Periodontitis (Gum Disease) and Systemic Health
Link between Gum Disease, Erectile Dysfunction and Cardiovascular Diseases
The South African Dental Association (SADA) today announced the theme of its public education programme for 2013 and warned that there is clinical evidence that impotence (Erectile dysfunction) may come about as a result of gum disease and poor oral hygiene.
Professor Londi Shangase, Head of the Wits Department of Oral Medicine and Periodontology, is acting as SADA’s spokesperson on the overall subject of Periodontitis (Gum Disease) and Systemic Health. The focus this year will be on four groups of different systemic diseases - and conditions – that may arise as a result of poor oral hygiene and, resultant gum diseases.
“Blockage of the smaller arteries in the extreme parts of the body such as the penis comes about as a result of the penile arteries becoming blocked by plaque build-up on the artery walls (atherosclerosis), or a clot (thrombus) lodging in the smaller arteries of the organ, having broken away from the plaque build-up in the main arteries of the body. Another cause may be the malfunction of lining cells (endothelial cells) of the blood vessels of the penis, resulting in compromised dilatation of these vessels.
Male impotence may also be caused by a combination of these two processes. Given the association between gum disease, blocked arteries and/ or endothelial dysfunction we, therefore, may assume safely that there is an association between poor oral hygiene, gum disease and male impotence.”
Dr Johann Lochner, President of South African Society for Periodontists (SASP), said that Cardiovascular Diseases (CVDs) are regarded as the leading causes of death worldwide. “The WHO International statistics indicate that an estimated 17,3 million people died from CVDs in 2008. It is estimated that by 2030 almost 23,6 million people will die from CVDs. It is even more alarming when these figures show that over 80% of CVD deaths occur in low and middle-income countries. It is estimated that gum disease affects an estimated 35% of people globally and is spread across the spectrum of young and old.”
Londi adds: “In South Africa 14.7 % of total deaths are linked to cardiovascular diseases. Smoking, stress, high blood cholesterol levels and diabetes, amongst others, have been identified as the traditional risk factors associated with CVD. However, not all patients with CVD exhibit these traditional risk factors. Therefore, there are other factors that may predispose these patients to CVD. Whilst the causes of CVD are diverse, blocked arteries and appears to be the most common. High blood pressure may further compromise the patient suffering from CVD.”
The primary cause of gum disease relates to the bacteria that live within the plaque build-up on teeth. Whilst these bacterial agents initially cause the gum disease, the propagation and sustenance of such a disease also depends on the level of other risks the patient is exposed to – and is seen particularly in those patients who are smokers, immune compromised, have diabetes or display abnormal changes in their genetic make-up.
These afflictions render the patient more vulnerable in that the poisons secreted by the oral bacteria involved in gum disease, stimulate the immune system to produce substances that will result in tissue breakdown and bone destruction if gum infections remain untreated. These substances normally play a protective role in a healthy body but, in a disease situation, can become destructive in the extreme.
Manifestations of CVDs
From research it is eminently clear that blocked arteries play a significant role in the development of CVDs and form the basis for the different manifestations of these diseases. CVDs include coronary heart diseases (CHD), strokes, increased blood pressure, peripheral artery diseases and heart failure.
Plaque build-up in arteries may result in ruptured plaque surfaces which in turn may manifest clots. If sufficiently large such clots may completely block the already narrowed passage or, may dislodge and travel to a smaller arteries where blockages will be caused at those locations.
Reduced blood supply to the heart may lead to an angina attack, heart attack or heart failure.
Narrowing of the blood vessels also accounts for increases in blood pressure. As the passages of the blood vessels progressively becomes narrower, the blood flow becomes more forceful, causing damage to the vessel wall which, in turn, causes more plaque accumulation and further blockage.
Blocked arteries are also at the base of what happens when one suffers a stroke. Clots that break loose from the plaque on the arterial walls may travel to a distant site resulting in the obstruction of blood flow through the arteries that supply oxygenated blood to the brain.
“The association between gum disease and many other systemic diseases is fairly recent and the discipline of periodontics deals with all issues affecting tissue and the other structures surrounding and supporting the teeth, says Londi. “The mouth, without a doubt, forms an integral part of the body and it is impossible to maintain good systemic/general health in the presence oral disease.”
“Current thinking on the subject represents a radical departure from previous views and places dentistry in the midst of a more holistic approach to the overall health of the patient. The future might see the dental and the medical fraternity collaborating more closely on the management of patients.”
Maretha Smit, Chief Executive Officer of SADA says that the treatment of patients suffering from CVDs is costly and prolonged, and its impact on the global economy is vast. “Currently the numbers of patients afflicted or dying of these diseases are unacceptably high – especially so in developing countries. The projected future statistics on the CVD-related deaths are even higher.”
These statistics are most relevant to South Africa when one considers the statistics that illustrate how gum disease is more prevalent in developing countries than in developed countries. It is of critical importance for SADA to highlight the general health dangers associated with gum disease and to make the South African public aware of the positive role that dental professionals can play in the early detection and relatively inexpensive treatment of the disease.”
Cape Town,Thursday, 28th February 2013
NOTES TO EDITORS:
- Erectile dysfunction (ED), the inability to attain and maintain an erection necessary and sufficient for satisfactory sexual performance, has a prevalence of 52% affecting males, mostly from the age of 40 onwards.
- Coronary heart disease is defined as a disease in which, as a result of the processes discussed above, plaque accumulates on the inside walls of the coronary arteries thus compromising supply of oxygenated blood to the heart muscles. The long-term effects of the plaque accumulation are significant narrowing, or even complete occlusion of the coronary arteries. Complete occlusion leads to myocardial infarction as a result of the lack of oxygen supply to the myocardium.
- Whilst causality in the relationship between periodontitis and systemic disease has not been fully proven, the possibility of the reduction of morbidity and mortality related to systemic diseases by treating periodontitis and improving periodontal health renders further evaluation of this relationship inarguably vital.
FOR FURTHER INFORMATION:
- Maretha Smit
Tel: +27 (0)11 484 5288, Mobile: 084 627 3842, Fax: +27 (0)11 642 5718
e-mail: msmit@sada.co.za - Prof Londi Shangase
Tel: 011 488 4887, Mobile: 072 395 2335, Fax: 011 488 4902 /0862074358
e-mail: Sindisiwe.Shangase@wits.ac.za - Dr Johann Lochner
Tel: 021 852 9235, Mobile: 072 419 7792, Fax: 021 852 6508
Email: doc@johannlochner.com - Mixael de Kock
Tel: 011 646 8501, Mobile: 083 651 4424
e-mail: coq@mweb.co.za
At a briefing in Cape Town today, the South African Dental Association (SADA) stressed the increased risks for developing Oral Cancer (OC) and Oro-pharyngeal Cancer (OPC) through the smoking of Cannabis (Marijuana) and the water pipe (Hubbly Bubbly / Hookah), the latter being particularly popular amongst teenagers and the younger generation.
Ms Maretha Smit, CEO of SADA says that in the past OC and OPC presented mostly in adults over 45 years of age but that in recent years, there has been an alarming increase in the incidence of these cancers in younger people.
