FDI WorDental Daily 30 Aug

Science & Practice Friday&Saturday, 30–31 August 2013 D etecting and managing po- tentially malignant dis- eases of the mouth still pose challengestodentalprofessionals worldwide. At the 2013 FD AWDC, Worldental Daily had the opportu- nity to speak with FDI presenter Prof. Stephen Porter from the UCL Eastman Dental Institute in Lon- donaboutnewriskfactors,preven- tion strategies and why actor Michael Douglas is not a good posterboyforchangingawareness of throat and mouth cancer. I Worldental Daily: A recent study on Turkish dental patients in cen- tral Anatolia has shown that only one in two people are aware of oral cancer. Are these results represen- tative of most people’s knowledge about the condition nowadays? Prof. Stephen Porter: It is not un- common for individuals not to be aware that cancer can arise in the mouth.Indeed,therearestudiesindi- catingthatevenpatientswithoutcan- cer who attend clinics that specialise in mouth cancer are unaware of the possibility.Thistrendregardingalack ofawarenessoccursacrosstheglobe, although it varies between countries. I WithcelebritieslikeactorMichael Douglas struggling publicly with the disease, do you think aware- ness of malignant diseases of the mouth is increasing? Undoubtedly, it will increase. Whenacelebrityannouncesthathe or she has a particular disorder, there is often an upsurge of refer- rals by concerned individuals. In the UK, this was perhaps best illus- trated when Freddie Mercury de- clared that he had HIV. There was a substantial rise in the number of persons seeking advice and/or testing for the disease in the after- math. A fair number of famous people have had oral cancer, including Sig- mund Freud, Ulysses S. Grant and TVproducerAaronSpellingtoname but a few. In the UK, journalist and first husband of TV cook Nigella Lawson John Diamond wrote a se- ries of articles detailing the progress of his disease and its treatment that informed many of the impact this disease can have on an individual and his or her family. Unfortunately, the Michael Dou- glas situation has perhaps con- fused the exact role of the human papillomavirus (HPV) in mouth can- cer. Certainly, it can cause mouth cancer and it can be acquired through orogenital contact, but there is no evidence that such con- tact will lessen any subsequent risk of contracting mouth cancer. I Oral cancer figures are rising worldwide. What are the reasons for this, and does it fulfil the crite- ria for an epidemic, as it has been called in some media reports? An epidemic is defined as new cases of a disease in a given human populationoveraparticularperiod. It often has an emotive element to it. Oral cancer certainly is on the in- crease in the developed world, al- though the number of new cases is falling in some parts of the globe, notably parts of India. The rise in some countries is gradual but sustained. Smoking to- bacco and/or drinking alcohol are the two factors that traditionally have given rise to mouth cancer. In addition, individuals are now ac- quiring cancer-causing (oncogenic) types of HPV, probably via orogeni- tal contact. This burst of infectious disease, or indeed sexually trans- mitted infection, is not a new phe- nomenon, but it has become much more manifest in the last 30 years. So, what is new is probably that oncogenic types of HPV are just more common in the sexually active population than in the past. The exact risk that it carries is unclear but it has been suggested that the risk of HPV-related mouth and/or throat cancer climbs when someone has had more than nine different sexual partners. I Whatotherfactorsbesidessmok- ing,drinkingandHPVarecurrently being investigated, and what is their malignant potential? People chew betel nut prepara- tions (e.g. paan masal and gutka) in parts of India, Pakistan, Bangladesh and surrounding ar- eas. These cause initial fibrosis of theoraltissue,termed“submucous fibrosis”, which carries a high risk of causing oral cancer of possibly 30 per cent. Submucous fibrosis can arise even in young individuals and is irreversible, and thus pa- tients are likely to have a lifelong risk of mouth cancer, even if they stop the causative habit. The night- mare scenario is that when examin- ing a patient with submucous fibro- sis the mouth opening can be so small that a clinician may be unable to see the cancer. Mouth cancer can also arise in patients who have rare genetic dis- orders, such as Fanconi anaemia and dyskeratosis congenita, but themostcommonoraldisorderthat is considered to be potentially ma- lignant is oral lichen planus. This is a global disorder that typically oc- curs in middle-aged and older women. It is a chronic immune dis- order that may cause painless white patches that sometimes are accompaniedbypainfulerosionsor ulcers. It affects about 1 to 2 per cent of the population and is the most common disorder to affect the lining of the mouth (the oral mu- cosa). It has been suggested that 1 to 2 per cent of patients with oral lichen planus will develop mouth cancer, but this risk is highly unpredictable because it does not appear to be consistently associated with the duration or type of treatment of the lichen planus, nor the age or sex of the patients, nor their alcohol or to- bacco habits. The good news, per- haps, is that 98 to 99 per cent of pa- tients with oral lichen planus will not contract mouth cancer. Isolated white or red patches on the oral mucosa (sometimes termed“leukoplakia”and“erythro- plakia”) have malignant potential as well, but these are actually un- “Thepatientshouldbetoldthetruth” 6 www.fdiworldental.org VarioFocus: See more, to know more Worldwide first adaptable system to all common dental microscopes (microscope head Opmi Pico) Small in size, big in performance Recognize better structures Shorter treatment times Flexible treatment options with two working distances 215 – 285 mm 200 – 350 mm PLAN-APO Important contribution for the quality and photo documentation CJ Consultation · Carsten Jung Charlotte-Bamberg-Strasse 4 D-35578 Wetzlar · Germany Phone: +49 (0) 6441 89 70 55 8 Fax: +49 (0) 6441 897 197 Homepage: www.cjconsultation.de E-Mail: info@cjconsultation.de AD AninterviewwithProf.StephenPorter,UK IProf.StephenPorter(DTI/PhotocourtesyofUCLEastmanDentalInstitute,UK) “Oral cancer certainly is on the increase in the developed world.” “There is no evidence that a particu- lar frequency of dental examination will lessen the risk of mouth cancer.”