What is it? Mouth cancer, also known as oral cancer, is where a tumour develops on the surface of the tongue, mouth, lips or gums. It’s also possible, but less common, for tumours to grow in the salivary glands and tonsils.
According to the NHS around 8,300 people are diagnosed with mouth cancer each year in the UK, which is about 1 in every 50 cancers diagnosed. More than 2 in 3 cases of mouth cancer develop in adults over the age of 55 and men are more likely to get mouth cancer than women. People with periodontal (gum) disease are 2.5 times more at risk.
The two leading causes of mouth cancer in the UK are drinking too much alcohol and smoking. Both alcohol and tobacco are carcinogenic - this means they contain chemicals that can damage DNA in cells and lead to cancer.
More than 90% of mouth cancers in men and 85% in women are linked to lifestyle (smoking and drinking alcohol) and environment (for example socialising, working or living with others who smoke).
A common cause for mouth cancer, although not seen much in the UK, is chewing betel nut. Betel nut is a vine leaf, popular in Asian countries, which is chewed normally with areca nut, and/or tobacco. Areca nut is also considered carcinogenic when consumed with tobacco.
Exactly what triggers these DNA changes that lead to mouth cancer is still uncertain, but the risk of mouth cancer increases significantly in someone who’s both a heavy drinker and heavy smoker. However it’s not just alcohol and smoking which increases the risk of mouth cancer - other risk factors include chewing tobacco or other smokeless tobacco products, poor diet, poor oral hygiene and the human papilloma virus (HPV).
The human papilloma virus (HPV) is a family of viruses that affect the skin and moist membranes that line your body such as the cervix, anus, mouth and throat. Although very uncommon, there’s evidence that certain types of HPV can cause abnormal tissue growth inside the mouth which can trigger mouth cancer. This can be picked up thorough oral sex with a person infected with HPV. Most infections don't cause any serious harm and are cleared by your immune system within two years.
How would I know I have it? The most common symptoms of mouth cancer include red or white patches in the mouth or throat, unusual lumps and ulcers that don’t heal or reoccur. These can be painless too, making it more difficult to detect. Other symptoms may include persistent pain in the mouth, pain or problems when swallowing, changes in voice or speech difficulties, swollen glands in the neck, unexplained weight loss, bleeding or numbness in the mouth, teeth loosening for no obvious reason or difficulty moving the jaw.
Mouth cancer is often spotted by a dentist during routine check ups. Using the mouth mirror, a dentist will examine the inside of your mouth and tongue - they can see parts of the mouth that can’t be easily seen ourselves. If the dentist does find something unusual, a referral to a consultant at hospital will be made. A small sample of cells may be gathered from the area (a biopsy) and these cells will be examined under a microscope for investigation. If the cells are cancerous, more tests will be carried out, in which the results will determine what course of treatment is required.
Can it be treated? As with any form of cancer, treatment is more successful when caught early. Despite the increase of mouth cancer cases over the last 10 years, more people are being treated successfully and living for longer.
Early detection results in a survival outcome of 90%, however, delayed diagnosis means survival rates fall to as little as 50%. It’s strongly advised you see your GP or dentist if any of the symptoms mentioned above have lasted for more than three weeks.
Mouth cancer, during the initial/early stages of the disease, tends not to cause any noticeable symptoms. This is one reason why regular dental check ups are so important, particularly if you’re a smoker, a heavy drinker or chew betel.
When brushing your teeth, look out for any changes, lumps, bumps and colour changes. If there are any changes noted, that don’t improve after three weeks, see your dentist or doctor.
Toothache / Abscess
What is it? Toothache is pain in and around the teeth and jaws. It’s most often caused by tooth decay.
How would I know I have it? The pain usually starts suddenly and it can vary from mild discomfort to a severe throbbing, which is often worse at night. The area of your jaw close to the infected tooth may also be sore and tender to the touch. Toothache can either come and go or be constant. Eating or drinking can make the pain worse, particularly if the food or drink is hot or cold.
