Oral Cancer Facts

Since this is Oral Cancer Awareness month, I wanted to start and end the month with some thoughts on this collection of cancers. I was recently asked to talk about oral cancer on one of our local television stations and so I contacted the Oral Cancer Foundation for some information. I talked with their Director who is an oral cancer survivor of 11 years. He was a pleasant person to speak with and had lots of valuable information to share. Among his statistics:

1. 110 people every day are diagnosed with an oral cancer
2. 1 person dies every hour of every day from oral cancer
3. Anecdotally, on the oral cancer foundation survivor list, about 1/3 are under 30 years of age
4. There seems to be a correlation with the HPV virus and oral cancers
5. In 2007 oral cancers rose 11%
6. Survival rate is good if found early, but overall about a 55% survival after 5 years

The signs of possible oral cancer lesions inside your mouth include both “raised” and “sunken” lesions, changes in coloration, hardening lesions and lesions that bleed easily. These changes should have been present at least 14 days before you start to worry, and your dentist is a great place to start for a diagnosis.

Always feel free to talk to your dentist about what to watch for and ways to prevent oral cancer.

Massachusetts has an oral health plan

The plan, presented at the Massachusetts State House by the Better Oral Health for Massachusetts Coalition on April 12, is the result of over a year and a half of work by a dental care providers, program sponsors, lawmakers, state officials, insurers, health advocates, policy leaders, and consumers, in communities from Cape Cod to the Berkshires.

The goal of the state Oral Health Plan is to improve the system of oral health services in the state through a strategy that includes increasing access to preventive services, broadening the public’s understanding of oral health, developing the oral health workforce, and strengthening disease surveillance. The plan emphasizes cost-effective strategies and public-private partnerships at the local, regional and statewide levels.

The Better Oral Health for Massachusetts Coalition was formed in 2008 in response to data provided in 2008 report by the Catalyst Institute’s report, The Oral Health of Massachusetts. This report found gaps in access to preventive oral health services across Massachusetts. For example, 48% of children under the age of 9 suffer from tooth decay and 1 in 10 children from low-income and minority families reported mouth pain while at school. Untreated tooth decay can inhibit a child’s ability to learn, speak, and eat, and result in lower educational attainment and poorer overall health.

I had the pleasure to serve as master of ceremonies at the launch of the plan. Speakers representing state government and the health care community spoke about the importance of oral health and its connection to overall health.

The DentaQuest Foundation has been the primary supporter of the Better Oral Health for Massachusetts Coalition through in-kind and financial contributions. View the plan at www.massoralhealth.org or, at www.dentaquestfoundation.org/resources/reports.php.

Guest post by Ralph Fuccillo, President, DentaQuest Foundation

Acid Reflux and Oral Cancer

The survival rate for people with oral cancer has not shown much improvement over the past several decades and we should discuss some reasons for that.

In general terms, mouth cancers have about a 50% survival rate after 5 years. Most physicians believe this is because the cancers of the mouth are diagnosed later than other cancers, mainly because the public ignores many early signs.

As a dentist, I am expected to perform a 90-second oral cancer screening for patients. In this screening, I look for color changes in the tissues or small ulcerations in the oral cavity. Many lesions are found at the base of the tongue and under the tongue – places most people never look at in their own mouths.

A dentist needs to take a piece of gauze and pull your tongue, twisting it from side-to-side to get a good look under and behind the tongue. There are other tools available to dentists today for biopsying these ulcerations to tell if they are cancerous. One popular tool uses a rinse and blue light to show ulcerations. This tool does not give a diagnosis of the tissue changes, but it makes them easier to find. For those with insurance, the visual oral cancer screening is included as part of the oral evaluation performed by dentists, and should not be charged separately.

The leading causes of oral cancer include the use of tobacco and alcohol, but certainly it can strike anyone. My mother died nearly 40 years ago from a form of oral cancer related to acid reflux and which is almost completely preventable today. Prior to her death, I was not aware that acid reflux can irritate the esophagus until it becomes malignant. Common associated diagnoses are GERD and Barrett’s esophagus. GERD is a term for acid reflux; Barrett’s esophagus is the pre-cancerous esophagus caused from acid reflux that then becomes irritated and later may become malignant. Your dentist may be able to recognize untreated Barrett’s from signs of erosion on the teeth from the acid and may alert you to have a conversation with your physician.

