosphonate therapy. Dentures should be removed and thoroughly cleaned each night.
Bisphosphonates are excellent medications for bone diseases and osteoporosis that help relieve bone pain and prevent fractures. However, long-term use of bisphosphonates, particularly IV bisphosphonates for metastatic bone disease, may be associated with a small but real risk of developing osteonecrosis of the jaw. While MRONJ is a new and potentially serious condition, it is important to know that the doctors of Associates in Oral and Maxillofacial Surgery are experienced and knowledgeable in the prevention and treatment of this disease.
Facial injuries also referred to as facial trauma, encompass any injury to the mouth, face and jaw and associated facial structures. Most facial injuries are caused by a sports mishap, motor vehicle accident, on-the-job accident, act of violence or an accident in the home.
Oral and maxillofacial surgeons, the surgical specialists of the dental profession, are specifically trained, skilled and uniquely qualified to repair and manage injuries to the teeth, mouth, jaws, and associated facial structures.
Treating Facial Injury (Trauma)
Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures to the upper or lower jaw and/or palate), or injuries to special regions (cheekbones and eye sockets).
Soft Tissue Injuries
When soft tissue injuries such as lacerations occur on the face, they are repaired by “suturing” or sewing up the laceration. In addition to the obvious concern of providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). Our surgeons are proficient at diagnosing and treating all types of facial lacerations.
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient. When an arm or leg is fractured, a “cast” is often applied to stabilize the bone and allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaws. However, certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small “plates and screws” at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of “rigid fixation” have profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner. Importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is “hidden.”
Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth which have been displaced or “knocked out.” These types of injuries are treated by one or a number of forms of “splinting” (stabilizing by wiring or bonding teeth together). If a tooth is “knocked out,” it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better for the survival of the tooth. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to “wipe the tooth off.” Since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.
Don’t Treat Any Facial Injury Lightly
While not all facial injuries are extensive, they are all complex since they affect an area of the body that is critical to breathing, eating, speaking and seeing. Even in the case of a moderately cut lip, the expertise of the oral and maxillofacial surgeon is indispensable. So a good rule of thumb is not to take any facial injury lightly.