“While part of the explanation of this can be attributed to the Human Papilloma Virus (HPV) and the changing sexual behaviours of a younger generation where multiple partners and oral sex feature strongly, many other lifestyle practices also become significant in view of recent research results that indicate causal links between OC / OPC and Cannabis and Hubbly Bubbly pipe smoking.”
Professor André van Zyl, together with Professor Willie van Heerden, both of the School of Dentistry, Faculty of Health Sciences, University of Pretoria - and active members of SADA – are the programme leaders for the association’s awareness campaign regarding OC / OPC. They are of the confirmed opinion that the younger generation may be exposing themselves to an increased risk of the possibility of an HPV infection either through smoking Cannabis or indulging in the trendy smoking the Hubbly Bubbly pipe.
Cannabis (marijuana - also known as dagga, weed, pot, grass and hash)
Cannabis has the same risk as any smoked tobacco in that it contains carcinogens that may cause cancer. Van Zyl points out an alarming fact that has emerged from recent research: Cannabis smoking is strongly associated with HPV positive OPC. The danger of developing HPV positive cancer increased with increasing intensity of Cannabis usage, as well as the duration of use. In comparison to non-smokers it was found that Cannabis users had a more than 4-fold increased risk of developing HPV positive cancer, which indicates that it is an independent risk factor for HPV positive OPC. “In those who had smoked the substance at a rate of at least one joint per day for 5 or more years, a more than 11 fold increase in risk for developing HPV positive cancer was seen!”, explained Van Zyl.
In South Africa the use of Cannabis amongst school-going children is on the increase and follows trends elsewhere with figures released in the USA at the end of 2011 showing that school children there smoked Cannabis on a regular basis. This increased trend in Cannabis usage also reflects a decline in the smoking of cigarettes within the same group.”
“Coupled to changing sexual behaviours in the same age groups and where oral sex features prominently, these trends will most likely lead to increases in HPV OPC’s in the next 10 to 20 years.”
“Although it is possible that Cannabis can alter cells in the upper airway to become cancerous, it is more likely that the cannabinoids modify the immune system, thereby causing the Human Papilloma Virus (HPV) to spread easier during oral sex. Once it has spread, the cannabinoids will also promote the persistence of the HPV infection, as well as promoting tumour formation by suppressing those parts of the immune system required to protect against cancer.”
Water Pipe/ Hubbly Bubbly/ Hookah
While it is important to note that the Hubbly Bubbly pipe can be used to smoke many different combinations of tobacco, as well as drugs - the most popular inclusion being Cannabis - for the purposes of this discussion it is sufficient to limit the risks only to the normal flavoured tobacco usage.
In recent years, the American Lung Association published a Tobacco Policy Trend Alert referred to this smoking trend as “An Emerging Deadly Trend: Water Pipe Tobacco Use” and giving the vulnerable age in the range of 8 to 24 years.
Normal tobacco smoking, if started at an age younger than 16, puts these young addicts at greater risk to contract OC and OPC than the already high risks associated with adults indulging in the habit. It is thus in relation to the age group younger than 16 where the Hubbly Bubbly pipe becomes even more dangerous as many school children under this critical age regularly partake in this pastime.
“What is more disquieting is that this activity often is practised with the full knowledge and approval of parents who believes it to be innocent fun. The misconception that the water in the Hubbly Bubbly filters out all harmful substances, making it a safe practice, has been perpetuated by the inventor of the water pipe who, in the late 1500s, suggested that the water renders this form of smoking safe. For almost 500 years now this unsubstantiated and un-scientific belief has become accepted lore and is believed by water pipe users to this day.”
Van Zyl stresses that this conviction is totally untrue and quoted recent research that has shown that the smoke from the water pipes contains nicotine, tar and heavy metals. In addition, it exposes the user to high levels of carbon monoxide. One water pipe session of 45 minutes was shown to increase the nicotine levels in an individual’s blood by 250%.
Because the water pipe sessions can last a long time Van Zyl confirms that participants may inhale as much as the equivalent of 100 cigarettes as well as high levels of carbon monoxide.
There is of course the additional danger that the sharing of mouthpieces may very well spread other infectious agents such as herpes virus, hepatitis virus and tuberculosis. The latest US studies found that 26% of schoolchildren had smoked a water pipe with cigarette smoking on the decline but with a concomitant increase in water pipe smoking. The study found that one of the main reasons for this trend is fact that teenagers and young adults believe this to be much safer.”
Van Zyl says that much research still needs to be done on the exact dangers of the Hubbly Bubbly, but for now the public, and especially young people, need to be made aware of the dangers of this increasing trend and that it may very well lead to OC and OPC cancer amongst a range of other serious diseases. Based on current scientific evidence it is patently clear that these individuals are also exposed to lung cancer and gum disease.
“The bottom-line message is that water pipe smoking can deliver carcinogenic substances directly into the mouth and upper respiratory tract as well as lungs. Young people who use the water pipe thus do so in the mistaken belief that they are indulging in a safe practice”, says Van Zyl. “At the very least it is as dangerous as cigarette smoking while a further worrying aspect of the water pipe is that it exposes young people to the habit of smoking, increasing the risk of addiction. Also, because it is happening under the critical age of 16, these individuals are at enormous increased risk to suffer various cancers under the age of 45 years.”
Cancers associated with HPV and Cannabis and Hubbly Bubbly pipe smoking occur mostly in young adults. Van Zyl continues: “These young people could never imagine that they might develop OC or OPC, and, it therefore is imperative that regular dental check-ups are conducted to ensure an early diagnosis of cancer in either the oral cavity or in the Oro-pharyngeal area.”
“While OC and OPC, if detected in the early stages, responds very well to treatment and can be cured, the tragedy is that in most cases the diagnosis is made too late and the patient often succumbs to the disease.”
“Today a range of new diagnostic technologies are available that can be utilized to assist the dentist in ensuring that all suspicious oral lesions are properly evaluated. A dentist is the most appropriate health care professional to perform these examinations and be responsible for patient management, which may include referral for appropriate cancer treatment”
Maretha further states that OC/ OPC are diseases that globally affect up to 400 000 new patients per year. “While this statistic in itself is disturbing, the shocking fact is that 50% of people affected by OC / OPC will die within five years of diagnosis.”
“These relatively poor survival rates have not changed significantly over the last 50 years and are in stark contrast to several other types of cancers where improvements in diagnosis and treatments have led to many types of cancer being regarded as curable diseases today.”
Professor van Zyl adds: “Should OC / OPC be identified by the dentist at an early stage, then there is every possibility to stop the process and achieve a cure. It is for this reason, and the fact that dentists are trained particularly to detect early OC / OPC - in that they are the healthcare professionals who routinely examine the oral cavity – that all efforts should be focused on raising public awareness and on encouraging people to visit the dentist strictly on a half-yearly basis.”
It is one of SADA’s stated objectives to ensure that its members are encouraged to utilise all knowledge and cutting-edge technology available to dental practitioners to protect patients and to ensure that OC / OPC, which may be deadly, are identified in the very early stages. Maretha says, “This emphasises the need for regular dental check-ups. In excess of 90% of people who are diagnosed in the early stages of OC/ OPC survive as opposed to as low as 12% when these cancers are detected in the very late stages.”
Maretha Smit also detailed the full list of other causes of Oral and Oro-pharyngeal cancer, some of which are yet to be highlighted and discussed as separate subjects during the course of the “SADA Oral Cancer Awareness Year”.
