Article Excerpt: Mouth ulcers are very common and can be due to a variety of reasons. Trauma from accidentally biting your tongue or lip is a common cause of ulcer. Drinking a hot cup of coffee too quickly can also result in an ulcer. Other causes include certain medications, stress, viral, bacterial or fungal infections and certain foods. The mouth is often the part of the body that gives us clues about the health of the entire body. As such, mouth ulcers can also be due to nutritional deficiencies such as deficiencies in Vitamin B12, folate and iron. Skin disorders (Lichen Planus), gastrointestinal disorder (Crohn’s disease) and immunological disorders (Bechet’s syndrome) can manifest as mouth ulcers. Among these many different causes, a persistent mouth ulcer can also be due to oral cancer which if not detected early enough can lead to significant spread to other areas of the head and neck requiring invasive treatment or result even in death.

From 2008 to 2012, about 500 people were diagnosed with oral cancer in Singapore, making up an average of 100 cases a year. In Singapore and other parts of the world, only half of the oral cancer patients managed to survive for more than five years after diagnosis and treatment. It gets more difficult to treat cancer if it is diagnosed later, and this is why it’s extremely important to look out for the warning signs and go for health checks regularly to detect the early signs.

What is Oral Cancer?

Oral cancer is cancer that develops in any of the parts that make up the mouth and throat such as lips, gums, tongue, the inside lining of the cheeks and the roof or floor of the mouth. The possible signs and symptoms of oral cancer are swelling, lumps or bumps, red or white patches in the mouth, a persistent ulcer that does not seem to heal after 3 weeks, a change in the way the teeth fit or dentures fit, difficulty chewing, and persistent sores, among others.

What-is-Oral-Cancer

Oral cancer or mouth cancer can be particularly dangerous as the early symptoms are usually painless or not easily noticeable. Hence, patients would either self-medicate or completely ignore the symptoms until the cancer has metastasized (spread) to another location—mostly the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in the localized area in the mouth. This is because the cancer has not only spread, at the later stages, the primary tumour also has had time to invade deep into local structures, which may make it even harder to treat.

Oral cancers are also more frequent among men than women, especially the middle-aged and elderlies. However, in recent years, an increasing number of women are being diagnosed with oral cancer. This year, the American Cancer Society estimated around 10,750 deaths surrounding the oral cavity and oropharyngeal cancers in the United States. Nevertheless, there are ways to treat and control oral cancer, mainly with early detection. If cancer has spread to deeper areas of the face and jaw considerably, extensive surgery will be required to remove the cancerous growth and this often leaves the patient with some disfigurement of the face.

There are plenty of factors that lead to mouth cancer but the biggest risk factor is the consumption of alcohol and tobacco use—chewing tobacco or smoking cigarettes, cigars and pipes.

Canker Sore VS Oral Cancer

Canker-Sore-VS-Oral-Cancer

What differentiates between the two?

  • Canker Sore – Typically small, bubble-like ulcers that can be found inside the mouth, lip, cheeks or tongue. They can be painful at times but they are not contagious nor cancerous. Canker sore looks like an ulcer but the middle part may appear white, grey or yellow while the edges are red. You can self-medicate canker sore by applying medications, eating soft food or gargling with salt water, and it will go away in a matter of one to two weeks’ time.
  • Oral Cancer – In the early stages of oral cancer, it may look like an open canker sore (which explains the confusion) or it could also take the form of a discoloured lump on the edge of the lip. However, unlike canker sore, oral cancer does not heal or go away. It will stay in a concentrated spot before spreading more aggressively. So before it spreads, it is vital for you to get a quick check-up with your dentist for early detection.

How to reduce the risk of Oral Cancer

1. Do not smoke

Do-not-smoke

1. Do not smoke

If you are an avid smoker, refrain from using tobacco be it chewed or smoked. Tobacco exposes the cells in your mouth to dangerous chemicals that can lead to cancer. If you don’t use tobacco, great! And don’t start!

2. Drink alcohol in moderation

Drink-alcohol-in-moderation

2. Drink alcohol in moderation

High alcohol intake can irritate the cells in your mouth, making them vulnerable to cancer. You can drink, but try to do so in moderation. Healthy women can drink up to one glass (approx. 350ml) per day. As for adult men, one drink per day is recommended for those aged 65 and above, and two drinks (approx. 700ml) per day for those below the age of 65.

3. Avoid excessive sun

Avoid-excessive-sun

 3. Avoid excessive sun

Excessive exposure to the sun can cause lip cancer. Limit your sun exposure or use UVA/B-blocking sun-protective lotions on your skin and lips when going out.

4. See a dentist

See-a-dentist

4. See a dentist

Sometimes, dangerous lumps or spots in your mouth can appear very tiny and difficult to detect on your own. Therefore, it is advisable to seek professional help from your dentist. With regular dental checkups, we can detect any unusual signs early and suggest the next best step to you. So be sure to not skip your biennial dental appointment!

Are you due for a dental health check? Come book an appointment with us!

Have an interesting topic you would like us to cover? Just let us know!