This month (April) is oral cancer awareness month. I wanted to remind you to make sure your dentist pulls and twists your tongue at your next visit.

Reform Measures for Oral Health

Wrapping up a prolonged national discussion on health care, Congress approved health care reform legislation (H.R. 3590 and H.R. 4872). President Obama signed the Affordable Health Care for America Act into law. During the debate, DentaQuest spoke out to make sure there would be oral health provisions in the final law.

The new law will offer essential dental benefits for children as part of their overall health plan. These covered dental care visits should provide adequate oral care and preventative measures for all children.

All Americans should become better informed about how oral health improves their general wellbeing through programs that educate the public about the importance of oral health. We anticipate more funding for research in dentistry and greater use of proven prevention measures like dental sealants and community water fluoridation.

The reform bill addresses access to dental care with provisions targeted to expanding the number of professionals within the industry. One way is to support minorities who wish to undertake careers in health. The Centers of Excellence (COE) program will enhance recruitment, training, academic performance, and other support; there may be scholarships for disadvantaged students who work in medically underserved areas as primary care providers, and loan repayments for individuals who serve as faculty in eligible institutions through the Health Professions Training for Diversity.

Current dental care providers may become eligible for funding to further their education in the field of dentistry; this means more qualified dentists to treat more individuals who receive coverage via the healthcare reform bill.

Finally, the Affordable Health Care for America Act allows for standalone dental plans, like DentaQuest, to be offered through the new health exchanges. Today, stand alone dental plans provide 97 percent of dental coverage and work to control costs with an emphasis on preventive services. The bill also exempts dental coverage from the premium amounts subjected to the “Cadillac plan” excise tax.

Guest Blog post by Fay Donohue, DentaQuest CEO.

The Silent Epidemic: Early Childhood Caries

The DentaQuest Institute recently had the opportunity to participate in the National Initiative for Children’s Health Quality’s (NICHQ) Annual Forum for Improving Children’s Healthcare and Childhood Obesity Congress. NICHQ is a great organization doing important work to make sure all children receive the high quality healthcare they need. Dr. Man Wai Ng, Chief of the Department of Dentistry of Children’s Hospital Boston and I gave a presentation about some interesting work we are doing with Early Childhood Caries.

Early Childhood Caries (ECC) – or aggressive tooth decay in very young children – is something that we should never have to talk about. ECC, like all dental disease, is almost completely preventable. But caregivers need to be aware of the right things to do for their children from the moment the youngster gets his or her first teeth. Preventing ECC is why dentists recommend that children get their first oral health check up around their first birthday, why we recommend brushing a child’s teeth every day, and why dentists advise against giving children bottles of anything other than plain water before a nap or bedtime.

Too many children don’t get the preventive care they need and deserve early in life; too many end up in hospital-based dental clinics where the only solution is to treat the dental disease surgically in the operating room. The numbers of children in this situation are surprisingly large and many must wait in pain for months to get time in the hospital’s operating room. Even after treatment, there is often a high rate of recurrence of the cavities. Early childhood caries is painful to the child, and if untreated, can impact the proper development of permanent teeth. The results are eating and speech problems that limit the child’s ability to grow, to thrive, and to enjoy a normal life.

For the past 18 months, Dr. Man Wai Ng of Boston Children’s Hospital, Dr. Dan Kane of St. Joseph Hospital for Specialty Care in Providence, and the DentaQuest Institute have been testing a different model for treating ECC. We’ve been using an evidence-based, risk-based disease management approach adapted from the concept of chronic care management of medical conditions. Our emphasis has been on educating the caregiver as a first line of defense in reversing the cycle of the child’s dental disease. I’m happy to say that we have seen some very positive results. Given the success of this initial effort, we are working on plans to further expand this chronic care model and we look forward to partnering with clinical partners across the country on more effective approaches to prevent and manage oral disease in children.