Cape Town, 23 January 2012
NOTES TO EDITORS:
Cannabis
- Cannabis is a drug produced from the Cannabis sativa (commonly known as hemp) or Cannabis indica plant, which is related to nettles and hops. It's believed to have originated in the mountainous regions of India, and grows wild in many parts of the world.
- The plant contains more than 400 chemicals, including cannabidiolic acid, an antibiotic with similar properties to penicillin. The different chemical derivatives of the plant can be used for medicinal or recreational purposes.
- The recreational drug cannabis comes in many forms – herbal (dried plant material), resin, powder and oil - and is known by many slang terms, including weed, pot, grass and hash. In the UK, cannabis is a Class B illegal drug
Effects and uses of cannabis
- Cannabis is most widely used as an illegal street drug for its relaxing properties. It is usually rolled into a cigarette known as a joint, but can also be smoked in a pipe, brewed as a tea or mixed with food.
- The main active ingredient in cannabis is tetrahydrocannabinol (THC). One type, skunk, can be particularly potent as it contains two to three time as much THC as other types.
- Cannabis acts as a mild sedative, leaving most people feeling relaxed, chilled out or just sleepy. It also:
- Has mild hallucinogenic effects, causing a distortion of reality
- Makes some people become more animated
- Releases inhibitions, making people talkative or giggly
- Can cause nausea in some people (despite the fact that cannabis can have an anti-nausea effect), while it quite often makes others feel hungry
- Cannabis or its derivatives may also be used as a medical treatment. There is some scientific evidence to suggest it may be useful in a wide range of conditions. But the complex nature of the substances contained within the plant makes it difficult for medical research to establish clearly its safety or efficacy, so its effects are far from proven or well-understood. The active chemicals within cannabis (known as a group as cannabinoids) are gradually being identified and wide-scale trials testing the safety and efficacy of these cannabis extracts (or synthetic forms of them) are currently underway in the UK and elsewhere.
- There's increasing evidence that cannabis use is linked to a number of health risks. It damages the ability to concentrate, decreases motivation and more than occasional use in teenagers can affect psychological development. Users can become anxious, suspicious and even paranoid. Heavy use increases the risk of serious psychiatric illness.
- Users of skunk, a stronger and increasingly more available form of cannabis, are seven times more likely to develop a psychotic illness, such as schizophrenia, than people not using cannabis or using the more traditional forms. Cannabis also interferes with coordination, causing problems with balance, walking and driving.
- There are other side effects of the drug, but they vary considerably and are less predictable, partly because cannabis has more than 400 active ingredients. They may include effects on the heart, such as increased heart rate and blood pressure, and damage to fertility. People who smoke cannabis are also exposed to the toxic chemicals in tobacco smoke.
- People may become dependent on cannabis and find it difficult to stop using it, experiencing unpleasant withdrawal symptoms if they do stop such as cravings, agitation, mood changes, sleep problems, appetite disturbance and other symptoms.
The Hubbly Bubbly/ Hookah/ Water Pipe
- The water pipe or the Hookah/ Hubbly Bubbly is also known as narghile, or shisha.
- It is a single or multi-stemmed instrument for smoking flavored tobacco in which the smoke is passed through a water basin (often glass based) before inhalation.
- The tobacco smoked is referred to as mu'assel, or "shisha."
- The Origin of the hookah is in India, Persia,or at a transition point between the two.
- The word hookah is a derivative of "huqqa," which is what it was call in India in the past.
- According to author Cyril Elgood who does not mention his source, it was Abul-Fath Gilani, a Persian physician at the Indian court of the Mughol emperor Akbar (1542 – 1605), who “first passed the smoke of tobacco through a small bowl of water to purify and cool the smoke and thus invented the hubble-bubble or hookah.” However, a quatrain of Ahli Shirazi (1535) refers to the use of the ?alyan in Safavid Iran.
- Smoking the hookah has gained popularity outside of its native region, in India and the Middle East, and is fast gaining popularity in North America, South America, Europe, Australia and South Africa.
- Please note that Oral Cancer (OC) can be divided into two anatomically different areas, namely Oral Cancer (cancer of the mouth) and Oro-pharyngeal Cancer (OPC) (cancer of the throat), each with distinctly different challenges and often different causes. Throat Cancer (OPC) simply is a term used for Oral Cancer (OC) which manifests further back in the mouth. The mouth and throat are two interconnected areas and covers a relatively large area.
- OC is a cancer that starts in the lining mucosa of the oral cavity and is often associated with a visible alteration of the mucosa, called a potentially cancerous lesion.
- In developing countries the incidence of OC is still on the increase whereas it is on the decline in some western countries.
- An additional factor which clouds the whole issue of OC in South Africa is the fact that not all OC cases are taken up in the official cancer statistics of the country. This is owing to the fact that often it is picked up too late and patients receive no formal diagnosis and palliative care only is given to make their last days more comfortable. (We owe our patients more than this in a civilized country!) There is thus an under-estimation of the true burden of OC in this country.
- Maretha Smit
Tel: (011) 484 5288, Mobile: 084 627 3842, Fax: (011) 642 5718
e-mail: msmit@sada.co.za - Prof André van Zyl
Tel: (012) 319 2336, Mobile: 079 464 6563, Fax: (012) 326 3375
e-mail: andrevanzyl@up.ac.za - Dr Jeff Michelson
Tel: (011) 484 5288, Mobile: 084 200 1187, Fax: (011) 642 5718
e-mail: jmichelson@sada.co.za - Mixael de Kock
Tel: 011 646 8501, Mobile: 083 651 4424/ 071 226 8063/
Fax: (011) 646-8501
e-mail: coq@mweb.co.za
Causal Factors and other Facts regarding Oral Cancer
- Oro-pharyngeal cancer: A sexually transmitted disease
Over the last 30 years an increase has been seen in cancer of the head and neck areas. This is mainly because of an increase in Oro-pharyngeal cancer, a subset of head and neck cancer. The Human Papilloma Virus (HPV) is linked to Oro-pharyngeal cancer (OPC) and HPV is sexually transmitted, with the odds of infection linked to the number of oral sex partners. HPV Oro-pharyngeal cancer seems to affect mostly young males between 20-40 years of age, whereas traditional tobacco-alcohol associated OC’s and OPC’s are usually seen later in life.
- Hubbly-Bubbly and Oral Cancer
All forms of tobacco are carcinogenic – meaning they put the user at risk of developing oral and Oro-pharyngeal cancer. Hookah-pipe smoking (called Hubbly Bubbly in South Africa) is becoming more popular internationally and, especially in our country, Hookah cafés are gaining in popularity. Research has shown that a one-hour Hookah session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.
- Alcohol
The role of ethanol in alcoholic beverages holds the same risk for causing oral cancer as the nicotine in tobacco. When used in conjunction with tobacco, it accounts for up to 75% of oral cancers. This is however changing and new research has shown that up to 70% of OPC can be attributed to the Human Papilloma Virus. The role of alcohol is complex and especially young people need to be educated about the dangers of alcohol as a cause of oral cancer.
