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Oral cancer is rare, but according to the American Dental Association the number of cases of oral cancer is on the rise. Not only is this fact a concern among healthcare professionals, but among these cases more are being found in those who don't have the traditional risk factors for the disease.

In 75 percent of mouth cancer patients, heavy alcohol consumption and smoking are co-factors, said Dr. James Sciubba, a dentist and consultant at the Milton Dance Head and Neck Center at Greater Baltimore Medical Center and in private practice as an oral pathologist. He is also a spokesman for the ADA.

"Smoking and heavy drinking synergize to produce a higher rate of oral cancer," he said. "However, there has been a more recent trend of people under 45 and more women who have no risk factors" developing oral cancer.

Doctors aren't sure why this is happening. In women, the human papilloma virus may be a factor since there are HPV-related cancers in the head and neck, he said.

"There is more HPV out there and certain types of HPV, especially HPV16, can produce cancer," he said. "Approximately 3 to 4 percent of all cancers are oral cancer or about 29,000 cases a year."

HPV16 is the type associated with most cervical cancers and is the one predominately associated with head and neck cancers, said Dr. Robert Burk, a researcher and professor of obstetrics, gynecology and women's health at Albert Einstein College of Medicine, Bronx, N.Y.

The mortality rate, if not caught

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early, is high. "Fifty percent of mouth cancer patients don't survive after five years," said Sciubba.

However, if the cancer is discovered at Stage I or II, patients can do very well, he said. Oral cancer is a slow-growing disease and early detection is key. The ADA has therefore created an awareness campaign to get the word out.

Whether you know it or not, during your biannual dental visit, your dentist visually checks your mouth and soft tissue for any suspicious lesions or spots. Anything suspicious will be tested.

"These exams should include all the soft tissues of the mouth, the oropharynx, lips and manual palpation of all the salivary glands and cervicofacial lymph nodes," said Dr. Robert Meisner, a dentist in East Aurora, N.Y. "I also always examine the thyroid gland since it is a common place for pathology."

Meisner speaks about dental health topics, including oral cancer, on radio and TV programs in the Buffalo area.

"I recommend to people that they observe how their doctor examines them," he said. "Does he or she pull the tongue out with a gauze and carefully inspect the lateral borders and interior surface? Do they examine these soft tissues every year?"

He said the incidence of oral cancer in his practice is low, less than 15 cases in his 30 years of practice. Two local dentists we spoke with reported the same. "Ninety-nine percent of the time when I see something, it's nothing to worry about," said Dr. Jeffrey Cahn, a dentist for 27 years practicing in Stamford. "Every six months I'm looking at [a patient's] soft tissue — tongue, hard and soft palette, inside the cheeks, lips.

"We're dealing with a cancer showing itself in a very exposed way. The ADA ad campaign is trying to target those people who don't go to the dentist regularly," he said. "The incidence of oral cancer is not tremendously high, but it's significant."

In the past, a scalpel biopsy, which is "the gold standard," said Sciubba, was the only choice to check for oral cancer. But, more recently, there is a simpler and painless way to test for pre-cancerous cells called the BrushTest.

Sciubba compares it to the Pap test, which screens for cervical cancer, to catch the disease at an early stage. It's not a routine test, like the annual Pap smear should be for women, and is used only if the dentist sees something.

Cahn, for one, would like to see more routine testing and said he believes such a test is in development. To aid dentists in spotting suspicious areas they may not normally see, the dentist may use a light device such as ViziLite or VELscope.

Cahn started using the BrushTest about three years ago and has had very few cases of cancer. He said the test involves no cutting, but rather the dentist brushes the suspect area with a circular brush then swabs the collected cells onto a slide, which is sent to a lab for testing. A report is faxed back to the dentist's office in a few days.

"Statistically, oral cancer is a very small percentage of total cancers detected," Cahn said. "The problem is if oral cancer is not detected early enough, there is a high mortality rate.

"In general, it's not detected early enough. If we can catch these things early, we are definitely saving people's lives," he said.

Dr. Ellen Karandisecky, a Bridgeport dentist in practice for 24 years, has used the BrushTest about two dozen times in the past couple of years and had only one positive result, she said.

"If I see something suspicious I tell the patient about the brush biopsy," she said. "For any additional attention, they go to an oral surgeon.

"People come in and you may be their only health-care provider," she said. "They need to realize that oral cancer is out there and don't take a wait-and-see attitude."

For more information, visit the American Dental Association Web site at www.ada.org.