Mouth Cancer. Eeeeek. Now this blog post is not designed to scare you, in fact far from it I want you to come away from this feeling super confident about the signs and symptoms of mouth cancer and what the next steps would be if and when the situation arises, but to get to the positives we are going to have to go through a few uncomfortable minutes talking about the details.

Mouth cancer is the 6th most common cancer in the world, there are about 8300 cases of mouth cancer diagnosed every year in the UK, so we need to know about it.

Now over the course of my career and as a student I have seen patients who have been suffering from mouth cancer. I check absolutely every patient see, sometimes twice, even if I know they have already been checked by the dentist. I complete training on the subject every year, I bring loads of patients back for reviews of areas. I get loads of second opinions, I see loads of patients be referred to oral medicine, I see loads of patients get biopsies. You would think I would hear lots of stories of these patients coming back with a positive diagnosis and in actual fact this isn’t usually the case, even so, I couldn’t sleep properly at night if I didn’t check everyone.

The reason I, and most hopefully all dental professionals, do this is the earlier we can detect something like mouth cancer the better the outcome and the quality of life for that person will be and that my friends is a reason to celebrate!!! I can’t do all this on my own though, some of my patients I only see twice a year, (some of you guys aren’t my patients but hopefully you are regularly seeing your Dentist and Dental Hygienist) some of them not even that much so you need to know the risks, you need to know what looks normal, you need to know what isn’t normal and you need to know what to do next.

The Risks

Getting Older - 2 out of 3 cases happen in over 55s, so its really important to have a dental health check every 6 months
Being Male - however the jury is out on this a bit and its my personal opinion that women are just as much at risk as men.
Smoking - again you want to have regular checks again with your Dentist at least every 6 months. The best thing for your gum health, general health and risk for mouth cancer is not to smoke.
Drinking Alcohol (which is multiplied if you smoke and drink alcohol), generally sticking to no more than 14 units of alcohol a week is fine, but the more alcohol you drink the more your risk of mouth cancer increases. Alcohol can actually also effect your gum health, you can read more about alcohol consumption and alcohol units etc on my blog post here.
HPV (Human Papillomavirus) infection - HPV has no symptoms and you may not know you have it, it is really common and most people will contract HPV in their lifetime, the best thing to do is limit your number of sexual partners you have if posible and always always practice safe sex. You can read more about HPV infection on the NHS website here.

What is normal?

The tissues inside your mouth are living and breathing and they’re going to change a lot over your lifetime, this is completely normal. Now I’ve decided not to put any crazy pictures in here because as I said earlier I don’t want to scare any one, but I am going to attach some pictures of things which are 100% normal so I don’t cause unnecessary panic, if you don’t know what these are, these things can be pretty freaky looking and I’ve had a few patients unnecessarily worried when they’ve started doing their own checks at home.

Mouth Ulcer

apthous ulcer.jpg — Mouth Ulcer 100% normal

Mouth Ulcers are super common, they usually last between 3-5 days although some massive ones can last about 10 days. Harmless ones usually sting a bit and feel swollen. I’m only really concerned if a mouth ulcer lasts for more than 3 weeks. You can read more about mouth ulcers in my blog post here.

Cheek Biting

Again this is really common, something I suffer from regularly because I clench or grind my teeth together at night and I have a really bad habit of biting the inside of my lip during the day. It can occur on both sides or just one side, it usually looks white in colour, rough and raised up in a horizontal line.

Fordyce Granules

These look like little freckles on the inside of your mouth, they look lighter in colour to the insides of your mouth, they might be raised up a bit and they can form on the insides if your cheeks or lips, even around the back of your wisdom teeth. Again I have these and they’re nothing to be concerned about.

Mandibular Tori

Some people have these, and some don’t. I actually think they’re pretty marvellous but for some Dentists and lower denture wearers they’re an absolute pain in the neck. The usually occur on the lower jaw pretty much between your lower teeth and the floor of your mouth. They are usually perfectly symmetrical and they feel hard to touch.

Circumvallate Papillae

circumvalate papillae.jpg — Circumvallate Papillae 100% normal

These are just supersized taste buds. They appear at the back of your tongue and they’re completely normal.

Swollen Glands or Lymph Nodes

If you’ve been ill, its likely that your lymph nodes are going to be a bit swollen. If this doesn’t disappear in a about 2 weeks or if it only happens on one side I would run this past your GP.

Fissured Tongue

Your tongue is like a fingerprint, it is 100% unique to you, some tongues can be fissured with deep grooves on the surface. This is completely normal.

Amalgam Tattoo

fissured tongue.jpg — Fissured tongue 100% normal

Sometimes, after a silver filling, part of the silver filling material becomes embedded in the soft tissues of your mouth. This usually happens close to a silver filling, but not always. The area should feel completely smooth and flat. We see these all the time at the dental practice.

Cold Sores

Cold sores, like mouth ulcers are really common. Some people will get them more than others. They usually appear on the outside of the lip but you can get them inside your mouth and inside your nose too. Always good to keep an eye on these and let your dentist know if you’ve had one for more than 3 weeks. These can be treated with acyclovir gels, remember if you have a cold sore you may have to reschedule your dental appointment so always best to contact your practice.

The most important thing is to find out what’s normal for YOU. You’re going to have to get all up in that mouth as best you can. Get in front of the bathroom mirror, get the light on or even better use a little torch if you have one. Make funny faces, stick your tongue out, wiggle it around, move your lips about. You want to be doing this though deliberately and regularly, we need a system in place.

Pick a day every month, the first day, the last day, maybe its the same day you check your boobs etc
Always use your finger, preferably the same finger to check

Do the same thing every time you check so you don’t miss anywhere, i’ll attach a little video but my system is:

Check the outside of your top lip then your bottom lip
Check the inside of your top lip then your bottom lip
Check the inside of your cheeks
Check the floor of your mouth
Check your tongue for blemishes top, underneath and both sides
Check your palate if you can
Check your tonsils if you can and say ahhhh
Check the sides of your neck and under your chin

You are looking for

lumps and bumps, especially if they only appear on one side
ulcers or sores that don’t heal
thickening of an area
persistant numbness
loose teeth - now don’t get too hung up on this one I know a lot of you guys that see me have loose teeth, but a tooth that has become very loose out of the blue is worth checking out
Hoarseness or sudden change in voice
Abnormal swallowing or difficulty chewing
Red or White patches
Crusts or Sores
Something that just feels plain weird and doesn’t go away after 2-3 weeks.

What to do if you aren’t happy with something

If you’re feeling unhappy or concerned, first of all take a breath and don’t panic. It could be a cut from eating something sharp or burn from eating something too hot. Could it be that you’ve bitten your cheek or tongue whilst eating or in the middle of the night? Leave it 2 weeks and if there are no changes, schedule a dental appointment. Its important to let the receptionist know over the phone that you have a concern, you may not see your regular Dentist, but you will see someone who can look at the area for you. Its important to still do this even in the middle of all of these Covid-19 regulations, don’t worry the Dentist will still be able to triage you as appropriate.

Remember a lot of cases turn out to be nothing, but its always better to have things checked, especially if you are a smoker, drink a lot of alcohol, smoke and drink alcohol or have a known history of HPV.

Thanks so much for reading this blog, remember don’t panic, the most important thing is to check yourself regularly, konw whats normal for you, attend your dentist regularly and be aware of the risks. Any questions please comment below or if you would rather message me privately you can do so through the contact us section.