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Oral Cancer: Within Normal Limits or a Dangerous Assumption?

Oral cancer is on the rise, increasingly associated with HPV rather than traditional risk factors like tobacco and alcohol use.

In 2021, the professional community was stunned by the untimely demise of a young dentist, Dr. Manu Dua. At just 34, Manu succumbed to metastatic squamous cell carcinoma, a situation that could possibly have been avoided with an earlier diagnosis. His story reflects a harrowing reality, urging us to revisit the general assumptions surrounding oral cancer and to foster vigilance that might indeed save lives.

Dentistry Today Article

The Fatal Oral Cancer Misassumption: A Journey through Denial to Realization

The saga began with a seemingly innocent lesion on Manu’s tongue, which lingered much longer than anticipated, nudging at the potential danger it signified. Manu, untethered by the traditional risk factors associated with oral cancer, disregarded it as a possibility until it was too late.

This unfortunate event showcases the precariousness of the ‘Within Normal Limits’ (WNL) assumption, a medical mantra often adopted to differentiate between health and disease, sometimes erroneously disregarding critical signals that border on life and death. The underestimation of the seriousness of symptoms that persist for over 14 days, and the relegation of younger individuals and those devoid of historical risk factors to the ‘low-risk’ category, have inarguably facilitated delays in cancer diagnosis.

A Shift in Etiologic Pathways and the Unanticipated Culprit

The American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) highlight a remarkable shift in the causes leading to oral and oropharyngeal cancer, pointing towards the rising implication of Human Papillomavirus (HPV), a virus also notorious for instigating a majority of cervical cancers.

Presently, the forefront of this battle witnesses a dramatic 225% rise in HPV-associated oropharyngeal cancer, overtaking the contribution from traditional pathways involving tobacco and alcohol use, which have fortunately descended by 50% over the past two decades. The predominance of HPV necessitates an urgent reassessment of our diagnostic strategies and popularization of the protective HPV vaccine.

Balancing Patient Welfare with Practice Sustainment

Aside from the compelling moral argument to diagnose early and potentially save lives, there’s also a monetary perspective to consider. Misdiagnosis or failure to identify oral cancer ranks as the third prevalent cause of malpractice in dentistry, harboring the capacity to financially bankrupt practitioners. The severity of indemnity payments aligns with the length of diagnosis delay, portraying a stark necessity for meticulous screening practices, and avert ‘watch and wait’ pathways that foster escalated treatment costs and patient morbidity.

Recalibrating the WNL Paradigm: A Mandate, Not an Option

A historical lens on verdicts paints a picture of escalating allegations and awards, with failures to diagnose standing tall as the most recurrent accusation across decades. A rejuvenated approach begs for the annual extraoral and intraoral examinations for all adults, intensified by more frequent checks based on individual risk profiles.

Dismayingly, less than 25% of regular dental visitors report undergoing oral cancer screening, a figure that starkly contrasts the easily executable 4-minute examination procedure that holds the potency to rewrite this narrative.

Moving Towards a Brighter Future: The Role of Vaccination and Technology

While the path appears rugged, the beacon of hope emerges through advancements in vaccination and technology. The 9-valent Gardasil vaccine presents a robust shield against potential HPV-triggered cancers, demonstrating a readiness to nip the danger in its budding stage. Technological strides have introduced VELscope, an adjunctive screening device endorsed by USI, one of the largest insurance groups in the country, acknowledging the efforts and investments of dental practices in early cancer detection, thus offering reduced malpractice insurance premiums.

Oral Cancer: A Clarion Call to Save Lives

As we stand at a juncture where a dangerous assumption contests against a life-saving intervention, the choice seems clear. A 4-minute oral examination can pivot the narrative from potential loss to prevention and recovery. Let this year echo with stories of lives saved through vigilant screenings and timely interventions, solidifying a future where WNL resounds with certainty and not regret. It’s time to shift from ‘We Never Looked’ to ‘We Never Lost.’ Let us pledge to undertake this mission with renewed zeal, advancing towards a future where oral and oropharyngeal cancer lose ground, one successful diagnosis at a time.


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  2. Dua A. Life Interupted: Dr. Dua’s Survival Guide. Laurel Elite Books; 2021.
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  11. Centers for Disease Control and Prevention. Cancers caused by HPV are preventable. https://www.cdc.gov/hpv/hcp/protecting-patients.html
  12. LED Dental officially partners with USI. Dent Today. 2023. https://www.dentistrytoday.com/led-dental-officially-partners-with-usi/


Ms. Jones is a recognized thought leader and an international, award-winning speaker who has delivered more than 1,000 presentations worldwide. She was named a 2023 Dentistry Today Leader in CE for the 13th consecutive year and is a 2021 Fellowship Award recipient with the International Academy of Facial Dental Esthetics. She partners with the Oral Cancer Foundation in conveying the urgent need for change in the way practitioners screen for oral and oropharyngeal cancer. She was instrumental in launching the international “Check Your Mouth” campaign promoting oral self-examination between professional visits. She can be reached at jjones@jo-annejones.com.

Disclosure: Ms. Jones is a consultant for LED Dental, Inc. She did not receive financial compensation for this article. 

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