At the Bedside: UTHealth Houston patient shares the importance of oral health after cancer diagnosis
Last year, during her routine daily brushing, Barbara Smith, 72, noticed bleeding from her gums. She didn’t think much of it until the bleeding continued and became excessive.
“I thought I may just be brushing too hard, or my gums were just irritated right then. I told myself it was nothing to worry about,” Barbara said. “But the bleeding didn’t stop.”
After a few days of excessive gum irritation and bleeding, Barbara saw a dentist but left with no clear answers, just a recommendation to see a gum specialist, called a periodontist.
Based on her symptoms, the periodontist believed she could have an autoimmune disease called lichen planus, a chronic inflammatory condition that can affect the gum tissue, causing various symptoms like soreness, bleeding gums, and red to lacy white patches with ulcerations. Lichen planus is caused by the body’s immune system mistakenly attacking a person’s skin and oral mucosal cells.
To confirm this was the cause of her gum issues, the periodontist sent a biopsy of Barbara’s gums to Nadarajah Vigneswaran, BDS, DrMedDent, DMD, professor and director of the Oral and Maxillofacial Pathology Service at UTHealth Houston School of Dentistry.
Vigneswaran determined that some of the microscopic findings in the biopsy material had features overlapping with lichen planus and a precancerous condition called proliferative verrucous leukoplakia, a potentially malignant oral disorder characterized by slow-growing, persistent, and often multifocal white growths, particularly on the gums. However, the results of the biopsy were inconclusive, so Barbara’s periodontist recommended that she consult Vigneswaran personally, referring her to UT Dentists, the multidisciplinary faculty practice of the UTHealth Houston School of Dentistry.
“When I was examining the biopsy site, I suspected lichen planus, but as I was looking at the rest of her mouth, I pushed the tongue and saw an area in the back that looked worrisome,” said Vigneswaran, who is an oral pathologist at UT Dentists.
Vigneswaran did another biopsy, but this time on the tongue, and found early cancer. Barbara was diagnosed with squamous cell carcinoma of the tongue, a type of cancer that develops from squamous cells, which are flat, thin cells that line the tongue.
“No one thinks you’re going to go to the dentist and be diagnosed with cancer,” Barbara said.
Vigneswaran referred her to Jonathan Shum, DDS, MD, professor in the Department of Oral and Maxillofacial Surgery at the School of Dentistry and an oral and maxillofacial surgeon at UT Dentists.
Shum was able to remove the cancer completely. “Because the cancer was detected so early, the cancer was removed without signs of spread or high-risk features. Fortunately, it did not require additional treatment,” Shum said.
Oral health is vital for overall health. If Barbara had waited, her outcome may not have been so quick and easy.
“Bleeding in the gums is fairly common for a lot of people. When we see these patients, some do the right thing, and some don’t, which will delay treatment. Fortunately for Mrs. Smith, we identified it early, and she got treated, and basically, she was cured,” Vigneswaran said.
Barbara now has routine visits with Vigneswaran and Shum every few months to monitor her gums for any regrowth or precancerous symptoms she may have.
“My tongue was hurting, but it was just this one little spot that was bothering me, and I probably wouldn’t have gone for at least another couple of months before I bothered to do anything about it. So I am thankful for the quick and thorough treatment of all the UTHealth Houston dental team,” Barbara said.
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