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Dr. Timothy Iafolla obtained his undergraduate and dental degrees from the University of Pittsburgh, followed by a General Practice Residency at the Veterans Administration Hospital in Portland, Oregon.  He spent eight years as a dentist in private practice, then returned to school at the University of North Carolina Gillings School of Global Public Health, where he received his Master of Public Health degree in 1991.

In 2014, he assumed his current position as Chief of the Program Analysis and Research Branch of NIDCR’s Office of Science Policy and Analysis.  Dr. Iafolla lives in Germantown, Maryland, with his wife, Kimberly, who is a neonatologist (pediatric specialist in premature babies) at several local hospitals.  They have two grown children and one grandson.

Dr. Iafolla answers your questions below:

What are the 3 top causes of oral cancer?

The top three risks factors for oral cancer are tobacco use, alcohol, and HPV (human papilloma virus).

By far the biggest risk is tobacco—about 80% of all oral cancer is tobacco-related. And it’s not just smokeless tobacco (snuff, dip, or chew).

Any type of tobacco, including cigarettes, cigars, pipe, snuff or dip, chewing tobacco, and even exposure to secondhand smoke can put you at risk for oral cancer.  The risk increases with the amount of tobacco used.

The second risk factor is alcohol, with heavy drinkers at much higher risk for oral cancer.

For someone who is a heavy smoker and a heavy drinker, the risk of oral cancer becomes extremely high—as much as 30 times greater than for someone who has never used tobacco or alcohol.

Finally the third  major risk is HPV, which is a sexually transmitted disease.  Some types of HPV increase the risk of oral cancer—it’s responsible for about 10% of new cases and the trend is up. Unprotected oral sex that leads to HPV infection may eventually lead to oral cancer.

Keep in mind that not everyone who uses tobacco or drinks or has HPV is going to develop oral cancer, but almost all new cases of oral cancer are related to one or more of these risks.

Dr. Tim, is bad breath an indicator of possible oral cancer?

Bad breath is most often caused by food, gum disease, dry mouth, smoking, or another medical condition; cancer would be a very unlikely cause.

Strong tasting or smelling foods (like garlic or onions) affect the air you exhale.  Particles of food can remain in the mouth, collecting bacteria, which can cause bad breath—so brushing and flossing is the answer.  A high-protein diet may also cause unpleasant breath because of changes in body chemistry (called ketosis).

Bad breath or a bad taste in the mouth that doesn’t go away can also be one of the signs of gum disease—the major cause of tooth loss in adults. In addition to all the other health problems caused by tobacco, it can also cause bad breath. Tobacco users are more likely to have gum disease (which also causes bad breath).

Some medical conditions can cause bad breath. Uncontrolled diabetes, sinus or lung infections, bronchitis, and some liver or kidney diseases are among those that can have that effec

What about dry mouth – what causes that?

Dry mouth happens when the amount of saliva decreases.  It can be caused by various medications, problems with the salivary glands, or habitual mouth breathing. Saliva naturally cleans your mouth; if there isn’t enough, food particles can remain and collect bacteria, leading to bad breath. Artificial saliva is available for people with dry mouth; sugarless hard candy may also be helpful.

Can oral sex cause oral cancer?

Oral sex per se does not cause oral cancer.  But oral sex can spread HPV (human papilloma virus), which has been linked with oral cancer.  HPV is more common in men than in women and in whites more than African Americans, though nearly all sexually active men and women will get at least one type of HPV at some point in their lives (which is why the CDC and the American Academy of Pediatrics recommend the HPV vaccine for all children).  There is no way to know for sure which people infected with HPV will go on to develop cancer. About 10% of oral cancer cases are related to HPV.

My gums are very sensitive to cold. They use to be dark all my life, now they have lightened up to pink. Is this a concern?

What you describe is much more likely to be a type of gum disease or infection than oral cancer. However without an examination, I am of course not able to provide a specific diagnosis.

