EP #5: One American an Hour

The silent killer lurking in your mouth could be taking your life without you even knowing it. One American dies every hour from oral cancer, yet this devastating disease remains largely under the radar compared to other forms of cancer. Why aren't we talking about this more?

Dr. Alex Semidey and Jeremy Wolf dive deep into the world of oral cancer, exploring the early warning signs that could save your life. That persistent sore in your mouth that won't heal after two weeks? That numbness or tingling that feels slightly off? These subtle signals might be your body's desperate attempt to alert you to something serious happening beneath the surface.

We explore the holy trinity of risk factors – tobacco use, alcohol consumption, and HPV – and how their combined effect creates a perfect storm for oral cancer development. With HPV now changing the demographic landscape of oral cancer patients, even non-smokers and younger adults need to pay attention. The conversation takes an important turn toward vaping, that seemingly innocuous alternative that might be causing cellular DNA changes we don't fully understand yet.

The power of early detection cannot be overstated. Learn about the comprehensive screenings that should be part of every dental visit, from physical examinations to cutting-edge fluorescence technology that can detect suspicious tissue changes before they're visible to the naked eye. We also explore the revolutionary world of salivary diagnostics – how a simple spit test might soon transform how we detect and treat oral cancers, potentially saving countless lives.

Whether you're a regular at your dental office or someone who avoids the dentist like the plague, this episode delivers critical information about a disease that could profoundly impact your quality of life. Give yourself the gift of awareness – your future self might thank you with many more healthy years of smiling, eating, and kissing the people you love.

Chapters

• 0:00 Introduction to Oral Cancer Crisis
• 4:09 Warning Signs and When to Seek Help
• 8:56 Major Risk Factors: Smoking, Alcohol, and HPV
• 15:14 Vaping: The Unknown Threat
• 20:39 Comprehensive Oral Cancer Screenings
• 26:22 Advanced Detection and Treatment Options
• 30:18 Quality of Life Impact and Prevention

Transcript

Speaker 1: 0:00

Welcome to the Semi-Day Dental Podcast. We're here to provide you expert insights on how dentistry can improve your quality of life and extend your health span. I'm Alex Semi-Day and I'm a practicing dentist, and I'll be your host, along with Jeremy Wolf. Enjoy the show.

Speaker 2: 0:18

Hello, hello everyone, and welcome back to another episode of the Semi-Day Dental Podcast. And welcome back to another episode of the Semiday Dental Podcast. One American dies every hour from oral cancer. Just sit with that for a second, alex. Why is it that oral cancer is?

Speaker 1: 0:40

still flying so far under the radar today. Yeah, it's crazy, right, it's a sobering statistic. You don't hear a lot about it, you don't, you don't, and honestly, that's shame on us, on the whole dental community, for not raising more awareness about oral cancer and it's detection, it's diagnosis, it's treatment. It definitely doesn't get the same amount of play as, like you know, prostate and breast cancer get, which are important for people to be aware of too. But, man, when you hear that stat that one American dies every hour from oral cancer, it kind of like puts it in perspective, right, and with oral cancer specifically, it's like, even if the cancer doesn't take your life, it's devastating on your quality of life, right, which really matters too. So we'll talk a little bit more about that. But, yeah, it's an incredible statistic and thankfully, we're raising more and more awareness. April is Oral Cancer Awareness Month, so hence why we're doing the podcast in April to let people know about what they need to be looking out for and how their dentist can help.

Speaker 2: 1:48

So, speaking of that, what are some of the early warning signs, what are some red flags, what are some things that you can notice that would bring to your attention that there might be an issue that needs to get checked out?

Speaker 1: 2:02

so definitely anything in the mouth that is outside of the the norm for you right, any little, any irritation, any tingling or numbness or anything that usually lasts more than a week or two is probably something that you may want to get checked out.

Speaker 1: 2:19

I'll share an example with you. I personally had I, um, I a bag of Doritos or something like that, and kind of cut the inside of my cheek, down where my, where my gums are, and uh, nothing of it, and that little cut kind of persisted and it lingered and it was like a week and then two weeks and it was still there and I was personally getting a little, a little concerned at that point. So I went and had a buddy of mine take a biopsy and check it out and see what it was, and thankfully it turned out to be nothing but that one to two weeks. Generally the mouth heals very, very fast. So if you have anything going on that you've noticed, any red or white patches, certainly anything that's bleeding, anything that feels outside of the norm for a couple of weeks, is definitely something that we might want to get checked out.

