The early warning signs of cancer can appear suddenly, and when faced with a potential diagnosis, endodontists have to be prepared. During this time, it is especially important for endodontists to perform their diagnostics correctly, inspecting areas not normally looked at for extra precaution and assurance for the patient. Oral cancers, in particular, can be especially life-threatening, which is why endodontists need to provide the best resources possible for their patients. In these cases, many endodontists have protocols in place to perform accurate diagnoses and recommendations for their patients, and below we’ll be offering a brief explanation of this process and what special precautions are taken to determine if cancer is present:
Diagnostic Tools Used To Identify Oral Cancer
Dentists in this position need to be able to provide oral cancer tests to locate and diagnose the affected tissues within the mouth and facial regions to provide the best outcome for their patients. These tests help observe the tissue’s current state and any associated behaviors but first determine whether the cancer is present at all or if it is related to other oral health conditions. These tests include:
- Endoscopies: Endoscopies are one of the main ways dentists locate tumors, using thin, flexible tubes to check areas inside the mouth and throat. The tube has a view lens attached to it to help the dentist locate it, determine its type, and notice other factors related to the tumor’s behaviors.
- Barium Swallowing Tests: Barium swallowing tests help dentists identify areas of abnormal tissue growth in the oropharynx. During the test, patients swallow small portions of liquid barium, which allows the dentists to observe how the liquid passes through the oral cavity to the stomach and observe signs of blockage.
- Oral brush biopsies: Oral brush biopsies help dentists submit small samples of tissue to oncologic laboratories for additional testing. These tests use a small collection of tissue cells that are then submitted to a pathologist or oncologist to determine the type of cancer.
- HPV Testing: In rarer cases, HPV has been linked to certain types of oral cancer and can sometimes be used to determine if cancer is present.
Alongside these tests, endodontists will use MRI scans, x-rays, and CAT scans to observe the oral cavities from various angles to notice details about the affected area, including its location, ability to spread, and symptoms. From there, the type of cancer would need to be determined to further progress with potential treatment options. Some of the types of cancer that affect the mouth include:
- Lymphoma: Because the oral cavities contain numerous lymph nodes, lymphoma can occur anywhere where the lymph nodes form, including the mouth.
- Mucosal Melanoma: The mouth also contains numerous mucosal membranes, and mucosal melanoma is considered one of the most commonly found cancers within the mouth.
- Sarcoma: Tissues such as fat, nerves, blood vessels, and fibrous tissues can be affected by sarcoma cancer, although it occurring in the mouth is considered rare.
- Minor Salivary Gland Cancer: In some circumstances, carcinoma-type cancers can also appear within the salivary glands throughout the mouth.
Afterward, the stage and grade of cancer need to be determined to be able to identify factors such as growth speed, severity, affected areas, and other factors involved. In these cases, endodontists need to work alongside their patient’s pathologists and oncologists to identify its stage within the staging system. The staging system has four categories, which include:
- “T” for Primary Tumors: Abbreviated as “T” within the system, it’s considered the first stage for identifying cancer’s location and size. The size is measured in millimeters and centimeters, and each stage is separated into smaller groups to help further describe the tumor in detail, including any nearby structures, its progression into the muscles and bone, the number of skin layers it’s reached through, and how advanced it has become.
- “N” for Regional Lymph Nodes: The “N” stage assesses the clinical and pathological infection of the cancer cells in relation to the lymph nodes. This assessment determines the speed and rate at which the infected cancer cells can spread and determines how the immune system is responding to those cancer cells.
- “M” for Metastasis: Also abbreviated as “M,” this stage determines the rate at which cancer spreads to other parts of the body. If the cancer is able to spread to other parts of the body, then the cancer is going through metastasis.
- “G” for Grades: Abbreviated as “G” in the system, the Grade system determines the cellular health of the cancer cells in relation to normal, healthy cells. More specifically, it determines how much contrast there is between the cancer cells and healthy cells to look at how much they resemble normal tissues in order to categorize its stage further.
Managing Oral Cancer Alongside Endodontic Treatment
All of these staging systems help oncologists in their fields determine the severity, rate, and growth patterns of the patient’s cancer, and through this can come numerous challenges for both the patient and their medical care team to handle these circumstances. For endodontists, this also means managing their patient’s dental health becomes a challenge, especially when faced with previous endodontic treatment, which can cause those patients to become more sensitive to various dental treatments. Because of the increasing rate of infections cancer patients face, endodontists have to cooperate with other members of the dental team to provide certain treatments that can help alleviate dental problems. These treatments include:
- Oral Mucositis Management: One of the side effects of cancer therapy is oral mucositis, and the degree of infection depends on the amount of radiation used, causing lesions in the mouth, which can be treated with anesthetics such as lidocaine, benzocaine, dyclonine, and capsaicin.
- Dry Mouth Management: Dry mouth is also a common side effect of cancer treatment. Cancer treatments such as chemotherapy and radiation therapy cause irreversible damage to the salivary glands but can also be managed with salivary stimulants, cavity treatments, custom administering trays, and diet changes.
- ORN Management: ORN, or osteoradionecrosis, is exposed bone loss of the mandibular jaw bone, which typically occurs from severe cancer treatment. Depending on the stage, radiation doses, and oral hygiene levels, certain treatments such as deep periodontal scaling, flap surgery, and other types of restorations can be applied to encourage healing.
To learn more about your available options, visit your dentist, oncologists, and cancer treatment centers regularly for information about types of oral cancers and available dental treatment options.