Since you have noticed sensitivity and a change from the normal color of your gums, I would recommend that you see a dentist. Gum disease is the most common cause of tooth loss in adults, and the earlier it is treated, the better the results will be.

Good morning, Doctor. What’s the life expectancy of someone with oral cancer after diagnosis and treatment? How many stages of oral cancer are there? Can the affected area be removed?

The key to successful oral cancer treatment and a long life after diagnosis is early detection.

There are various methods used to classify or stage all cancers, including oral cancers.  Some of these are very complex and rely on microscopic examination of the tumor. However, the most basic way to describe the severity or progression of a cancer is based on how far it has spread.

Localized: the cancer is a single area or tumor.

Regional: the cancer may have grown beyond its original location and has spread to the nearby lymph nodes under the jaw and in the neck.

Distant: the cancer has metastasized (tumor cells have broken off and spread to other parts of the body such as the lungs or liver).

If oral cancer is detected at the localized stage, the 5-year survival rate is about 85% (a little lower in men than in women, and somewhat lower in blacks than whites).

The 5-year survival rate drops to about 62% if it is diagnosed at the regional stage, and to about 38% if it isn’t discovered until after it has metastasized. That is why early detection is so important!

Treatment of oral cancer depends on its stage, its size, and many other factors including its microscopic and genetic characteristics. A small tumor can sometimes be surgically removed without affecting the normal functions of the mouth. Removal of a larger, more advanced tumor may involve more extensive surgery that could affect talking or eating. Advanced cancers may also require chemotherapy and/or radiation.

Possible signs and symptoms of oral cancer include:

·         A sore, irritation, lump or thick patch in your mouth, lip, or throat

·         A white or red patch in your mouth

·         A feeling that something is caught in your throat

·         Difficulty chewing or swallowing

·         Difficulty moving your jaw or tongue

·         Numbness in your tongue or other areas of your mouth

·         Swelling of your jaw that causes dentures to fit poorly or become uncomfortable

·         Pain in one ear without hearing loss

An oral cancer examination is quick, painless, and easy.  It’s important to go to the doctor or dentist if you have any of these symptoms in your mouth that last for more than two weeks. Most often, these symptoms do not mean cancer. An infection or another problem can cause the same symptoms. But it’s important to get them checked out—because if you do have cancer, it can be treated more successfully if it’s caught early. For more information on oral cancers and African-American men, click HERE. 

Should a bad tooth be examined for oral cancer?

By far the most common reasons for a bad tooth would be tooth decay, gum disease, and injury or trauma.  Unless there was some other reason to suspect oral cancer, the appropriate treatment would address one of those problems. I would recommend seeing a dentist if you have any concerns.

Can oral cancers be cured without disfiguring your face?

Treatment of an oral cancer tumor depends on its stage, its size, and many other factors including its microscopic and genetic characteristics. A small tumor can sometimes be removed with minor surgery, in a way that doesn’t cause any disfigurement or affect the normal functions of the mouth. Removal of a larger, more advanced tumor may involve more extensive surgery that could affect talking or eating, and may involve cosmetic changes. Advanced cancers may also require chemotherapy and/or radiation. The difference in cancer treatment and outcomes is why early detection is so important.

How could African-Americans suffer oral cancer  more than any group when whites smoke cigarettes, cigars and chew tobacco more than African-Americans?

As recently as 20 years ago, the oral cancer rate for African-American men was much higher than for whites.  Since that time there has been some good news: the risk for African-American men has been dropping sharply—now it’s about the same as for white men.

Because oral cancer is related to tobacco and alcohol use, this improvement is most likely related to the drop in smoking rates and alcohol use among African-Americans over the same time period.

There is, though, still a difference between the outcomes of blacks vs. whites after a diagnosis of oral cancer; one likely reason is due to the cancer being diagnosed at a later stage.

How could African-Americans possibly and disproportionately suffer every conceivable disease than any group?

Your question about the health and longevity differences between whites and African-Americans is an important one. The National Institutes of Health (NIH) is funding research across the country to better understand health disparities and test interventions to find ways to close that health gap.

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