Women in Dentistry - Blog

By: Dr. Parul Dua Makkar and Dr. Sanjukta Mohanta

As oral health professionals, the most important thing we can find isn’t a cavity or periodontitis. The most important thing we can detect is oral cancer. Typically, when oral cancer is discovered, it is in the later stages leading to disfiguring surgeries and even death.¹ This is what happened to Manu Dua, a 33-year-old healthy male from Calgary, Alberta, Canada who noticed a sore on the side of his tongue. At first, he didn’t take it seriously until the pain kept him up at night and he was having difficulty eating. Then he got the diagnosis in July 2019: Stage 2 squamous cell carcinoma of the tongue with lymph node involvement. Half of his tongue was removed and reconstructed along with a neck dissection to remove affected lymph nodes. He quickly returned to work and learned to speak, chew and use his tongue again. He thought he was cancer-free until his neck swelled up less than a year later. It was the start of the pandemic and Manu received devastating news – the cancer had spread. He went through 33 chemotherapy and radiation sessions and received more bad news -the cancer had metastasized and was spread in his lung lining, it was untreatable. The young man known for his muscular build, easy smile and multiple friendships was unrecognizable and isolated from his friends. His sister, Parul Dua Makkar, a dentist in New York, desperately wanted to see him, but had difficulty crossing the border during the lockdown. On March 14th, 2022 she goodbye to him over a WhatsApp video call and said, “You can let go now.” Manu was 34 years old. Manu was a dentist.

Manu was a young dentist with no risk factors and he died from oral cancer. Cancer can affect anyone and it is our duty to raise oral cancer awareness and to be diligent in doing oral cancer screenings. April is Oral Health Month and it is also Oral Cancer Awareness month. Let’s all raise awareness of oral cancer, reduce the risks and discover it in earlier stages. Here are ways we can help:

1. Encourage patients to check themselves for oral cancer and notify you if they notice anything unusual in the head and neck area.²
2. Post information about oral cancer on your office bulletin board, website and social media accounts.
3. Recommend the Human Papilloma Virus (HPV) vaccine. This decreases the risk of many cancers including oral cancer.
4. Do thorough oral cancer screenings on your patients at least annually
5. Talk to your patients about decreasing the risk factors for oral cancer such as smoking, drinking alcohol and using betel nut.³
6. Encourage healthy diets and good oral hygiene
7. Advise patients to use lip balm with sun protection factor (SPF)
8. Provide free oral cancer screenings
9. Biopsy or refer unusual lesions. If you suspect oral cancer, refer to an oral pathologist immediately instead of waiting 2 weeks.

Manu is not alive to share his story about oral cancer. It is up to us to raise oral cancer awareness so there will be no more sad stories like Manu’s. According to the CDC, oral cancer is increasing, primarily HPV related oral Cancers.⁴ Let’s stop this deadly trend. Together we can all reduce oral cancer.

In his last days, Manu wrote a series of blogs that are now a book, Life Interrupted, Dr. Dua’s Survival Guide (available on Amazon). It is a first-hand encounter of suffering from oral cancer while being a dentist: someone trained to diagnose the disease that took his life. Let Manu’s story not just be a statistic, but a movement to prevent oral cancer deaths with earlier diagnosis.

List 1: Signs and Symptoms of Oral Cancer (Canadian Cancer Society)

• Erythroplakia, leukoplakia or erythroleukoplakia
• Lumps and thickening
• Bleeding
• Earache
• Loose teeth
• Dentures do not fit
• Slurred speech
• Swollen salivary glands
• Swollen lymph nodes
• Numbness
• Jaw swelling
• Change in voice
• Pain swallowing
• Weight loss

List 2: Risk Factors for Oral Cancer (Canadian Cancer Society)

1. Tobacco
2. Alcohol
3. Betel Nut
4. Human Papilloma Virus (HPV)
5. Past cancer
6. Family history of squamous cell carcinoma
7. Sun exposure
8. Diet low in fruits and vegetables
9. Weakened immune system
10. Poor Oral Health

References

1. Seoane-Romero, J.-M., Vázquez-Mahía, I., Seoane, J., Varela-Centelles, P., Tomás, I., & López-Cedrún, J.-L. (2012, January 1). Factors related to late stage diagnosis of oral squamous cell carcinoma. Medicina oral, patologia oral y cirugia bucal. Retrieved January 2, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448190/#:~:text=Detecting%20oral%20cancer%20at%20an,visual%20and%20tactile%20exploration%20may
2. Lee, S. (n.d.). Symptoms of oral cancer. Canadian Cancer Society. Retrieved January 2, 2023, from https://cancer.ca/en/cancer-information/cancer-types/oral/signs-and-symptoms
3. Lee, S. (n.d.). Risk factors for oral cancer. Canadian Cancer Society. Retrieved January 2, 2023, from https://cancer.ca/en/cancer-information/cancer-types/oral/risks
4. Centers for Disease Control and Prevention. (2020, April 16). Trends in incidence of cancers of the oral cavity and pharynx - united states 2007–2016. Centers for Disease Control and Prevention. Retrieved January 2, 2023, from https://www.cdc.gov/mmwr/volumes/69/wr/mm6915a1.htm