Speaker 2: 3:10

So even if you had, let's say, just like a common cold sore and it just didn't go away, that would be something that could potentially be an issue.

Speaker 1: 3:17

So that's a really good question. Right With cold sores. People who get cold sores are very familiar with that process, right Like they're. They're familiar with the tingling that happens in the lip first and how it looks and how it presents and it generally, like, follows a very predictable course. Uh, so I wouldn't be too concerned if you have cold sores. If you get one, don't freak out. If it lasts a week or two, you should definitely see it trending in the right direction, though, Like cold sores don't generally last weeks and weeks and weeks. So if you have one that doesn't seem to be following the normal progression, absolutely get it checked out. Because I will say, we're in South Florida and living in sunny South Florida, you know the lower lip in particular gets a lot of UV radiation which people don't really think about. So it is a common source, or a common location rather, for oral cancer your lower lip, where the sun rays are constantly beating down on it.

Speaker 2: 4:13

You don't really think about that too much. You don't think about skin cancer, but not like on your lip right, Exactly, Exactly and that's all.

Speaker 1: 4:19

it is right. It's lip skin cancer and that's what oral cancer is right. It's just skin inside your mouth. So the same way we get UV radiation on the shoulders and can develop the skin cancers there, that can happen in the mouth as well.

Speaker 2: 4:37

What about risk factors? Right, obviously, I'd imagine, there's a genetic component, as with most cancers, but obviously lifestyle choices, like who's most at risk for oral cancer?

Speaker 1: 4:49

Yeah, good question. So the big two when it comes to any sort of cancer are smoking and drinking. They release a lot of free radicals, a lot of oxidative stress on the body, which can lead to cancerous changes. Now, they are both individually bad and when they're combined it has a synergistic effect. So it's one of those situations where one plus one equals three. And if you're a smoker and a drinker and actually not even just smoker, right, it's like any tobacco product. So dipping, snuff, cigarettes, cigars, If you combine that with excessive alcohol use, that is like super mega risk factors for oral cancer. The other big one is HPV. Have you heard of HPV?

Speaker 2: 5:43

Isn't that the human pablovovirus, papillomavirus? Yeah.

Speaker 1: 5:47

Very good, see that.

Speaker 2: 5:49

It was good. I don't forget everything. I read.

Speaker 1: 5:52

So HPV is a sexually transmitted disease and it's a very common STD. Actually, most people who acquire it will actually just fight it off with their normal immune system and really most people will never even know they had it. But for those that do get it, there are certain strains of that HPV that can colonize the mouth and the throat, and a lot of the new cancers that we're seeing, a lot of the oral cancers that we're seeing now, are HPV related. So clearly that opens up the pool of people that need to be concerned about this to anyone who's sexually active, right, teens, right. So there are vaccines for the HPV virus that are designed because it's not only oral cancer that HPV leads to. It's also cervical cancer, right, because it's the same kind of tissues that we have in both areas of the body. So there's a vaccine out there for teenagers. It is recommended if they're going to be sexually active. But yeah, smoking, drinking and HPV exposure are the big three right now so I'd never heard about that.

Speaker 2: 7:09

So there's a vaccine now. They're specifically for teenagers. Surrounding that, because I that's something that was not on my radar at all and I got you know kids that are entering the teen years soon. Yeah, the vaccine you mean? Yeah, never even really heard of that until now.

Speaker 1: 7:27

Good thing you're listening to the podcast.

Speaker 2: 7:29

Yes, yes, something else that caught my attention. I was reading your blog on the same topic and you talked a little bit about vaping, and that's something that's kind of been on my mind lately because, as you know, my daughter about to turn 13,. She's not vaping, not vaping. But, that being said, I'm hearing that, even for a year now in school, middle school there's kids nowadays vaping.

Speaker 2: 7:53

You see, a lot of you see a lot of people kind of ditching cigarettes, which is great because it seems objectively you'd think that smoking is worse than vaping. But I think the jury's out yet with vaping we don't really know what the harm is that.