- Areca nut chewing
Worldwide 600 million people chew the Areca nut. Almost 60% of all oral cancers occur in South-East Asia, mainly because of Areca nut chewing, alone and in combination with other products. In KwaZulu- Natal, Areca nut chewing is still very prevalent amongst the Indian community and most users are unaware of the dangers involved. There is a need to develop a programme to educate these communities about this dangerous pastime and, especially the younger generation needs to be made aware of this menace.
- Warning signs of Oral Cancer
The abysmal 5-year survival rate of people with oral cancer has remained largely unchanged over the last 50 years. This is partly owing to the late diagnosis of oral cancer in most patients. Patients need to be educated about the danger signs and how they themselves may play a role in ensuring earlier diagnosis and, consequently better survival rates. This is one of the most important aspects of working towards a better quality of life for oral cancer patients.
- If worried – who should you see?
Oral Cancer (OC) and especially Oro-pharyngeal Cancer (OPC) straddles many specialities and professions. The importance is that all need to work together towards the common goal – improving the survival rate of oral cancer – especially amongst the poorest of the poor. The dentist remains the only trained health care worker who will screen oral health routinely, and has to be an important front person for diagnosing this increasing disease. Getting the dentist to diagnose cancer early and to liaise with the other health care workers for successful management of oral cancer – is the challenge.
Most oral cancers go through a phase of early changes that have not become cancerous yet. These can easily be spotted by the dentist, using special screening tools. Early diagnosis can lead to a cure of the oral cancer. There have been major advances in cancer screening over the last 3 years and patients and dentists should both be aware of these. It, therefore, also is of crucial importance to incorporate South Africa’s primary health care workers into this team of professionals.
- How is oral cancer managed?
If oral cancer is diagnosed early, the management and survival is significantly better and more successful than if diagnosed late (90% versus 20%). As management of the cancer still largely relies on surgical excision, the focus on early intervention is of critical importance. Radiation and chemotherapy is as successful as surgery in some cancers. Knowing the HPV status of Oro-pharyngeal cancer (OPC) is of critical importance, as it carries a much better survival rate than HPV-negative Oro-pharyngeal cancer (OPC).
- What can the patient contribute to lowering the risk of oral cancer?
Aside from abstaining from the use of risk factors such as tobacco and alcohol abuse, patients can lower the actual risk of developing Oral Cancer (OC) – by eating themselves healthy! Certain foodstuffs such as fruit and non-starch vegetables can lower the risk of oral cancer substantially. Patients need to be made aware of the exact role of foodstuffs that are beneficial.
- Benefits of coffee
Over the past few years it has emerged that coffee with its potent anti-oxidants, can actually lower the risk of developing oral cancer. Coffee has other benefits too, and if used in moderation, can promote health. Current research has not found any other beverage with these protective properties.
- Are certain sections of the South African population more at risk of oral cancer development?
Yes! Certain sections of the population are more at risk, especially the poor, the malnourished and those far from health care services. As poverty is a serious problem in South Africa, we need to formulate strategies to combat the role poverty may play in adverse oral cancer outcomes. Information regarding oral cancer lowering diets, information about diagnosing oral cancer, risk factors and such – need to be incorporated in school curricula, especially at primary school level. This message needs to be taken to every person in South Africa.
- CAN HPV VACCINE PROTECT AGAINST ORO-PHARYNGEAL CANCER?
Vaccination against the Human Papilloma Virus (HPV) is now regarded as standard procedure in the prevention of cervical cancer in females and provides protection against a range of disease caused by the specific HPV variants targeted by the vaccine. The past two years there has been increased support for the vaccination of males. The USA’s Centers for Disease Control and Prevention (CDC) now recommends routine vaccination for males from as young as nine to the age of 26 years old. The vaccine protects males against genital warts, anal cancer and Oro-pharyngeal Cancer (OPC). More research is expected to emerge during the coming 12 months and, hopefully, the costs of the vaccines will decrease concomitantly.
Following recent media reports regarding teeth whitening, the South African Dental Association (SADA), once again, wishes to warn the public against unethical bleaching services offered by cosmetologists*, beauty salons and spas. In terms of South African law and under the provisions of the World Dental Federation (Federation Dentaire Internationale – FDI*), procedures requiring the “performance of any aesthetic or cosmetic procedure on a patient pertaining to the oral or peri-oral area” falls within the legal operations of a qualified dentist and, more recently, an oral hygienist.
But, despite the clear provisions of the law, countless beauty salons persist in their devious circumvention of the law by daily delivering countless dental bleaching sessions to their clients. What these individuals in the beauty industry do not seem to realize is that performing or aiding such a procedure is actually a criminal offense under The Health Professions Act of 1974. The Health Professionals Council of South Africa (HSPCA), already two years ago, warned of the inherent dangers of teeth whitening if not applied by a qualified and registered dental professional. The resultant effects of the procedure, if not correctly performed, could be severely increased tooth sensitivity and damage to the gums - at times irreversible. This august body also resolved that only dentists, dental therapists and oral hygienists were adequately trained to perform teeth whitening.
Dr Jeff Michelson, Chief Dental Officer at SADA says that in recent months, the Association has received many reports about beauticians and spas offering dental bleaching services to the public. “In fact, a formal complaint concerning this issue had already been lodged with the HSPCA in August 2009! At the time the Medical and Dental Board responded that that in terms of the law, the scopes of practice for dentists and oral hygienists included teeth whitening and, therefore, non-dentally qualified and registered individuals cannot be allowed to provide such services.” (see verbatim resolution under Notes to Editors)
SADA followed this action by submitting to the HPCSA numerous specific complaints about unlawful practices. The Council responded that they could not take action against offenders who were not registered with them and that such matters should be reported to the police.
“It is SADA’s stated objective to act as guardian of public dental health and the current increase in non-professional dental services is of grave concern to us,” says Maretha Smit, Chief Executive of the Association. “The public must be made aware of the dangers of having any dental procedures performed by unqualified persons. To this effect we are now taking legal advice in the matter and hope to secure the involvement of the Office of the Director of Public Prosecutions and the South African Police Services to investigate and take further steps.”
Johannesburg 29 June 2011
But, despite the clear provisions of the law, countless beauty salons persist in their devious circumvention of the law by daily delivering countless dental bleaching sessions to their clients. What these individuals in the beauty industry do not seem to realize is that performing or aiding such a procedure is actually a criminal offense under The Health Professions Act of 1974. The Health Professionals Council of South Africa (HSPCA), already two years ago, warned of the inherent dangers of teeth whitening if not applied by a qualified and registered dental professional. The resultant effects of the procedure, if not correctly performed, could be severely increased tooth sensitivity and damage to the gums - at times irreversible. This august body also resolved that only dentists, dental therapists and oral hygienists were adequately trained to perform teeth whitening.
Dr Jeff Michelson, Chief Dental Officer at SADA says that in recent months, the Association has received many reports about beauticians and spas offering dental bleaching services to the public. “In fact, a formal complaint concerning this issue had already been lodged with the HSPCA in August 2009! At the time the Medical and Dental Board responded that that in terms of the law, the scopes of practice for dentists and oral hygienists included teeth whitening and, therefore, non-dentally qualified and registered individuals cannot be allowed to provide such services.” (see verbatim resolution under Notes to Editors)
SADA followed this action by submitting to the HPCSA numerous specific complaints about unlawful practices. The Council responded that they could not take action against offenders who were not registered with them and that such matters should be reported to the police.
