Dental surgeons and diagnosis of oral cancer

Squamous cell carcinoma is the most common malignant neoplasm of the oral cavity
and represents about 90% of all oral malignancies. Oral squamous cell carcinoma is an
important cause of morbidity and mortality worldwide with an incidence rate that varies widely
by geographic location. In India, oral cancer represents a major health problem constituting up
to 40% of all cancers and is the most prevalent cancer in males and the third most prevalent in
females. Even within one geographic location, the incidence varies among groups categorized
by age, sex or race. Recent publications have highlighted variations in oral cancer trends by
geographical location, anatomic site, race, age and sex. Despite several diagnostic and
therapeutic advances, the overall incidence and mortality associated with OSCC are rising, with
current estimates of age-standardized incidence and mortality being 6.6/100,000 and
3.1/100,000 in men and 2.9/100,000 and 1.4/100,000 in women, respectively.
Both public and professional awareness of oral cancer is fundamental for minimizing the
time from onset of signs or symptoms to diagnosis. In most instances, delay is attributable to
patients’ not seeking consultation. However, in a considerable number of cases, diagnosis has
been delayed because a clinician did not suspect the malignant nature of the lesion and treated
it by empirical procedures inadequate for cancer control. Most reports reveal that patients
usually delay seeking professional advice for more than 3 months after having become aware of
an oral sign or symptom. Such delays in diagnosis can only lead to local extension of a lesion
and increase the risk of metastatic Spread of Tumor, Staging, and reduce Survival rate of the
patient.
A clinician’s dilemma in oral diagnosis stems from the multitude of ill-defined, variable-
appearing, controversial, and poorly understood lesions that manifest themselves in the oral
cavity. Most of these lesions are benign, and many present changes that may easily be confused
with malignancy. Conversely, early malignancy may be mistaken for a benign change. Some
lesions are considered premalignant because they are statistically correlated with subsequent
associated cancerous changes. Inescapably, then, much clinical uncertainty is involved in the
early detection of malignancy as well as in the understanding and management of other lesions
that may not always remain benign.
The distinct and favorable features of oral cancer which helpful in early diagnosis are
1-Accessible site for routine examination
2-Low cost of oral examination
3-Most oral cancers preceded by long standing premalignant lesions and conditions
which can be prevented from transformation by early diagnosis and treatment
The dental speciality called oral medicine and radiology concerned with the oral
healthcare of medically complex patients and the diagnosis and nonsurgical management of
medically related disorders or conditions affecting the oral and maxillofacial regions. These
conditions includes oral mucosal disorders,benign and malignant tumors,oral manifestations of
systemic conditions, and oral sequelae of medical treatments.
Oral radiology and maxillofacial imaging deals with diagnosing all soft tissue and hard
tissue pathology of maxillofacial region using radiography,ultrasonography, CT ,MRI, guided
imaging etc
Inspite of remartkable progress in treatment modalities of oral cancer early detection
and early less complicated management is less in India. Dental surgeons especially Oral
medicine and radiology specialists are only able and experienced clinicians in this field of early
detection of oral diseases especially oral cancer. Premalignant lesions usually identified
accidentally in routine dental examinations.
In Kerala majority of dental treatment is provided by private clinics. The diagnosis and
early management and prevention of oral cancer is not carrying out in private clinics due to low
economic status people not seeking private health care due to high cost of dental treatment.
Low economic strata of population depends commonly Government hospitals. Dental surgeons
and oral medicine specialists has an important role in this scenario. A large number of dental
surgeons present in our country were forced to depend on private practice due to lack of job
opportunity in public sector. Number of dental surgeons in state of kerala is around ninty(90)
which is too small compared to private sector. Improving man power in dental speciality in
general and oral medicine in particular will definitely improve early detection of oral diseases,
premalignant lesions and malignancies which will prevent this dreadful disease to an extend.