Speaker 1: 8:09

What's your take on vaping as it pertains to this topic specifically? That's the truth. The jury is out. We're not entirely sure yet what the outcome is going to be. On all the research that's being done because it's still relatively new right, it seems like it's less harmful than cigarettes.

Speaker 2: 8:24

See, it seems like it is, it seems that way right, it just feels like intuitively it would be.

Speaker 1: 8:29

But who knows? But even even beyond that, um, some studies suggest that the amount of damage that vaping does like, if, if you, if you are, you have your back against the wall and you are forced to either smoke a cigarette or vape, go with the vape. You're probably safer out of those two choices, right?

Speaker 2: 8:48

But I can imagine though I don't smoke or vape, but I can imagine that it would be easier to vape a lot more than smoke. It's like most places you can't smoke, you got to go outside to smoke. It's not socially acceptable. But vaping, you can just pull the vape out all day long and just keep puffing on it. Uh like, imagine like the concentration you'd get could be potentially lethal.

Speaker 1: 9:09

That's. That's a really good point. Right, the access to vaping um is is more ubiquitous than than with smoking. Right, with smoking, you gotta take a smoke break, you gotta go outside generally have to, like, walk 50 feet away from the building. Right, there are so many impediments to lighting up that cigarette compared to just pulling out your, your, your vape pen. Right, I think, and hopefully we get wise to this and curtail some of the the vaping in public places too. Right, because I don't want you puffing a huge cloud of vape smoke. You know, smoke in my face as I'm walking through the lumber aisle in Home Depot and it's happening. People are just like chiefing on these things like it's water vapor and there are chemical compounds in the vapor that you're ingesting, that you're blowing out, that aren't necessarily healthy.

Speaker 2: 10:04

Yeah, it's just not as noxious as cigarette smoke, so it's more socially acceptable. It's like flavor.

Speaker 1: 10:09

Oh, it smells sweet, right, so it's like oh, this can't be bad.

Speaker 2: 10:14

Meanwhile it's entering your body.

Speaker 1: 10:15

Let me inhale your smoke Exactly. Yeah, exactly. But there is research that came out of USC that shows that there's like at the cellular level of your mouth, changes in the DNA composition in response to vaping.

Speaker 2: 10:34

Yeah.

Speaker 1: 10:35

So it is having a profound effect on the cells in the mouth and we just don't have studies that link one thing to oral cancer yet. Right, but I think in the next couple of years that that research is definitely going to be coming out.

Speaker 2: 10:54

Sure, I mean, if you do it like anything else, anything in moderation, within reason, but if you're puffing on that thing day in, day out, it can't be great man. Yeah, it's got to have some long-term bad effects on you, man.

Speaker 1: 11:07

Yeah, no such thing as a free lunch right, yep, yep.

Speaker 2: 11:13

This next thing this should seem fairly obvious, but it's important to shine a light on it thing this should seem fairly obvious, but it's important to shine a light on it and like why are regular dental visits so critical in all of this? It should seem obvious, but I think, I think there's a lot of people, myself included, that we avoid the dentist, right, we, you know, as long as I can put it off, I mean, I don't sorry to say I don't love going to the dentist. I think there's a lot of people out there that just kind of they don't see anything wrong, there's nothing on the surface that shows there's an issue, and they just put it off until it becomes a problem. So, like, talk a little bit about I am routinely surprised by how surprised patients are, routinely surprised by how surprised, yeah.

Speaker 1: 12:08

But when we do our oral cancer screenings as part of our initial consultation, our initial visit with every single patient is to do an oral cancer screening, and we do it once a year thereafter when they come in for their normal hygiene visits. Now it's crazy to me how many times people are like I've never had this done. No one's ever talked to me about oral cancer or what we need to be looking for or things like that. So let me just kind of run you through what an oral cancer screening looks like, right? So it's a very simple process, takes less than a couple of minutes, and there's two components to it, three components, right. So number one we feel we're going to feel all the lymph nodes associated with the mouth, from the neck to behind the ears, around the side, here underneath the jaw. We're going to feel all of these areas to make sure there's no lumps, bumps, masses, right, that everything feels normal. Okay, then we're going to do the same thing feel inside the mouth, all of the tissue inside the mouth, the floor of the mouth, the sides of the tongue. We're going to look and feel it, all of that, to make sure that there's nothing, nothing that shouldn't be there, right?