“It is SADA’s stated objective to act as guardian of public dental health and the current increase in non-professional dental services is of grave concern to us,” says Maretha Smit, Chief Executive of the Association. “The public must be made aware of the dangers of having any dental procedures performed by unqualified persons. To this effect we are now taking legal advice in the matter and hope to secure the involvement of the Office of the Director of Public Prosecutions and the South African Police Services to investigate and take further steps.”
Johannesburg 29 June 2011
The South African Dental Association (SADA) today expressed concern at the way in which reality television shows are distorting the perceptions that the public holds of dentists and dentistry and how, in a developing country such as South Africa, these shows are diverting the attention from the real need for good general dentistry and dental services to our communities.
“We are gravely concerned about recent media reports that South African dentists are smiling because of the profits they are making,” says Maretha Smit, Chief Executive of SADA. “Figures are regularly misquoted and taken out of context which creates the impression that dental practices are making huge profits. This is simply not true of a profession which is known to be struggling to keep its doors open to the public.”
“In reports, overall practice turnovers are often quoted without any reference to the high cost structures in dentistry, thus creating the impression of an exceedingly wealthy profession. In reality, only about 5% of dental practices specialise in cosmetic dentistry and even in these practices the true profits run at a mere 10 – 20% only!”
Smit continues: “Most serious businessmen will smirk at such low profit margins in a low turn-over environment. But the situation is even worse in general dentistry. With profit margins in elective dentistry at such minimal levels, one can very well understand why so many dentists are leaving the country. Dentists must be allowed an opportunity at earning a decent professional income in return for the years of study towards this vocation.”
SADA’s Chief Dental Officer, Dr Jeff Michelson points out that in the context of the current economy and the pressure brought about by medical schemes which are not providing adequate cover for essential dental procedures, the man in the street is placing dentistry low on the list of essential needs.
“Dentists in South Africa are by no means smiling. The high outlay for basic equipment, and the staggering costs of materials, most of which are imported from abroad, leaves very little room for a fair profit. And, very few patients understand that their Medical Aid Schemes are responsible for this failure for basic dentistry to be made accessible and that the scheme rates offered to dentists, in many instances, fall way below the actual costs of treatment and service.”
To support this statement, Michelson pointed out that during the last number of years once thriving dental practices have been going bankrupt and fewer people are entering the profession than ever before, while emigration continues to void the profession.
In its discussions with medical funders and policy makers, the South African Dental Association is consistently making an effort to point out the inherent risks to patient care in a funding environment that patently disregard the need for sustainability in private practices. However, in its own pursuit of members and profits, medical schemes continue to promote “no co-payment” plans and the establishment of non-sustainable provider networks.
“For instance, payouts to dentistry from schemes have been reduced from 8.4% in the late nineties to 2.2% last year!” exclaims Maretha Smit. “It is time that members of Medical Schemes start asking serious questions and demand that benefits in this area of basic medical care is re-structured. If not, there will be very few dentists left in a country that can hardly afford the further loss of any of its medical services, let alone dentists.”
While SADA prides itself on its ethical codes of conduct, subscribed to by its members, it is concerned that, in the current environment, it seems inevitable that something will have to give in an effort for dentists to make a living. The majority of dentists are currently facing an ethical dilemma of having to lower standards, use inferior materials and deliver an affordable but substandard service to clients. This ethical dilemma being faced by South Africa’s dentists is growing by the day and SADA fears that this will lead to erosion in the quality and availability of dental care in our country.
“Misinformation given in the media does not help an already critical situation where an essential service is embattled. It is time that the public is made aware that dentistry in South Africa is a profession under threat and that it is a threat that extends to every household and every family of this country. Marginalization of the profession through inaccurate reporting, simply serves to make South Africa and its people the poorer. Unless the crisis in dentistry in South Africa is addressed, soon there will be no smiles from anyone around”, Smit concludes.
Johannesburg 18 August 2011
“We are gravely concerned about recent media reports that South African dentists are smiling because of the profits they are making,” says Maretha Smit, Chief Executive of SADA. “Figures are regularly misquoted and taken out of context which creates the impression that dental practices are making huge profits. This is simply not true of a profession which is known to be struggling to keep its doors open to the public.”
“In reports, overall practice turnovers are often quoted without any reference to the high cost structures in dentistry, thus creating the impression of an exceedingly wealthy profession. In reality, only about 5% of dental practices specialise in cosmetic dentistry and even in these practices the true profits run at a mere 10 – 20% only!”
Smit continues: “Most serious businessmen will smirk at such low profit margins in a low turn-over environment. But the situation is even worse in general dentistry. With profit margins in elective dentistry at such minimal levels, one can very well understand why so many dentists are leaving the country. Dentists must be allowed an opportunity at earning a decent professional income in return for the years of study towards this vocation.”
SADA’s Chief Dental Officer, Dr Jeff Michelson points out that in the context of the current economy and the pressure brought about by medical schemes which are not providing adequate cover for essential dental procedures, the man in the street is placing dentistry low on the list of essential needs.
“Dentists in South Africa are by no means smiling. The high outlay for basic equipment, and the staggering costs of materials, most of which are imported from abroad, leaves very little room for a fair profit. And, very few patients understand that their Medical Aid Schemes are responsible for this failure for basic dentistry to be made accessible and that the scheme rates offered to dentists, in many instances, fall way below the actual costs of treatment and service.”
To support this statement, Michelson pointed out that during the last number of years once thriving dental practices have been going bankrupt and fewer people are entering the profession than ever before, while emigration continues to void the profession.
In its discussions with medical funders and policy makers, the South African Dental Association is consistently making an effort to point out the inherent risks to patient care in a funding environment that patently disregard the need for sustainability in private practices. However, in its own pursuit of members and profits, medical schemes continue to promote “no co-payment” plans and the establishment of non-sustainable provider networks.
“For instance, payouts to dentistry from schemes have been reduced from 8.4% in the late nineties to 2.2% last year!” exclaims Maretha Smit. “It is time that members of Medical Schemes start asking serious questions and demand that benefits in this area of basic medical care is re-structured. If not, there will be very few dentists left in a country that can hardly afford the further loss of any of its medical services, let alone dentists.”
While SADA prides itself on its ethical codes of conduct, subscribed to by its members, it is concerned that, in the current environment, it seems inevitable that something will have to give in an effort for dentists to make a living. The majority of dentists are currently facing an ethical dilemma of having to lower standards, use inferior materials and deliver an affordable but substandard service to clients. This ethical dilemma being faced by South Africa’s dentists is growing by the day and SADA fears that this will lead to erosion in the quality and availability of dental care in our country.
“Misinformation given in the media does not help an already critical situation where an essential service is embattled. It is time that the public is made aware that dentistry in South Africa is a profession under threat and that it is a threat that extends to every household and every family of this country. Marginalization of the profession through inaccurate reporting, simply serves to make South Africa and its people the poorer. Unless the crisis in dentistry in South Africa is addressed, soon there will be no smiles from anyone around”, Smit concludes.
