Delay or failure to diagnose and/or refer for treatment of mouth cancer

At DNC, our dental negligence lawyers understand the terrible anxieties and concerns of being diagnosed with mouth cancer and the additional frustrations and emotional impact of learning that negligent dental care may have delayed the diagnosis and/or treatment of the cancer.

Our team have helped many people make successful claims and receive compensation for their dental injuries as well as for any corrective treatment that may be required. We are true professionals with both legal and dental knowledge and expertise to help you through this difficult time.

What is mouth (oral) cancer?

All cancers are the result of unwanted changes within the cells. These changes make the cells divide more rapidly than normal and so a cancer grows. As the cancer gets bigger, it may push outwards on the tissues and organs and/or invade and take over these tissues and organs.

If the cancer cells get into the blood stream or the lymph nodes, the cancer may spread to other areas of the body. This is called metastasising and the additional cancers are called secondary cancers or metastases.

Cancer that occurs in our mouth (anywhere in the oral area that covers our lips, tongue, palate, cheeks and the back of our throat – the oropharynx) is called oral cancer.

Although cancer can also occur in the salivary glands (most usually, the parotid gland- the one in our cheeks that swells up when we have mumps), most lumps and swellings in the salivary glands are due to non – cancerous conditions.

Precancerous conditions

Leukoplakia and erythroplakia are two precancerous conditions that may occur in the oral area. Leukoplakia causes white patches in the mouth and erythroplakia causes red, slightly raised patches.

Although many white and red patches in the mouth may be perfectly normal, the areas of leukoplakia and erythroplakia may contain abnormal cells and in time, these abnormal cells may develop into cancer cells.

It is therefore very important that any white and/or red patchy areas in the mouth are noted and checked so that if leukoplakia and/or erythroplakia is present, you can receive the appropriate treatment and preventive care and/or advice.

Smoking is the most common cause of erythroplakia and leukoplakia, although chewing tobacco and poorly fitting dentures or badly shaped fillings, which continually rub the oral mucosa, may also cause these precancerous conditions.

If you stop smoking/chewing tobacco, get a better fitting denture and/or correct any dental problems then the white and red patches caused by these precancerous conditions often just disappear. However, even if the white or red patches are surgically removed (cut out), if you continue to smoke, they are more likely to come back – and with it, the increased risk of developing mouth cancer.

Diagnosis of mouth cancer and precancerous conditions

Dentists are trained to examine not only our teeth and gums, but also the oral mucosa (the soft, pink tissue that covers our tongue, palate, cheeks, the back of our throat – the oropharynx -and our lips). Dentists are also trained to check our jaw joints and to examine our face and neck for any irregular changes or swellings (including the lymph nodes).

Even if you have no natural teeth and wear full dentures (false teeth), it is still important to see a dentist for regular checks to make sure that your dentures are well fitting and your gums and oral mucosa are healthy. Every dental appointment gives an opportunity for abnormalities to be seen, diagnosed and treated.

The dentist should not only visually examine, but also palpate (feel) the soft tissues in and around our mouths for any abnormal (non-healthy) areas, lumps or swellings.

If the dentist is unable to diagnose any abnormal or suspicious area, we should be referred for further investigation and specialist review.

A biopsy (sample of the mucosa) is usually required in order to confirm whether the abnormal area is indeed cancer.

Whilst it is perfectly understandable to be very worried if you need to have a biopsy, please remember that many conditions of the oral mucosa are benign (non-cancerous) and some require very simple, if any treatment. For example, the fungal condition candida (sometimes known as ‘oral thrush’) appears as white areas in the mouth but these wipe off and can be easily treated with an anti-fungal medication.

However, as with all cancers, if oral cancer is present it is so important to get it diagnosed in the early stages as the treatment is likely to be far more successful (and far less harrowing).

When should a dentist refer for suspected mouth cancer?
As with many cancers, there are guidelines for dentists (and for GPs) about when to refer a patient to a specialist if they suspect that they may have oral (mouth) cancer.

Sometimes, a dentist may suspect mouth cancer just by the appearance or location of an abnormal looking area. In these situations, the dentist should immediately arrange a referral to a specialist for further review and/or biopsy.

Alternatively, a dentist may decide to prescribe simple treatment (for example, a mouthwash) and to examine you again to see if the area has changed and/or improved.

If an abnormal area is still present after 3 weeks, the current guidelines state that mouth cancer should be suspected and you should be referred to a specialist for review and/or biopsy within a two week period.

Treatment for mouth cancer

The only real treatment for the most common type of oral cancer (squamous cell cancer) is to surgically remove the cancerous area.

In order to prevent the cancer recurring (coming back) an area of healthy tissue around the cancer must also be removed.

If the cancer is large, you may require a skin graft to cover the area. The graft is often taken from the inside of your arm (or another non/minimally hairy part of your body).

If the mouth cancer has spread to the lymph nodes and/or has invaded the bone, you may require a graft of skin, muscle and/or bone from another part of your body to replace the lost tissue and restore appearance and function.

Although reconstructive surgery and rehabilitation (for example, speech) can produce some fantastic results, the initial surgery must sometimes be quite disfiguring and disabling in order to give the best chance of a full recovery.

If the cancer is spread to another part of the body, other treatments (for example chemotherapy or radiotherapy) may be necessary.

The importance of early and prompt diagnosis and/or referral for diagnosis and treatment is never more critical than when faced with the prospect of mouth cancer.

If you are aware of any unusual area, lump or swelling in or around your mouth PLEASE get it checked – it may be something that can be easily and simply treated. Even if you do have mouth cancer, if it is diagnosed and treated at an early stage, your recovery will be so much quicker and so much more complete.

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