Speaker 1: 13:18

And then at the office we also have a special technology called fluorescence. It's it looks like a little mag light on steroids, right, and it shines a very powerful light that, when it's when it's shined inside the mouth, healthy cells in the mouth will reflect this light in a certain way. Healthy cells in the mouth will reflect this light in a certain way, and precancerous and cancerous cells won't reflect the light. So we'll see dark, shadowy outlines in areas where the tissue is a little suspicious, right, and that's not necessarily a diagnostic right. Like we're not saying, okay, this tissue looks suspicious under the light, it's cancer, but it gives us a target to evaluate further, right, and with this light we'd be able to catch things that way before we'd see it with the naked eye, right. So catching something early with the naked eye is huge. If you can catch it before you'd be able to even see it, that's amazing, right.

Speaker 2: 14:18

That will dramatically transform your, your experience having to deal with with whatever it is, with the oral cancer yeah, that probably speaks to the fact that and I could be mistaken, I'm just kind of speaking out loud here. When it comes to something like oral cancer or, I guess, skin cancer or at least I don't hear a lot about oral cancer, but I hear a lot about skin cancer it's something that is generally caught earlier than something that lives internally, so I guess there's less lethality from it. And is that accurate? Because there's more like presentable warning signs where you wouldn't necessarily Internalized.

Speaker 1: 14:56

Yes and no. Okay, so really, what makes cancer a problem, right? Well, a lot of things make cancer a problem, but what's really insidious about it is that it's generally painless, right, so you don't really feel anything happening until it's very, very advanced, and at that point it's. It's a huge problem, right? So little things in the mouth, like a little cut or a little swelling or a little tingling, that this thing is advancing and it's just easy to sort of you know, discount and like, oh, it's probably something else, it's nothing, right? Honestly, especially folks in our demographic right Middle-aged men we love to bury our head in the sand for everything.

Speaker 1: 15:50

Women take a much more proactive approach, generally speaking, right, if they notice something, they want to get checked out, they want, they want answers, they want to. We tend to be the opposite. We tend to oh, it's nothing, I got a million other things, I can't be bothered with that. And, man, we end up paying the price, right, because we end up going to get things checked out when it's just further down the road and had we gone six months earlier, it would have been a totally different ball game. Yep, yeah, are you guilty of that, mr Wolfe?

Speaker 2: 16:22

because I sure am you know I am brother, I uh, it is guilty as charged, guilty as charged. Another thing that stood out for me in in the blog you wrote was this this maybe I'm pronouncing it wrong Salivary diagnostics. Yeah, perfect, look at you go, there you go, so like, like, how is that changing the game for you guys?

Speaker 1: 16:48

Yeah, no, this. The game's changing a lot and it's changing fast. And with the incorporation of AI too, I feel like medicine and diagnostics in general are going to be revolutionized in the next. You know, two, three, four or five years. But as it pertains to the mouth, specifically with salivary diagnostics, you literally spit in a cup and now we're able to put it under a microscope and analyze and see a whole new world Right, like we can actually see things that you know might mean that you have cancer. Right, just just from simply analyzing this library. We don't need to take biopsies anymore. Let me rephrase that we won't need to take biopsies anymore. We're not quite there yet, as excited as I may be, but currently in the market today for HPV related cancers, there is a diagnostic salivary test already.

Speaker 2: 17:48

What sorts of things are you seeing in that test that would lead you to believe that there is an issue?

Speaker 1: 17:55

So different markers, different cancer markers and DNA changes that would be a result of having oral cancer and, as I said, right now it is just it's FDA cleared only for HPV related cancers, but I believe next year they're being cleared for non-HPV related cancers and cancer screening and down that line. We're just going to be able to just very simply spit in a cup and test for a multitude of different conditions and pathologies and be able to catch things way earlier than we were in the past with a fraction of the invasiveness and cost.

Speaker 2: 18:37

Yeah, man, that's absolutely huge. I'm curious about treatment options. This is something that's been on my mind for a while now with cancer generally speaking, and it's why is it that it's so difficult to treat? Why is medicine unable to find a way to fight this that's not as messy as it is right now with chemotherapy and everything like? What types of treatments are available for oral cancer? And also why, like more generally speaking, why do you feel it is that, um, it's just so difficult to find a cure for cancer well that I feel like that, that is.