References:

1. Facts about moderate drinking. (2019, December 30). Retrieved September 09, 2020, from https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm

2. Fighting Oral Cancer with Drool //. (n.d.). Retrieved September 09, 2020, from https://www.ndcs.com.sg/giving/fighting-oral-cancer-with-drool

3. Friedman, M. (2019, October 10). Oral Cancer: Symptoms, Causes, Treatments, and More. Retrieved September 09, 2020, from https://www.webmd.com/oralhealth/guide/oral-cancer

4. Key Statistics for Oral Cavity and Oropharyngeal Cancers. (n.d.). Retrieved September 09, 2020, from https://www.cancer.org/cancer/oral-cavity-and-oropharyngealcancer/about/key-statistics.html

5. Mouth cancer. (2019, January 03). Retrieved September 09, 2020, from https://www.mayoclinic.org/diseases-conditions/mouth-cancer/symptoms-causes/syc20350997

6. Oral Cancer (Mouth Cancer). (n.d.). Retrieved September 09, 2020, from https://www.healthhub.sg/a-z/diseases-and-conditions/170/oral_disease_and_oral_cancer_nuh

For some children, brushing their teeth is more than just a good hygiene practice, it is also their “snack time.” Kid-friendly flavoured toothpastes were invented to encourage children to brush their teeth. They come in different fun colours (and sometimes glitter too!), packaging designs, candy-like scents and flavours. As more and more parents worry about their child’s dental hygiene, the best way to entice a child into regular, and thorough, brushing is finding a toothpaste they like.

“My child swallowed some toothpaste, should I be worried?”

Most toothpastes contain fluoride to help strengthen our teeth and prevent tooth decay. Even in most children’s toothpastes, there is fluoride but the concentration is much lower than adult’s. This special ingredient is what makes our teeth more resistant to acids found in food and beverages. Children can, however, get fluoride from other sources such as drinking water. Other natural sources of dietary fluoride include tea, fish, and vegetables such as spinach. Nevertheless, if your child is swallowing too much toothpaste, they may run the risk of developing ‘fluorosis’ on their permanent teeth. This may result in the change of colour and texture of your child’s teeth.

To prevent this, you can control the amount of toothpaste your child is using. For kids under 3, a smear of children’s toothpaste is enough; for kids between the ages of 3-6, use a pea-sized amount. In this case, if your child swallows their toothpaste, it is not as harmful. However, do note that if your little one accidentally swallowed a large amount of toothpaste, they may experience an upset stomach.

“My child won’t stop eating toothpaste, how do I stop it?”

#1 Do not leave your child
unattended when
brushing their teeth

Do not leave your child unattended when brushing their teeth

#1 Do not leave your
child unattended when
brushing their teeth

Firstly, you should not let your child brush their teeth without an adult’s supervision if you fear for their safety. While you’re watching, you can also take the opportunity to show them the correct way of brushing. After all, it is important to start young when inculcating healthy habits, and parents should lead by example.

#2 Apply the toothpaste for them

Apply the toothpaste for them

#2 Apply the toothpaste
for them

As mentioned earlier, one of the ways to prevent your little one from ingesting more toothpaste is to control their usage. Treat toothpastes like medicines—hide it away in a cabinet or somewhere out of their reach. This way, you can rest assured that your child is not consuming an excessive amount of toothpaste.

#3 Make sure they spit it out

Make sure they spit it out

#3 Make sure they spit it out

Show your child that toothpaste is not meant to be swallowed by making sure they spit it out after brushing. Then, teach them to rinse their mouth with water to ensure that there is no residual toothpaste. Your child will develop permanent front teeth at about 7-8 years old. So if they have been ingesting a high amount of fluoride at about 2 years of age, those permanent front teeth are at risk of fluorosis where white or brown spots will appear on the surface of the teeth.

#4 What about babies?

What about babies

#4 What about babies?

When brushing your baby’s teeth, angle their head slightly downward so that any extra toothpaste can dribble out of their mouth. Otherwise, you can use teeth and gum wipes meant for babies to remove any excess toothpaste. Same goes with toddlers. Although it is safe for them to consume a small amount of toothpaste, it is still better to be watchful of them. If your child is not capable of spitting out the toothpaste yet, opt for fluoride-free toothpaste for starters.

#5 Switch to a more minty toothpaste

Switch to a more minty toothpaste

#5 Switch to a more minty toothpaste

As your child gets a little older, you can start looking for a slightly mint-flavoured toothpaste. This is a good trick to deter them from eating toothpaste as it is not as enjoyable as the fruity ones they were used to. However, you need to be careful when buying mint-flavoured toothpaste. Since they are mainly catered to older children and adults, it might be too strong for your little one.

In general, children’s toothpastes contain a fluoride concentration of less than 600ppm (parts per million) while adult’s have a fluoride concentration of 1,000-2,500ppm. Children should, therefore, NOT use an adult’s toothpaste and only use toothpaste specifically made for them.

If your child (or you) is due for a dental checkup, come book an appointment with us!

Have a specific topic that you would like us to talk about? Just let us know!

Journal References:

1) American Dental Association Council on Scientific Affairs. (2014). Fluoride toothpaste use for young children. Journal of the American Dental Association (1939), 145(2), 190.

2) Pretty, I. A. (2016). High fluoride concentration toothpastes for children and adolescents. Caries Research, 50(Suppl. 1), 9-14.

3) Ismail, A. I., & Hasson, H. (2008). Fluoride supplements, dental caries and fluorosis: a systematic review. the Journal of the american Dental association, 139(11), 1457-1468.

4) Ammari, A. B., Bloch-Zupan, A., & Ashley, P. F. (2003). Systematic review of studies comparing the anti-caries efficacy of children’s toothpaste containing 600 ppm of fluoride or less with high fluoride toothpastes of 1,000 ppm or above. Caries research, 37(2), 85-92.