Oral Cancer – what you need to know

April is here, bringing warm wet weather, Easter egg hunts, and dreams of May flowers.  But April is an important month in other ways, as it is oral cancer awareness month.  That means that now is a great time to learn a little more about the signs, symptoms and causes of this disease.  Maybe not something we all want to talk or think about, but very important. According to the American Academy of Oral and Maxillofacial Surgeons, oral and pharyngeal cancer kills nearly one person every hour of every day of the year. 

Oral and pharyngeal cancer is located in the oral cavity, nose, pharynx, voice box trachea and esophagus.  The mortality rate is higher than other cancers because typically it is not detected early.  The prognosis for patients who have oral cancers is much higher the earlier it is detected.   Oral cancer can be broken into two categories, non-HPV related oral cancers and HPV related oral cancers.

The most common cause of non-HPV related oral cancers are excessive alcohol and tobacco use.  In particular, the combination of smoking and heavy alcohol use increases the risk of oral cancer by 15 times, according to the NIH.  Men are at higher risk than women, as well as those age 55 or older.   Exposure to sunlight can increase the risk of oral cancers of the lip (so don’t forget your sunblock!)

Signs and symptoms of oral cancer caused by tobacco usage and/or excessive alcohol usage may include one or more of the following and are persistent in nature (meaning they do not resolve on their own and linger beyond two weeks:

  • Any sore or ulceration that does not heal within 14 days.
  • A red, white, or black discoloration of the soft tissues of the mouth.
  • Any abnormality that bleeds easily when touched.
  • A lump or hard spot in the tissue, often on the lateral border of the tongue or underneath the tongue.
  • Tissue raised above the area that surrounds it; a growth.
  • A sore under a denture, which even after adjustment of the denture that does not heal.
  • A lump or thickening that develops in the mouth.
  • A painless, firm, fixated lump felt on the outside of the neck that has been there for at least two weeks.

HPV related oral cancers differ slightly form non-HPV cancers.  HPV is the human papilloma virus.  According to the CDC, up to 8-0% of Americans with have an HPV infection during their lifetime, but the great majority (99%) will not develop cancer as their immune system will clear the virus.  Men are affected more than women (approximately 4:1), particularly white, non-smoking men between the ages of 35-55.  The HPV vaccine protects against cancers caused by the virus.  Your child can and should be vaccinated as early as 11 or 12.  The vaccine is recommended for young women through age 26 and young men through age 21.

Signs and symptoms of HPV related oral cancer may include:

  • Hoarseness or sore throat that does not resolve.
  • A painless, firm, fixated lump felt on the outside of the neck, which has been there for at least two weeks.
  • Constant coughing that does not resolve.
  • Difficulty swallowing; a sensation that food is getting caught in your throat.
  • An earache on one side (unilateral) that persists for more than a few days.

In addition to preventing, identifying and treating diseases of the dentition and periodontium, one of the most important jobs your dental team does is screen for oral cancer.  This includes both an extra oral assessment of the head and neck region as well as a thorough assessment of the oral cavity including the lips, tongue, tongue, cheeks, tonsils and throat.  If you have noticed a lesion that you are concerned about, make sure to let your dental team know.  

There is always more to learn about Oral Cancer.  Check it all out at the Oral Cancer Foundation’s web site.

By Dr. Warder, Dental Director

What you need to know about Juuling (and other electronic cigarettes)!

Juuling has quickly become very popular in our high schools, colleges, and even middle schools.  While electronic cigarettes were created to help people quit smoking, in young people they are actually becoming the introduction to tobacco use.  Here are some key things to know:

Safer does not equal safe.  Yes there are no studies linking e-cigarettes to cancer.  Just because e-cigarettes are safer than traditional cigarettes does not mean they are safe.  They still contain many chemicals that we know are airway irritants and carcinogens.  They contain nicotine.   We have no long term studies of the safety of e-cigarettes.

Nicotine is addictive. The Juul pods contain the same amount of nicotine as a pack of cigarettes.    Some e-cigarettes juice is even stronger.  Studies have shown e-cigarette fluid that claims to be nicotine free often contains nicotine.  We also know nicotine affects the developing brain leading to difficulties with attention, learning, impulse control, and mood.

Teens are the target of advertisement. Juul, the most common e-cigarette used among teenagers, began advertising on Youtube, Instagram, and Twitter.  There is a huge social media presence of Juul and Juul is starting to show up in TV shows and movies.  #doitforJuul is a common hashtag that people use to show them using a Juul.  This affects teens, even if they do not realize.

People vape a variety of substances. On youtube you can find videos of people using a variety of fluids including caffeine, alcohol, and Marijuana. Anytime someone is breathing in a substance, it is likely to irritate the airwyas.  There have even been cases of people dying after vaping synthetic cannabinoid.

Juul use is increasing tobacco use among teens. Starting in the 1990s there was a steady decline in tobacco use among teenagers, reaching as low as 12% of all teenagers ever using tobacco.  With the advent of Juul, as many as 35% of teenagers admit to using nicotine containing products.  Unfortunately, many of these Juul users go on to smoke traditional cigarettes.

Juul and other ecigarette companies create fruit flavored fluids that appeal to young users.  Juul can be easily concealed and has become a trend among high school students.  Our teens are getting addicted to nicotine and we must do our best to prevent this!

By Dr. Ashlee Mickelson

Nurse Practitioner Residency Program Receives Accreditation

The CHAS Health Nurse Practitioner Residency Program has received accreditations from the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC). The NNPRFTC serves as a national accrediting organization, focused on consistently upholding the principles of excellence in accreditation and clinical training while fostering innovation and leadership in healthcare. Accreditation shows the commitment of CHAS Health to provide the highest levels of rigorous clinical training for postgraduate trainees and the same high level of conduct in business practices.
The CHAS Health Nurse Practitioner Residency Clinic opened in August 2017, to help train the next generation of Nurse Practitioners beyond their stand-alone education. The clinic is designed for fully licensed and credentialed ARNPs seeking to perfect their knowledge, skills, and abilities in a real world primary care setting. The program has expanded healthcare access to patients, while advancing the education of new nurse practitioners. The clinic has three long-term CHAS Health providers onsite, who provide guidance for three fully licensed ARNP Residents during the 13 month program.
Through accreditation, CHAS will be able to further develop our program through self-evaluation; identification of strengths and weaknesses; on-going refinement of the curriculum; and program enhancements to meet changing practice environments. For our patients and communities, accreditation is beneficial because it promotes the health, safety and welfare of society by fostering the development of competent health professionals, some of whom we hope to retain.
This is trailblazing work, as less than 10 programs are accredited nationally and CHAS Health was the first to successfully receive pre-accreditation prior to full accreditation.