Frequently Asked Questions

Oral Cancer

Oral cancer, the sixth most common cancer, accounts for about 3.6 percent of all cancers diagnosed, with roughly 40,0000 new cases of oral cancer reported annually in the United States. The vast majority of oral cancers occur in people older than 45 years, with men being twice as likely as women to develop the disease.

The most frequent oral cancer sites are the tongue, the floor of the mouth, and soft palate tissues in back of the tongue, lips and gums. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery, and even death. Your general dentist can perform a thorough screening for oral cancer.

Scientists aren’t sure of the exact cause of oral cancer. However, the carcinogens in tobacco products, alcohol and certain foods, as well as excessive exposure to the sun have been found to increase the risk of developing oral cancer. Risk factors for oral cancer may also be genetically inherited.
Oral cancer – represented by red, white or discolored lesions, patches or lumps in or around the mouth – is typically painless in its early stages. As the malignant cancer spreads and destroys healthy oral tissue, the lesions or lumps become more painful. However, oral cancer is sometimes difficult to self-diagnose so routine dental exams are recommended.

See your dentist immediately if you observe: any sore that persists longer than two weeks; a swelling, growth or lump anywhere in or about the mouth or neck; white or red patches in the mouth or on the lips; repeated bleeding from the mouth or throat; difficulty swallowing or persistent hoarseness.

Your dentist should screen for oral cancer during routine checkups. He or she feels for lumps or irregular tissue changes in your neck, head, cheeks and oral cavity, and thoroughly examines the soft tissues in your mouth, specifically looking for any sores or discolored tissues.
If your dentist suspects oral cancer, a biopsy of the lesion is required to confirm the diagnosis. Surgery is required to remove the tumors, which may cause disfiguration. Radiation therapy may be used as part of the treatment.
Oral cancer accounts for roughly 9,000 deaths annually (about 3 percent of all cancer-caused deaths). Of all major cancers, oral cancer has the worst five-year survival rate at about 54 percent. Because oral cancer is usually not diagnosed in its early stages, less than half of all oral cancer patients are cured. You can prevent oral cancer by not smoking, using spit tobacco and drinking excessive alcohol. When tobacco use and alcohol use are combined, the risk of oral cancer increases 15 times more than non-users of tobacco and alcohol products. Research suggests that eating plenty of fruits and vegetables may safeguard against oral cancer. Because successful treatment and rehabilitation are dependent on early detection, it is extremely important to see your dentist for an oral cancer screening and regular checkup at least every six months. Survival rates greatly increase the earlier oral cancer is discovered and treated. During your next dental visit, ask your dentist to do an oral cancer screening.

Managed Care Answers

To purchasers primarily concerned with cost, managed dental care is likely to grow more prevalent. Short-term cost savings make it appealing, and too often quality considerations take a back seat to the bottom line emphasis. But aggressive, sophisticated marketing of direct reimbursement programs by the dental community has the potential to undercut the seemingly inevitable trend toward managed dental care. About one-third of Americans have dental insurance. While managed care will represent an ever growing portion of the insured dental market, most care will reflect a fee-for-service, market driven reality.

While there is some evidence that judiciously applied managed care is demanded by excesses of American medical care, the same case cannot be made for intrusion in dentistry. From 1960 to 1991, the average annual increase in U.S. health care expenditures was 11.3 percent. Dental care costs rose significantly over this same period, but dental increases were substantially outstripped by hospitals, physicians, and other general health care costs hikes. A cost/benefit analysis concludes that the dramatic recent improvement in American’s oral health is unparalled in the rest of the health care system, despite a drop in dental expenditures over the same period. The dental profession has failed to adequately communicate its successes in prevention and primary care, and failed to take credit for an extraordinarily cost effective delivery model. To insert dentistry into a costly and too often ineffective medical model would be an economic mistake and clinical travesty.

Because dentistry represents such a small slice of the American health care pie, it is too often mingled indiscriminately with medical care by public policy makers and independent health care analysts. Current dental care costs are 4.2 percent of U.S. health care costs compared to 6.2 percent in 1975 and 7.4 percent in 1960.

The rhetoric of managed dental care is that of a responsible, prevention-oriented oral health system. The reality of such dental plans is too often assembly-line, low-quality care. Managed care generally is predicated upon disease prevention, leading to long-term health improvements or stabilization and long-term cost savings. This implies significant front-end investment in an individual’s health needs. Given the volatile and transient nature of American health and dental insurance (where the average person remains in a health plan less than two years before changing), there’s little incentive for insurers to make the very investments that lend legitimacy to the managed care concept. Why invest in a patient’s care today if the benefits of that investment accrue to a rival health plan in the years to come?

The conclusion is inescapable: managed health care too often saves money by denying patients needed and appropriate care.

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