Johannesburg 18 August 2011
The South African Dental Association (SADA) today announced its oral health theme for the year. Ms Maretha Smit, CEO of SADA says that Oral Cancer (OC) and Oro-pharyngeal Cancer (OPC) will be the association’s theme of its public awareness programme for the next twelve months. “SADA will focus the attention on all the different causes and relevant aspects pertaining to this subject and, our first briefing session to the media, therefore, deals specifically with the alarming increase in Oro-pharyngeal Cancer (OPC) as a result of oral sex.”
The causal link between OPC and oral sex in the younger generation, especially young males, is menacing as Oro-pharyngeal cancer can be caused through the invisible presence of the Human Papilloma Virus (HPV). This virus, with its more than a hundred sub-types, is relatively prevalent. The high-risk variants of the HPV virus cause cervical cancer in women and, consequently, through the practice of oral sex, can be transmitted to the oral cavity where it can be one of the causes of Oro-pharyngeal cancer.
Professor André van Zyl, together with Professor Willie van Heerden, both of the School of Dentistry, Faculty of Health Sciences, University of Pretoria - and active members of SADA - will be the programme leaders for the association’s awareness campaign regarding OC and OPC. They are of the opinion that the younger generation, while avoiding infection with HIV by practising oral sex, may be exposing themselves to the possibility of HPV infection.
“Oral sex is perceived to be a safer sexual behaviour in an AIDS dominated world”, says Van Zyl. “However, while it is true that the spread of HIV infection is lowered through the practice of non-genital sex, the spread of HPV has become more prevalent and, in turn, the cases of HPV-related Oro-pharyngeal cancer have increased dramatically over the past decade.”
HPV-related cancer occurs mostly in young adults. Van Zyl continues: “These young people could never imagine that they might develop Oro-pharyngeal cancer, and, it therefore is imperative that regular dental check-ups are conducted to ensure an early diagnosis of cancer in either the oral cavity or in the Oro-pharyngeal area.”
According to statistics, multiple oral sex partners significantly increase the risk for becoming infected by the Human Papilloma Virus (HPV), which may then lead to the development of Oro-pharyngeal Cancer (OPC). “While this type of cancer, if detected in the early stages, responds very well to chemo-radiation therapy and can be cured by such modern treatment, the tragedy is that in most cases the diagnosis is made too late and the patient often succumbs to the disease.”
Maretha says that the dental community is aware of the dangers that oral sex poses for the younger generation in particular and, that dentists have been made vigilant to a possible spike in the incidence of this type of Oro-pharyngeal Cancer in the years to come.
“Today a range of new diagnostic technologies are available that can be utilized to assist the dentist in ensuring that all suspicious oral lesions are properly evaluated. A dentist is the most appropriate health care professional to perform these examinations and be responsible for patient management, which may include referral for appropriate cancer treatment”
Maretha further states that OC/ OPC are diseases that globally affect up to 400 000 new patients per year. “While this statistic in itself is disturbing, the shocking fact is that 50% of people affected by OC/ OPC will die within five years of diagnosis.”
“These relatively poor survival rates have not changed significantly over the last 50 years and are in stark contrast to several other types of cancers where improvements in diagnosis and treatments have led to many types of cancer being regarded as curable diseases today.”
Professor van Zyl adds: “Should OC/ OPC be identified by the dentist at an early stage, then there is every possibility to stop the process and achieve a cure. It is for this reason, and the fact that dentists are trained particularly to detect early OC/ OPC - in that they are the healthcare professionals who routinely examine the oral cavity – that all efforts should be focused on raising public awareness and on encouraging people to visit the dentist strictly on a half-yearly basis.”
It is one of SADA’s stated objectives to ensure that its members are encouraged to utilise all knowledge and cutting-edge technology available to dental practitioners to protect patients and to ensure that OC/ OPC, which may be deadly, are identified in the very early stages. Maretha says, “This emphasises the need for regular dental check-ups. In excess of 90% of people who are diagnosed in the early stages of OC/ OPC survive as opposed to as low as 12% when these cancers are detected in the very late stages.”
Maretha Smit also announced a list of the other causes of Oral and Oro-pharyngeal cancer, each of which will be highlighted and discussed as separate subjects during the course of the “SADA Oral Cancer Awareness Year”.
Johannesburg 4 October 2011
The causal link between OPC and oral sex in the younger generation, especially young males, is menacing as Oro-pharyngeal cancer can be caused through the invisible presence of the Human Papilloma Virus (HPV). This virus, with its more than a hundred sub-types, is relatively prevalent. The high-risk variants of the HPV virus cause cervical cancer in women and, consequently, through the practice of oral sex, can be transmitted to the oral cavity where it can be one of the causes of Oro-pharyngeal cancer.
Professor André van Zyl, together with Professor Willie van Heerden, both of the School of Dentistry, Faculty of Health Sciences, University of Pretoria - and active members of SADA - will be the programme leaders for the association’s awareness campaign regarding OC and OPC. They are of the opinion that the younger generation, while avoiding infection with HIV by practising oral sex, may be exposing themselves to the possibility of HPV infection.
“Oral sex is perceived to be a safer sexual behaviour in an AIDS dominated world”, says Van Zyl. “However, while it is true that the spread of HIV infection is lowered through the practice of non-genital sex, the spread of HPV has become more prevalent and, in turn, the cases of HPV-related Oro-pharyngeal cancer have increased dramatically over the past decade.”
HPV-related cancer occurs mostly in young adults. Van Zyl continues: “These young people could never imagine that they might develop Oro-pharyngeal cancer, and, it therefore is imperative that regular dental check-ups are conducted to ensure an early diagnosis of cancer in either the oral cavity or in the Oro-pharyngeal area.”
According to statistics, multiple oral sex partners significantly increase the risk for becoming infected by the Human Papilloma Virus (HPV), which may then lead to the development of Oro-pharyngeal Cancer (OPC). “While this type of cancer, if detected in the early stages, responds very well to chemo-radiation therapy and can be cured by such modern treatment, the tragedy is that in most cases the diagnosis is made too late and the patient often succumbs to the disease.”
Maretha says that the dental community is aware of the dangers that oral sex poses for the younger generation in particular and, that dentists have been made vigilant to a possible spike in the incidence of this type of Oro-pharyngeal Cancer in the years to come.
“Today a range of new diagnostic technologies are available that can be utilized to assist the dentist in ensuring that all suspicious oral lesions are properly evaluated. A dentist is the most appropriate health care professional to perform these examinations and be responsible for patient management, which may include referral for appropriate cancer treatment”
Maretha further states that OC/ OPC are diseases that globally affect up to 400 000 new patients per year. “While this statistic in itself is disturbing, the shocking fact is that 50% of people affected by OC/ OPC will die within five years of diagnosis.”
“These relatively poor survival rates have not changed significantly over the last 50 years and are in stark contrast to several other types of cancers where improvements in diagnosis and treatments have led to many types of cancer being regarded as curable diseases today.”
Professor van Zyl adds: “Should OC/ OPC be identified by the dentist at an early stage, then there is every possibility to stop the process and achieve a cure. It is for this reason, and the fact that dentists are trained particularly to detect early OC/ OPC - in that they are the healthcare professionals who routinely examine the oral cavity – that all efforts should be focused on raising public awareness and on encouraging people to visit the dentist strictly on a half-yearly basis.”