Speaker 1: 19:13

That's a huge rabbit hole question, right, um, but on the very surface level, what we have available to us right now, right, and we'll talk about right now things are evolving quite a bit, but as of two, three years ago, we had, you know, surgery cut it out. We had radiation and chemo, you know, blasted out. Radiation was a little more targeted, chemo was basically full body right, just just nuclear war, right, and hopefully we kill more of the cancer than we do of the of the patient and they can live to fight another day. But now things are evolving a lot and again, ai is going to have a huge hand in this and helping us sort out and figure out and do modeling without having to do human trials that were unthinkable in the past.

Speaker 2: 20:06

Yeah, there's going to be some huge breakthroughs coming in every field as AI advances. It's advancing exponentially and you can see it in real time, really is.

Speaker 1: 20:14

Diagnostics are going to be unrecognizable in a few years. But today we actually have immune modulating medications, immunotherapies that basically teach the body how to fight your specific cancer Right, which is holy smokes. What a thought, right Like, let's not introduce anything foreign in here, but let's just train the body to be more effective at fighting off this cancer, the same way it would fight off, you know, a cold right or a cold sore. So, giving the body tools it needs to be more effective in that fight.

Speaker 2: 20:56

That's the trick right. Regenerative healing, regenerative medicine that's really like stimulating the body's natural ability to heal itself 100%.

Speaker 1: 21:06

And the other big one that's coming out is specific cancer vaccines, right? So these aren't preventive, these are treatment vaccines, right? So it's literally this vaccine would kind of like put a most wanted poster out for your body on that cancer and tell it okay, this is the bad guy, go get him.

Speaker 2: 21:31

Ah, which is which is incredible right Like it's.

Speaker 1: 21:33

It's really. I get goosebumps talking about it. It's so exciting that we're going to see this new generation in medicine happen in our lifetime it's good stuff, man, can't wait to see what's on the horizon.

Speaker 2: 21:50

So you alluded to something earlier, um, about how how oral cancer changes lives, even even if it doesn't kill you. Right? Talk a little bit about what can happen to someone if they get oral cancer and, you know, maybe they survive it, but it creates some damages to them.

Speaker 1: 22:09

Yes, yeah, for sure. I mean, I always say dentistry is the quality of life branch of medicine. Right, because everything that's fun to do starts with the mouth, whether it's eating, kissing, laughing, smiling, talking, right, like it's. It's, it's super important. Yeah, and you know we talked about it killing one American an hour and I have personally diagnosed in my career six cases of oral cancer. Two of those individuals have passed. One didn't really have a whole lot, he actually had to have part of his tongue removed but he did pretty good. He adapted fairly quickly.

Speaker 1: 22:55

The others have had significant issues with their quality of life. Right, because if you are having a big portion of your mouth removed because of the oral cancer, right, like some people have to have the majority of their tongue or their entire tongue removed, uh, half of their jaw right, upper or lower, Like it is. It's disfiguring. So it goes beyond the impact that it has on you being able to, you know, eat what you want and and just have a normal life. That impacts how you look and and you know you have to have, like facial prosthetics to to replace that part of your face that's gone. I mean it's, it's really devastating, it's. It's incredibly hard to to see and deal with and, and you know, unfortunately for so many of those, it could have been a totally different story, right, had they just had regular checkups, caught this thing early, right it?

Speaker 2: 23:59

so. So then then why? Why, alex? Why?

Speaker 1: 24:03

do we wait right? Why do?

Speaker 2: 24:04

people wait, like I'm guilty of this too. I know we all are maybe not for oral cancer screenings, but like everything, like why what stops someone from just doing the things required, like in this case, just go see your dentist, get a cleaning every six months. Just do the thing and do the routines and you're probably going to be okay. And if you, just why do people wait?

Speaker 1: 24:25

Yeah, I mean, why do we wait, jeremy? Right, like dentistry all areas of human health, and dentistry in particular it's almost entirely preventable. Right, like losing teeth and having to have a lot of, you know, crowns and bridges and things like that could have been avoided had we caught the cavity sooner. Right Like had we intervened when the problem was small. If we wait for the problem to be big, it's, it's a it's a it's a bigger issue. Right, and why do we wait? Why do we wait? Right, have fear of bad news? Uh, priorities, life gets in the way we don't like going to the dentist and yeah, well, sure, we don't like the dentist, right?