Can it be treated? Yes. It’s best to see a dentist sooner than later, as toothache will only intensify. Your dentist will assess you to see why you have toothache (decay, broken tooth, gum recession) and treat accordingly. Treatment could include a filling (a metal filling or a white ‘composite’ filling may be an option), root canal treatment (where the infected nerve tissue is cleaned out and the tooth internally disinfected) or extraction (tooth removal) depending on how the troublesome tooth presents to the dentist. They will inform you of all your available options.
Trauma / Broken tooth
What is it? Dental trauma is often the result of an accident. This could be a trip, fall, sporting accident or car accident- there are many possibilities. The damage caused can vary significantly; the tooth/teeth may have no symptoms, may feel bruised, the nerve in the tooth could die and form an abscess, the teeth could break or could even be knocked out completely. Whatever the circumstances, it’s always best to have your teeth checked by a dentist following a trauma.
Teeth can break for other reasons, not just trauma. A tooth can break if it bites something hard, if a large filling breaks or if it’s significantly decayed, among other reasons. It’s always best to see a dentist following a tooth has broken to allow them to offer treatment options and protect the tooth, if necessary, with a dressing.
How would I know I have it? Most people are aware there’s something wrong straight after a dental trauma, whether that’s a broken tooth, a tooth that’s come out, or pain.
However, occasionally it’s over a period of time symptoms may arise. This is usually the case when a tooth has had a knock and the nerve has died. Gradually the tooth will begin to cause pain, followed by hot and cold sensitivity, tenderness and normally the formation of an abscess. In this instance, a root canal treatment is required to clean out the infected nerve tissue causing the pain and abscess, thus making the tooth dead as it has no nerve supply. If a tooth breaks, pain and sharp edges are common symptoms.
Can it be treated? Most traumas and tooth breakage are repairable but how this is carried out depends on the circumstances. Repair can be immediate (such as a replacement filling) or may take months to give back function and aesthetics to a patient (such as implants and crowns following a car accident).
If a tooth breaks, how the tooth is repaired depends on how the tooth presents to the dentist. If the tooth can be filled with a filling, your dentist will discuss different material options with you.
This can include an amalgam (metal) filling. This type of filling needs a certain amount of tooth structure to be present to support the filling. A composite (white) filling may be an option, as a white filling chemically bonds to tooth structure; this can prove cost effective when there’s less tooth structure to hold a metal filling, and is cheaper than a crown.
A crown is often suggested when original tooth structure is lacking, therefore not providing a stable foundation or support for a filling. As a treatment option it’s advised to protect what tooth structure remains, as a crown covers a tooth, as a hat covers our head. The tooth in question will be drilled to minimize its shape and make it a smaller version of itself. Your dentist will take an impression of the tooth to be crowned. It’s common for the dentist to take impressions of all the teeth, upper and lower, which will be sent away to a laboratory where a crown will be made. The crown is completely bespoke and is manufactured to ensure a perfect fit. Once made, a crown is cemented in place.
It’s important to see a dentist as soon as possible to assess the situation, provide relief from pain and offer a treatment plan. If a trauma is serious and requires hospitalisation (such as a road accident) the consultants from the oral department will be involved.
If a whole tooth is knocked out (roots as well), place the tooth in milk. If milk isn’t available, place it in the mouth; the best place is in the lower lip if this can be tolerated, however extreme care is needed to ensure tooth isn’t swallowed. This keeps the tooth in its natural environment. Try not to touch the root of the tooth and if the tooth is dirty, rinse with milk or tap water. Don’t scrub the tooth or use disinfectant.
If there’s bleeding from the area, don’t panic. Get a clean handkerchief or clean cotton material, fold it up to fit the area of the socket and bite down to apply pressure. Don’t use cotton wool or tissue. If painkillers are required, avoid medication containing aspirin; this thins the blood slightly which will make the area continue to bleed.
It’s possible to try to put the tooth back in yourself. Hold the tooth by the crown and put it back into the socket firmly, root first. Bite on a clean handkerchief for about 15-20 minutes. However, if it isn’t possible to do this, place in milk or the mouth as above.