It is one of SADA’s stated objectives to ensure that its members are encouraged to utilise all knowledge and cutting-edge technology available to dental practitioners to protect patients and to ensure that OC/ OPC, which may be deadly, are identified in the very early stages. Maretha says, “This emphasises the need for regular dental check-ups. In excess of 90% of people who are diagnosed in the early stages of OC/ OPC survive as opposed to as low as 12% when these cancers are detected in the very late stages.”
Maretha Smit also announced a list of the other causes of Oral and Oro-pharyngeal cancer, each of which will be highlighted and discussed as separate subjects during the course of the “SADA Oral Cancer Awareness Year”.
Johannesburg 4 October 2011
Oro-pharyngeal cancer: A sexually transmitted disease
Over the last 30 years an increase has been seen in cancer of the head and neck areas. This is mainly because of an increase in Oro-pharyngeal cancer, a subset of head and neck cancer. The Human Papilloma Virus (HPV) is linked to Oro-pharyngeal cancer (OPC) and HPV is sexually transmitted, with the odds of infection linked to the number of oral sex partners. HPV Oro-pharyngeal cancer seems to affect mostly young males between 20-40 years of age, whereas traditional tobacco-alcohol associated OC’s and OPC’s are usually seen later in life.
Hubbly-Bubbly and Oral Cancer
All forms of tobacco are carcinogenic – meaning they put the user at risk of developing oral and Oro-pharyngeal cancer. Hookah-pipe smoking (called Hubbly Bubbly in South Africa) is becoming more popular internationally and, especially in our country, Hookah cafés are gaining in popularity. Research has shown that a one-hour Hookah session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.
Alcohol
The role of ethanol in alcoholic beverages holds the same risk for causing oral cancer as the nicotine in tobacco. When used in conjunction with tobacco, it accounts for up to 75% of oral cancers. The role of alcohol is complex and especially young people need to be educated about the dangers of alcohol as a cause of oral cancer.
Areca nut chewing
Worldwide 600 million people chew the Areca nut. Almost 60% of all oral cancers occur in South-East Asia, mainly because of Areca nut chewing, alone and in combination with other products. In KwaZulu- Natal, Areca nut chewing is still very prevalent amongst the Indian community and most users are unaware of the dangers involved. There is a need to develop a programme to educate these communities about this dangerous pastime and, especially the younger generation needs to be made aware of this menace.
Warning signs of Oral Cancer
The abysmal 5-year survival rate of people with oral cancer has remained largely unchanged over the last 50 years. This is partly owing to the late diagnosis of oral cancer in most patients. Patients need to be educated about the danger signs and how they themselves may play a role in ensuring earlier diagnosis and, consequently better survival rates. This is one of the most important aspects of working towards a better quality of life for oral cancer patients.
If worried – who should you see?
Oral Cancer (OC) and especially Oro-pharyngeal Cancer (OPC) straddles many specialities and professions. The importance is that all need to work together towards the common goal – improving the survival rate of oral cancer – especially amongst the poorest of the poor. The dentist remains the only trained health care worker who will screen oral health routinely, and has to be an important front person for diagnosing this increasing disease. Getting the dentist to diagnose cancer early and to liaise with the other health care workers for successful management of oral cancer – is the challenge. Most oral cancers go through a phase of early changes that have not become cancerous yet. These can easily be spotted by the dentist, using special screening tools. Early diagnosis can lead to a cure of the oral cancer. There have been major advances in cancer screening over the last 3 years and patients and dentists should both be aware of these. It, therefore, also is of crucial importance to incorporate South Africa’s primary health care workers into this team of professionals.
How is oral cancer managed?
If oral cancer is diagnosed early, the management and survival is significantly better and more successful than if diagnosed late (90% versus 20%). As management of the cancer still largely relies on surgical excision, the focus on early intervention is of critical importance. Radiation and chemotherapy is as successful as surgery in some cancers. Knowing the HPV status of Oro-pharyngeal cancer (OPC) is of critical importance, as it carries a much better survival rate than HPV-negative Oro-pharyngeal cancer (OPC).
What can the patient contribute to lowering the risk of oral cancer?
Aside from abstaining from the use of risk factors such as tobacco and alcohol abuse, patients can lower the actual risk of developing Oral Cancer (OC) – by eating themselves healthy! Certain foodstuffs such as fruit and non-starch vegetables can lower the risk of oral cancer substantially. Patients need to be made aware of the exact role of foodstuffs that are beneficial.
Benefits of coffee
Over the past few years it has emerged that coffee with its potent anti-oxidants, can actually lower the risk of developing oral cancer. Coffee has other benefits too, and if used in moderation, can promote health. Current research has not found any other beverage with these protective properties.
Are certain sections of the South African population more at risk of oral cancer development?
Yes! Certain sections of the population are more at risk, especially the poor, the malnourished and those far from health care services. As poverty is a serious problem in South Africa, we need to formulate strategies to combat the role poverty may play in adverse oral cancer outcomes. Information regarding oral cancer lowering diets, information about diagnosing oral cancer, risk factors and such – need to be incorporated in school curricula, especially at primary school level. This message needs to be taken to every person in South Africa.
CAN HPV VACCINE PROTECT AGAINST ORO-PHARYNGEAL CANCER?
Vaccination against the Human Papilloma Virus (HPV) is now regarded as standard procedure in the prevention of cervical cancer in females and provides protection against a range of disease caused by the specific HPV variants targeted by the vaccine. The past two years there has been increased support for the vaccination of males. The USA’s Centers for Disease Control and Prevention (CDC) now recommends routine vaccination for males from as young as nine to the age of 26 years old. The vaccine protects males against genital warts, anal cancer and Oro-pharyngeal Cancer (OPC). More research is expected to emerge during the coming 12 months and, hopefully, the costs of the vaccines will decrease concomitantly.
Johannesburg 4 October 2011
Over the last 30 years an increase has been seen in cancer of the head and neck areas. This is mainly because of an increase in Oro-pharyngeal cancer, a subset of head and neck cancer. The Human Papilloma Virus (HPV) is linked to Oro-pharyngeal cancer (OPC) and HPV is sexually transmitted, with the odds of infection linked to the number of oral sex partners. HPV Oro-pharyngeal cancer seems to affect mostly young males between 20-40 years of age, whereas traditional tobacco-alcohol associated OC’s and OPC’s are usually seen later in life.
Hubbly-Bubbly and Oral Cancer
All forms of tobacco are carcinogenic – meaning they put the user at risk of developing oral and Oro-pharyngeal cancer. Hookah-pipe smoking (called Hubbly Bubbly in South Africa) is becoming more popular internationally and, especially in our country, Hookah cafés are gaining in popularity. Research has shown that a one-hour Hookah session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.
Alcohol
The role of ethanol in alcoholic beverages holds the same risk for causing oral cancer as the nicotine in tobacco. When used in conjunction with tobacco, it accounts for up to 75% of oral cancers. The role of alcohol is complex and especially young people need to be educated about the dangers of alcohol as a cause of oral cancer.
Areca nut chewing
Worldwide 600 million people chew the Areca nut. Almost 60% of all oral cancers occur in South-East Asia, mainly because of Areca nut chewing, alone and in combination with other products. In KwaZulu- Natal, Areca nut chewing is still very prevalent amongst the Indian community and most users are unaware of the dangers involved. There is a need to develop a programme to educate these communities about this dangerous pastime and, especially the younger generation needs to be made aware of this menace.