Speaker 1: 25:11

Nothing hurts, right. So nothing on the surface level. Nothing has gotten advanced enough to interfere with my quality of life now, so everything's okay, and I just don't even want to hear that everything's not okay because I ain't nobody got time for that right. But you know, announce a prevention.

Speaker 2: 25:33

It's worth a pound to cure. That's right. You took the words right out of my mouth. What can we do today from a preventative standpoint? What can our listeners do today, right now, to lower the risk?

Speaker 1: 25:49

So, right off the top, quit smoking, and I make this caveat with every one of my patients that I have this conversation with. I was a smoker for years. I smoked my way through dental school. I smoked for a handful of years when I was in practice. I am not a holier than thou preach from the ivory tower. Smoking is bad, I get it, and it's a super hard habit to break, but it's worth it. All right. So minimizing tobacco smoking, dipping all of that stuff as much as possible. Minimizing your alcohol intake All right.

Speaker 1: 26:26

Spf right For that lower lip cancer that we were talking about being here in South Florida. So, wearing SPF, using chapstick with with SPF on it to protect your lips as far as HPV goes, either the vaccine or safe sex no sex Right. And absolutely getting those, like you said earlier, getting those checkups. I mean every six months, once a year, whatever it is. Go to your dentist regularly because really honestly, your physician doesn't really look in your mouth. They're not looking for signs of oral cancer or anything like that. So go to your dentist, get checked out.

Speaker 2: 27:07

Catch things early, do general lifestyle wellbeing practices play into this, Like in terms of like a good diet right. Obviously that's good for your overall health, but is that something that will also contribute to preventing potentially, oral cancer?

Speaker 1: 27:23

Yeah, absolutely, the healthier your body, the more, the better equipped it is to fight off. The healthier your body, the more the better equipped it is to fight off, you know, any, any assault. So, having a healthy lifestyle, yeah, eat well, sleep well. Right, we don't talk enough about the importance of sleep with, with maintaining a healthy, a healthy body. So important, so important. Don't discount the the importance of of a regular sleep pattern, good sleep hygiene, um, good nutrition, as you said before, working out, staying, staying active, right, giving your body, giving your body what it needs to function the way it wants to yeah, making sure it has all the tools available to heal itself from within.

Speaker 2: 28:06

Yeah, absolutely. What would be your final message to someone out there that's listening that you know? Not dissimilar to myself has been putting off a visit to the dentist for whatever reason, you know. Again, maybe they've had bad experiences like I've had. Maybe they just you know they don't see a problem, but they've been putting it off and they know they've been putting it off's in the back of their head. What do you say to that person?

Speaker 1: 28:30

you're not alone. You know there's a big contingent um, ourselves included, right, like we again, this isn't. We're not here to judge, we're here to support. Uh, everyone is guilty of that in some area of their lives, right?

Speaker 1: 28:47

if it's not your mouth it's whatever it could be, yeah, um, so we can all relate to what that, that avoidance out of fear of potentially bad news, what that's about. All right, but you know, I guess, at the end of the day, go get a checkup. You know, um, coming in will either give you peace of mind or help you catch things as early as possible. And you know, if you don't have a dentist, find one that offers oral cancer screenings and prioritizes that as part of a of a healthy mouth and a healthy body. Right, cause we're not just here to fix teeth, folks, we're here to improve your quality of life, help you live a more fulfilling life and, uh, be healthier well said, well said well.

Speaker 2: 29:34

Everyone, thank you so much for joining us on this journey today. If you found this content useful, don't forget to like, subscribe all that fun stuff. And if you've had your own personal experience yourself somebody close to you that struggled through oral cancer Let us know about it in the comments. We're interested to hear your thoughts and your feedback. Again, we appreciate everyone for joining and we wish you all a wonderful day and stay smiling.

Speaker 1: 30:00

Take it easy, Tooth Tribe. We'll see you in the next one. All right, Take care, guys. Thanks for tuning in to this episode of the Somebody Done With Podcast. We hope you enjoyed the show. Don't forget to subscribe, leave a review and follow us on social media for the latest episodes. You can find us at Seminary Dental. If you have any questions, feel free to reach out. We're always happy to help. Until then, keep smiling and stay curious.