Ideally a tooth needs to be reinserted within 24 hours of the accident for best results; the sooner the better for successful re-insertion, preferably within the first hour. Either a trip to a dentist or A&E will be required.
The tooth, if successfully reinserted will then need to be splinted to hold it in place while it heals and stabilizes in the jawbone. This is done by placing a piece of wire or fibreglass (which looks like a thin white strip of plastic) on to the teeth, which is long enough to reach the teeth either side of the loose tooth.
These teeth are now splinted together. The splint will need to stay on between 2 and 6 weeks, with the dentist checking the progress of the tooth regularly. Unfortunately this usually has to be done on the front surface of the teeth to hold it in place properly, so may be visible. Once the tooth is no longer loose, the dentist can remove the splint with the dental drill, leaving the teeth looking as they did before being splinted together.
Sometimes teeth that have been reinserted can die and need root canal treatment. This can normally be carried out by your dentist.
Where there’s a known risk of damage to your teeth, such as sports (rugby, hockey, boxing) it’s strongly advised an investment is made on a gum shield. Your dentist takes an impression of your upper teeth; this will only take 10 to 15 minutes. From this impression, a model of your teeth is made and a mouthguard is created on the model to ensure a snug, comfortable fit. Mouthguards range in price (£70 to £150 but call your dental practice for their fees) but are worth every penny as are certainly cheaper than a dental implant.
What is it? An ulcer is a painful round or oval sore that appears in the mouth. They can appear anywhere in the mouth but are most common on the tongue or cheeks. There’s no exact cause for an ulcer, but they most often appear following trauma such as biting the cheek or tongue, tooth brushing a bit too vigorously or a rough tooth or filling.
How would I know I have it? Ulcers can be quite sore and last a week or two. They often appear as a white coloured sore with a red inflamed border.
Can it be treated? Ulcers can be managed with topical gels (available from pharmacies and supermarkets) but normally it’s a case of waiting for them to heal. Avoiding acidic foods can help reduce soreness.
If a mouth ulcer doesn’t go after three weeks, it’s best to get it checked by your dentist. Usually, an ulcer in the mouth is nothing to be concerned about and will heal over. However, if you’re aware of having had an ulcer for three weeks or more, do get it checked as this could be a sign of mouth cancer. Your dentist will refer you to hospital to have the ulcer or lesion investigated if they feel it’s necessary.
Wisdom teeth eruption
What is it? On average between the ages of 18-25 wisdom teeth come through. Occasionally they erupt at an angle and can cause infection, pain, swelling and even decay in adjacent teeth.
How would I know I have it? Wisdom teeth can erupt without too much fuss. Gums can feel sore and tender but this soon settles and can be managed with over the counter pain remedies. Sometimes, wisdom teeth do not erupt and sit quietly in the jaw bone.
Occasionally though, wisdom teeth form at an angle, and try to erupt. Impacted wisdom teeth can sometimes be seen on x-ray and can often look as though a tooth has fallen over, depending on the angle of the tooth. An impacted wisdom tooth may begin to erupt, before physically becoming stuck. This can cause potential problems such as decay on the wisdom tooth and even the adjacent teeth, gum infections as the tooth becomes difficult to clean and food can trap under the gum, or even damage to the roots of the adjacent teeth where the wisdom tooth tries to find a way to erupt, which could lead to the loss of further teeth.
Can it be treated? Yes. If the gums become inflamed, sore and infected where a tooth is erupting, a dentist may prescribe antibiotics to help clear infection. They may also recommend warm salt water mouth rinses. Once a tooth has broken through the gum symptoms tend to settle and the tooth erupts with no further problems.
If flare ups continue, it’s found the wisdom teeth are impacted, decay is present on the wisdom or adjacent teeth, or if damage is occurring to adjacent teeth due to the position of the wisdom teeth, extraction may be advised. This may take place at your dental practice but it’s common for a referral to be made to a hospital for this to be done. Your dentist would arrange this for you.