- Guest blog post by Dr. Alex White, Director of Analytics, DentaQuest Institute.

Massachusetts’ 2010 Oral Health Heroes

Each February, the DentaQuest Foundation is pleased to join the Massachusetts Legislative Oral Health Caucus, Health Care for All, and other key partners at the Massachusetts State House in a special recognition event. The Oral Health Heroes Ceremony highlights the “Watch Your Mouth” oral health awareness campaign in Massachusetts, and celebrates Oral Health Heroes in the Commonwealth. This year marks our 5th Annual Oral Health Heroes celebration. As Master of Ceremonies, I had the honor of recognizing several individuals in the Massachusetts state legislature and in our communities for outstanding leadership in improving the oral health of Massachusetts’ residents.

This year’s legislative honorees are Senator Steven Panagiotakos and Representative Ellen Story. Senator Panagiotakos, while serving in a leadership role as Chair of the Senate Committee on Ways and Means, was instrumental in preserving dental benefits for adults on MassHealth (Medicaid) in the FY2010 budget. Representative Story has consistently stood up for oral health, signing on to many oral health bills and testifying at many hearings at the State House – all to promote oral health.

We also honored Hugh Silk, M.D., and Herlivi Linares, D.D.S. two members of our medical and dental community for their significant leadership in oral health. Dr. Silk is a family physician at Hahnemann Family Health Center in Worcester. He has been a longtime advocate for addressing oral health during well child visits, and has worked to include oral health in the education of residents.

Dr. Herlivi Linares, Associate Dental Director of Lynn Community Health Center’s Dental Services, provides crucial oral health services to her community which includes many low-income adults covered by Medicaid or the Commonwealth Care subsidized program.

Congratulations to all the 2010 Massachusetts Oral Health Heroes. I look forward to our continued work together as a community to bring Massachusetts residents greater access to oral health services and set an example for other states.

Blog post by Ralph Fuccillo, President, DentaQuest Foundation.

Let’s talk about the oral health of America’s children

Today, the Pew Center on the States released The Cost of Delay: State Dental Policies Fail One in Five Children, a study of how the 50 states are responding to the needs for prevention services and access to dental care for America’s children. The DentaQuest Foundation, with the W. K. Kellogg Foundation, provided support for the development of this report to increase awareness of the important things states can do to ensure good oral health for children.

There are an estimated 17 million (i.e. one in five) children who go without dental care each year, according to the report. Children from low-income households suffer the most— they are twice as likely to have untreated decay as their more affluent peers and are a fifth less likely to receive care.

Fortunately, unlike many health problems, the challenge of ensuring children’s dental health is one that can be overcome. With education, prevention services and access to care—dental disease is nearly 100% preventable. Investing in healthy kids early on pays off throughout their lives. The negative effects of untreated dental disease start early, impacting a child’s learning, speech, nutrition and success in education. Later in life, untreated disease impacts an individual’s ability to get and keep work and maintain good personal health.

In 2003, the U. S. Surgeon General challenged America’s health leaders to educate the general public and policy makers about the need for good oral health and to identify and replicate effective programs that will improve the oral health of Americans. The Pew report highlights proven efforts that are working in these key areas:

• Preventing dental problems in the first place
• Ensuring children have access to dental care
• Tracking progress in each state when it comes to children’s dental health.

One solution that is making a difference today is school-based dental programs. Across the U.S., school-based programs are bringing communities, dental care providers and educators together to provide prevention services--such as screenings, protective sealants and fluoride varnish at school, where children spend most of their day. Many children don’t see the dentist because the parent/caregiver doesn’t recognize oral care as a need, or the parent can’t take time off from work or doesn’t have transportation to get the child to the dentist. School-based programs solve all these problems, and provide an added benefit of pairing children, and their families, with accessible comprehensive care at a local community health center.

The DentaQuest Foundation hopes the data in this 50 state report will become a baseline upon which each state can build and move forward. I am hopeful that over the next few years we will see great progress in how we as a nation respond to the oral health needs of our children.

Guest post by Ralph Fuccillo, President, DentaQuest Foundation.