Warning signs of Oral Cancer
The abysmal 5-year survival rate of people with oral cancer has remained largely unchanged over the last 50 years. This is partly owing to the late diagnosis of oral cancer in most patients. Patients need to be educated about the danger signs and how they themselves may play a role in ensuring earlier diagnosis and, consequently better survival rates. This is one of the most important aspects of working towards a better quality of life for oral cancer patients.
If worried – who should you see?
Oral Cancer (OC) and especially Oro-pharyngeal Cancer (OPC) straddles many specialities and professions. The importance is that all need to work together towards the common goal – improving the survival rate of oral cancer – especially amongst the poorest of the poor. The dentist remains the only trained health care worker who will screen oral health routinely, and has to be an important front person for diagnosing this increasing disease. Getting the dentist to diagnose cancer early and to liaise with the other health care workers for successful management of oral cancer – is the challenge. Most oral cancers go through a phase of early changes that have not become cancerous yet. These can easily be spotted by the dentist, using special screening tools. Early diagnosis can lead to a cure of the oral cancer. There have been major advances in cancer screening over the last 3 years and patients and dentists should both be aware of these. It, therefore, also is of crucial importance to incorporate South Africa’s primary health care workers into this team of professionals.
How is oral cancer managed?
If oral cancer is diagnosed early, the management and survival is significantly better and more successful than if diagnosed late (90% versus 20%). As management of the cancer still largely relies on surgical excision, the focus on early intervention is of critical importance. Radiation and chemotherapy is as successful as surgery in some cancers. Knowing the HPV status of Oro-pharyngeal cancer (OPC) is of critical importance, as it carries a much better survival rate than HPV-negative Oro-pharyngeal cancer (OPC).
What can the patient contribute to lowering the risk of oral cancer?
Aside from abstaining from the use of risk factors such as tobacco and alcohol abuse, patients can lower the actual risk of developing Oral Cancer (OC) – by eating themselves healthy! Certain foodstuffs such as fruit and non-starch vegetables can lower the risk of oral cancer substantially. Patients need to be made aware of the exact role of foodstuffs that are beneficial.
Benefits of coffee
Over the past few years it has emerged that coffee with its potent anti-oxidants, can actually lower the risk of developing oral cancer. Coffee has other benefits too, and if used in moderation, can promote health. Current research has not found any other beverage with these protective properties.
Are certain sections of the South African population more at risk of oral cancer development?
Yes! Certain sections of the population are more at risk, especially the poor, the malnourished and those far from health care services. As poverty is a serious problem in South Africa, we need to formulate strategies to combat the role poverty may play in adverse oral cancer outcomes. Information regarding oral cancer lowering diets, information about diagnosing oral cancer, risk factors and such – need to be incorporated in school curricula, especially at primary school level. This message needs to be taken to every person in South Africa.
CAN HPV VACCINE PROTECT AGAINST ORO-PHARYNGEAL CANCER?
Vaccination against the Human Papilloma Virus (HPV) is now regarded as standard procedure in the prevention of cervical cancer in females and provides protection against a range of disease caused by the specific HPV variants targeted by the vaccine. The past two years there has been increased support for the vaccination of males. The USA’s Centers for Disease Control and Prevention (CDC) now recommends routine vaccination for males from as young as nine to the age of 26 years old. The vaccine protects males against genital warts, anal cancer and Oro-pharyngeal Cancer (OPC). More research is expected to emerge during the coming 12 months and, hopefully, the costs of the vaccines will decrease concomitantly.
Johannesburg 4 October 2011
The South African Dental Association (SADA) today reassured the South African public that the current scare created by a Yale University study concerning dental x-rays is unfounded. The study concerns an uncommon benign growth called a meningioma but, reports about the research, create the impression that anyone who has dental x-rays is more likely to get cancer. This is simply untrue. Maretha Smit, Chief Executive of SADA describes the articles about this rare and harmless phenomenon, published in local media, as regrettable. “Sadly the sensational impression is created that dental x-rays should be avoided at all costs.” SADA’s Dr Jeff Michelson says that extracts from this study has been quoted selectively and out of context. “It is of the utmost importance for people to know that the meningioma, on which the trials were based, is not a cancer but a benign (non-cancerous) growth which is extremely rare and very slow-growing.” “Dental radiographs, using modern x-ray equipment, use much less radiation than previously required to obtain images. To put the radiation dose into perspective, a typical dental x-ray image exposes a person to less than one percent of the total radiation that he or she would be exposed to during normal daily activities. Dentists should, as a matter of course, also use protective shields to avoid unnecessary exposure of parts of the body, other than those that need to be seen.” By shunning dental x-rays, many dental conditions could be missed, resulting in damaging and sometimes irreversible harm to your teeth or the supporting structures in the mouth. Dental x-rays enable a dentist to observe what's happening in areas we normally cannot see such as invisible tooth decay. Maretha says that the SADA agrees that dental x-rays should not be used indiscriminately and that patients have the right to ask the dentist if such imaging is really necessary. “But, we cannot stress enough the importance of dental x-rays concerning patients with high rates of decay, impacted teeth, abscesses and bone loss from gum disease. Complete avoidance of dental x-rays would, therefore, be unwise and potentially more harmful than judicious use thereof. Maretha says that she has every confidence that SADA’s members possess the required clinical expertise and professionalism to determine when x-rays of various types are indicated through sound clinical and evidence-based reasoning. Johannesburg, 19th April 2012 Photographs are available on request. We do not automatically include pictures as firewalls either reject our communication or divert it to junk mail. Please contact Mixael de Kock on 083 651 4424 to arrange for the pictures and captions.
NOTES TO EDITORS:
FOR FURTHER INFORMATION:
NOTES TO EDITORS:
- Since the Yale study was published on 10 April 2012 in the medical journal Cancer, it has drawn criticism from the American Academy of Maxillofacial and Oral Radiology for its methods of data collection and potential inconsistencies in its findings.
- Experts have pointed out that the Yale study is rife with “severe internal inconsistencies” and criticized the study’s reliance on participants’ memory. They also point out point out discrepancies between “smaller” and “larger” doses of radiation.
- A meningioma is a tumour that forms in the membrane around the brain or spinal cord. Most of the time these tumours are benign and slow growing, but they can lead to disability or life-threatening conditions if left untreated.
- The research, led by Elizabeth Claus of the Yale University School of Medicine, was based on data from 1,433 US patients who were diagnosed with the tumours between the ages of ages 20-79.
- The American Dental Association's guidelines call for children to get one X-ray every one to two years; teens to have one every 1.5 to three years, and adults every two to three years.
FOR FURTHER INFORMATION:
- Maretha Smit
Tel: (011) 484 5288
Mobile: 084 627 3842
Fax: (011) 642 5718
E-mail: marethas@sada.co.za - Dr Jeff Michelson
Tel: (011) 484 5288
Mobile: 084 200 1187
Fax: (011) 642 5718
E-mail: jeffm@sada.co.za - Mixael de Kock
Tel: 011 646 8501
Mobile: 083 651 4424/ 071 226 8063/
Fax: (011) 646-8501
E-mail: coq@mweb.co.za
